I wish u knew… how an oncology social worker can improve your cancer experience

Tim Hampshire

Christina Bach is a self-described jack-of-all-trades. Her specialization is social work in a clinical oncology setting. Most of us would read that job description and be stricken by its specificity—not just social work, but social work for cancer patients, and social work for cancer patients in a clinical setting. According to Christina, though, the job is anything but specific.

“I never know what to expect when I walk in,” she said.

Christina deals with a lot of different types of patients. Right now, she works at Penn Presbyterian hospital and sees them as part of a routine procedure. Her assignment is a demanding one: walk into a room with someone who has been diagnosed with cancer and ask, “How are you doing?”

Christina discusses the importance of having a social worker on your cancer care team.

People react differently. “98% of the time people are like OH THANK GOD; somebody to help me piece things out,” Christina told me. On the other hand, “There will always be those people who just don’t want to talk. And that’s okay. One of the most important lessons I learned in social work school is that you can’t love everybody, and not everybody is going to love you.”

For the willing 98%, it’s often a battle against the kinds of things that cancer brings with it. Those are the things for which Christina is responsible; her job is to contain the aftershock lest it crumble the reconstruction efforts. (That’s if cancer is an earthquake. It’s probably more of a reality quake.)

Loss is a major motif among the problems her patients face. “We definitely deal a lot with huge issues of loss. And I’m not just talking about loss in terms of death. There’s also loss of your hair, loss of your appetite, loss of body image, loss of job, loss of financial security. The loss is pervasive throughout the cancer trajectory,” she recounted. Christina has to help people with all of that. There’s the easy stuff—telling people where to get a nice wig when they’ve lost hair, or how to find their way back to the right floor when they’ve lost their way. Then there are the hard-hitting responsibilities like preparing people for the possibility of relapse, or talking over financial matters with people whose lives have been saved at the cost of their livelihoods. She does all of it with a warm smile. And she sticks around for as long as the patient is being treated. “”People may see different doctors at different times, but I like to be that consistent team member,” she said. “People may tell me they’re doing fine, and I’m like, ‘great, I’m thrilled you don’t need me.'”

The clinical oncology social worker has to put a floor beneath the falling. This requires Christina to be realistic. It might be a really low floor. “I think a lot of the time we take stock of what has been lost. And we see where there may have been positive coping mechanisms that may have come out of those certain losses,” she told me. Much of her job is meeting patients wherever they are. Whatever resources she offers, whatever counsel she gives, whatever reassuring gestures she can think to extend—all of it is based on getting to know the patients as people, and helping them through the process with whatever they need to cope. That could be just about anything. “I mean, I’m a knitter. I knit with patients. It is absolutely a form of social work,” Christina said with a laugh.

It was unexpected for Christina to find that, for many patients, “Cancer is the best thing that ever happened to them.” The patient she sees on the first day is not always the same patient who walks out and never has to come back. If the goal of the social worker is to help people surmount great difficulties and reorder themselves in the process, then the best thing that can come out of it is the thing she sees happening in her patients all the time: “Wow, it really helped them reshape who they were,” she told me with a touch of disbelief.

To make that happen, Christina keeps her ear to the ground. She listens for things that should be communicated to the healthcare provider, and she reserves things that lie between patient and the confidant (a role she often plays.) A sort of master of private information, Christina says that, “I like to be a facilitator of communication…I want to be able to do that for patients because it’s important for them, and it’s also important for the people who take care of them every day.”