Before this ethnography portfolio was even assigned, I spent my free time following around different types of nurses in Chester Memorial Hospital. My interest in the medical field led me to join the Pathfinders program offered over Christmas break. In the seven hours spent job shadowing with multiple different specializations, I decided on my future career. Most job shadowing experiences are supposed to be with the person one decides to interview for your most interesting part of your ethnography. COVID-19 had other plans for me and most of my class. Inserting my experience job shadowing during the Pathfinders Program gives a little bit more information on the broad topic of nursing and includes how things actually run in a cancer treatment facility.
Background
In order to be an oncology nurse who specializes in chemotherapy infusion, a minimum of two years of school is required. Most positions require their nurses to be RNs. Other small private practices in rural communities will train licensed practical nurses in their place because of registered nurse shortages. While some hospitals hire nurses with no experience in chemotherapy infusion, most want to hire someone with a background in that field. This keeps other nurses from having to go through a training period and follow another nurse. Keri-Jo Dierks, the chemotherapy infusion nurse I job shadowed, took a six-month course about the basics of oncology from a nurse’s perspective. She swears this gave her an advantage in landing jobs in the specialty she wanted. I plan on taking Dierks’ advice in order to gain a leg up in the fast-filled oncology positions.
Job Shadowing
In every medical television show, they make cancer patients look like a perfectly healthy, bald person. When entering the Chemo and Infusion wing of Chester Memorial Hospital, you’re in for a big surprise if you’re expecting the TV version. The head nurse, Keri-Jo Dierks, met me in the lobby and asked me if I knew exactly how busy today was going to be. Apparently Thursdays are their busiest day of the week because of a specialist from St. Louis checks on multiple patients with Stage three cancer. Stage three cancer is very hard to overcome because it has spread to other tissues, meaning it needs to be checked often. When entering the double doors, I too was shocked that these people weren’t as healthy looking as they were on Grey’s Anatomy. It was devastating, and I immediately felt bad for my facial expression. Not only was every chair full, almost everyone sitting was asleep, covered in multiple blankets. I immediately noticed their pale lips and grimaces etched into their sleeping faces. I watched Dierks make her rounds, slightly shaking everyone awake and checking their IV bags and their drinks.
People were buzzing into the brightly-colored room at a consistent pace while I talked to one patient who seemed to be a lot happier than everyone around her. I knew her well, our whole town did, but due to HIPAA law, her name cannot be stated. She explained to me exactly what Dierks was doing in “normal language.” The patient explained that fluids are given first intravenously in order to prevent fatigue, extreme cold chills, nausea, and urinary urgency. After fluids, she set up two bags, one with saline and one with chemo. Dierks piggybacked the two solutions so the chemo does not hit the patient as hard as it would if it was given alone. While she was giving intravenous treatment, I watched Dierks insert Benadryl and Pepcid through syringes into the IV line over a period of a minute. The slow injection allows saline to mix with potent medicines, which helps prevent pulsating. If strong medicine is given intravenously too quickly, it causes the entire body to pulsate and heat significantly. In order to make sure her patients are as comfortable as possible, Keri-Jo told me she always dilutes her medication with saline.
After my conversation with a very knowledgeable patient, Dierks took me to examine scans of patients. While standing behind the glass of a CT scan, one patient was being injected with dye for her monthly scan. She explained to me through the microphone that they inserted dye that is Iodine-based and Gadolinium-based through her port. This makes cancer cells more prominent in the images appearing on the screen in front of us. Vertical and horizontal images of the patient’s head and chest displayed on the screen, riddled with large white spots. Dierks turned off the microphone and informed me exactly where the cancer was and what it looked like last month compared to this scan. The dots had grown significantly. I could tell immediately this brought her spirits down but as soon as she entered the scanning room, a smile appeared on her face. I watched as the patient smiled right back, unaware of what we had just seen on her scans. This not only made me realize how important looking past the negatives in life is, it pushed me to realize sometimes making someone feel happier is better than being happy yourself. She slid a mask over her face and walked out of the hospital. Dierks explained how weak her immune system was and how she opted to wear a face mask to the hospital because her risk of getting sick was significantly higher than a normal person. Chemotherapy weakens a person’s immune system immensely. Cancer patients were wearing face masks and washing their hands every time they touched something before COVID-19 was a global pandemic.
The Coronavirus
Coronavirus, which commonly occurs in animals, rarely mutates enough to infect humans. Since this insane mutation of a disease that has plagued animals for years has ruined the last semester of my senior year, I have been doing research to make myself feel more secure in these times of uncertainty. Although many theories have been discussed how its mutation happened or why people are taking a 3% mortality rate so seriously, people are still cowering in their homes to avoid this sickness like… well, the plague. Social distancing, face masks, gloves, copious amounts of toilet paper, and insane political arguments have fueled a COVID-19 crisis that all of us will tell our children about to make them feel bad about being “bored.” Not only has the school been in the comfort of my home for four weeks, but I’ve also had contact with no one except my immediate family. What first started like two weeks of isolation “just in case,” quickly turned into six weeks and counting to flatten the curve in Randolph County. This government mandatory lockdown has affected everyone in the world, but most importantly healthcare professionals. People are swarming into hospitals, believing they have COVID-19 because they have the symptoms. Healthcare professionals are being run into the ground with overtime shifts, constant stress, and inability to come home to their families because they don’t want to put them at risk. Symptoms of COVID-19 are mostly common flu-like effects. Many people would test negative for the flu before they were even considered to be a coronavirus possibility. Symptoms include cough, fever, fatigue, body aches, sore throat, runny nose, and loss of taste and smell. Healthcare professionals are constantly on the lookout for these symptoms, especially in the Chemotherapy wing of any hospital. What could be a mild case of the flu could be deadly to a cancer patient with a low immune system, so imagine them contracting COVID-19. As of right now, officials are saying the sickness wreaks havoc on the lungs, especially if one has underlying health conditions, such as cancer. I knew this would be a huge damper on not only this ethnography but the rest of my senior year and possibly even my freshman year of college.
When I called Keri-Jo to schedule when I could come in again in March, COVID-19 was just getting out of hand in the United States. There were rumors that schools could possibly be closed for two weeks, but none of us thought it would end up in Southern Illinois. She immediately shut me down while apologizing profusely. She began to tell me how some patients had canceled their treatment sessions altogether in order to avoid hospitals and germ-infested people. She also mentioned that entry into the Chemo and Infusion wing was severely limited to keep their patients and staff safe. I understood completely after our phone call, but I was slightly nervous about the observation part of my ethnography. When other students in my class began to question how they were going to finish their paper with everything happening, we were informed we could do a paper solely about how we lived during our quarantine to make up for our loss of a job shadowing experience. I was compelled to do this option, but want my paper to be a cohesive unit, I recalled my experiences in Memorial Hospital’s Pathfinders Program.
Cause and Effect
COVID-19 affects everyone in the world, not just medical professionals. Although everyone is worried about catching this deadly sickness that has killed over 56,000 in the United States, cancer patients undergoing chemotherapy treatment are even more worried. Many cancer patients are immunocompromised because as their cancer spreads to different tissues it affects the body’s disease-fighting responses. One of the most common places for a secondary cancer site is the bone marrow. “Bone marrow is the spongy tissue inside some of the bones in the body, including the hip and thigh bones. Bone marrow contains immature cells, called stem cells. Healthy bone marrow and blood cells are needed in order to live and fight off sickness. When the disease affects bone marrow so that it can no longer function effectively, meaning having the common flu could be deadly” (Delk). Even the simplest of illnesses or infections could kill a cancer patient undergoing chemotherapy and infusion treatment. The coronavirus’ deadly cocktail of bacteria would be a death wish for immunocompromised patients. “COVID-19 starts out in the lungs like the common cold coronaviruses but then causes havoc with the immune system that can lead to long-term lung damage or death. However, the subtle genetic differences translate to significant differences in how readily a coronavirus infects people and how it makes them sick. COVID-19, also known as SARS-CoV-2, has all the same genetic equipment as the original SARS-CoV, which caused a global outbreak in 2003, but with around 6,000 mutations sprinkled around in the usual places where coronaviruses change. Think whole milk versus skim milk” (Neuman). 6,000 mutations on an already deadly virus contribute to many people in the oncology field being scared for their patients and even themselves.
Chemotherapy treatments have been reduced to one patient per two nurses. The entire chemotherapy wing limited to three people is a drastic change, even for rural hospitals like Chester’s. Only two nurses lower the exposure rate to the outside world, whereas a normal unit would have five or six nurses. Bigger hospitals are using different rooms to quarantine their higher-risk patients. They keep patients in the hospital in special rooms with limited contact in order to give them their required amounts of chemo per week to keep them on track. Some patients have decided to end their treatment altogether to avoid overcrowding and panic in hospitals right now. Although most patients are worried about their possibly life-saving treatment, they believe they have a better chance of survival without being around sick people more than once a week. Some patients would be entering a hospital more than three times a week for fluids, chemotherapy treatment, or just CT scans. Medical professionals have tested over two million people in the United States, only one-eighth of them being positive. Because people are panicking after one symptom occurs, patients there for chemotherapy are exposed to more illnesses than COVID-19.
My short encounter with Dierks in the chemo and infusion department in Chester Memorial Hospital is not even close to everything these nurses do on a daily basis. Not only did I realize how hard this profession could be on someone’s mental state, I realized how rewarding it could be. While that may seem like a contradiction, it is something you can never experience until you’re looking at insanely strong men and women fighting for their lives and you can do something to help ease that pain. My account was only a small portion of the tedious and selfless work they do to help people who are at their lowest point. I only touched on small parts of my job shadowing experience that I believed helped capture the true importance of this specialization. The coronavirus may have impacted my paper and even my senior year, but cancer patients and medical professionals have it worse than the rest of us. We have all recently increased our hygiene skills, but cancer patients and nurses who are around them daily have been doing this for a very long time to keep everyone safe. With everything happening in the world right now, it could use the smile of an oncology nurse to make things just a tad bit better.

Work Cited
Delk, Chris. “Health News.” Medical News Today, MediLexicon International, www.medicalnewstoday.com/.

Neuman, Benjamin. “Virologist Explains What The Coronavirus Does to Your Body That Makes It So Deadly.” ScienceAlert, www.sciencealert.com/why-is-this-coronavirus-so-much-more-dangerous-a-coronavirus-expert-explains.

Specktor, Brandon. “Coronavirus: What Is ‘Flattening the Curve,’ and Will It Work?” LiveScience, Purch, 16 Mar. 2020, www.livescience.com/coronavirus-flatten-the-curve.html.