Macmillan nurse Donna Parkes has worked on the Western Isles for 24 years, including 15 years with Macmillan. She is part of the palliative oncology team.
‘We support patients with cancer and their families in the hospital, home or hospice setting. We see patients of all age groups and with all types of cancers. Wherever the patient goes, we go. From the breaking of bad news in the outpatient department, we work with that patient and their family through treatment and surgery – to discharge if they get well or to end-of-life care and bereavement support to the family if they don’t.
‘My day starts at my base in the Western Isles Hospital at 8am. The first thing I do when I come into the office is take any urgent messages over the phone. We don’t have an overnight Macmillan service but the community team will update me and my colleagues on anything that has happened.
‘We always leave some space in our diaries in the morning so we can respond to urgent needs. With our geography, that could mean a 120-mile round trip to the base of Harris on single track roads to see a family.
‘On Monday, we have a meeting with the chemotherapy staff and pharmacy so we can plan the week. Normally we triage our work in the morning. The day is made up of hospital appointments where we see patients who can come to us, or who are coming in for a scan. If they are travelling into the main centre it makes sense for us to use that time to offer support. We will also have consultant-led clinics for breaking bad news to patients where we give them our contact details and arrange to follow up with them.
‘A typical day could also find me doing a bereavement visit, a multi-disciplinary team meeting to see who needs a hospice bed, or talking to a GP practice to see how patients are doing.
‘We finish at 6pm but tend to be flexible with patients. We will accommodate them so they are not having to take additional time off work for support. We may arrange to see them after 5pm, so if they are based some distance from the hospital, by the time we drive back it can be quite late. However, if you’re late one day, you might finish early the next day. For us, offering support at a time which suits them rather than asking them to take time off, means that the service really is patient-centred.
‘One of the big strengths of our service is the common link all the way through. Patients and their families will meet me or one of my colleagues and we will maintain that contact. It means we can advocate for them with GPs, consultants and oncologists. For us it’s great. It’s where we get huge satisfaction in our role.
‘However, no one single bit of what we do with patients would be possible without the incredible support of our district nurse colleagues, GPs. AHPs, radiologists and all the other services that work with us to make it possible to deliver care like this. It’s a huge team effort.
‘We also work closely with our mainland colleagues and have strong links with the Beatson, Raigmore and Aberdeen hospitals. If a patient has to go to the mainland, we will liaise with our colleagues there and they always let us know when someone’s coming home.
‘There are huge pluses working in a small community. It’s very easy to get to know all the other teams. They move heaven and earth to get patients in quickly and scans reported quickly.
‘However, the downside is it’s very hard for us to be off-duty. You’ll go to get petrol and meet someone recently diagnosed with cancer or a bereaved family. You don’t want to talk to them in the middle of Tesco about cancer, but if someone bursts into tears you can’t just tell them you’re off-duty. These are my neighbours, colleagues and friends. Your personal time gets impacted. It can be quite a challenge to go out for dinner with family as you can’t ignore people.
‘The hardest bit is the reality of a cancer diagnosis and the devastation it brings. Even if people get better, there are times of the journey that are so dark. When you lose people, it can be very challenging because you have got to know them so well and have built such solid, professional relationships with them. And you see the devastation it causes to family life. But if you were indifferent to it, then you shouldn’t be doing this job.
‘It’s an incredible privilege being able to walk this journey with a person, at a time when they are very vulnerable. I get to know the whole family and friends. You get to be part of people’s lives and get to know them at a whole different level. I just love that.’