By BETSY COHEN of the Missoulian
Creating a new position out of thin air, funding it and then waiting to see if the gamble meets the need is not an easy decision for any organization.
Yet that’s exactly what Community Medical Center did in 2009 when the hospital hired Michelle Weaver Knowles, a registered nurse, to be its first breast health navigator.
Now, four years later, after tirelessly serving hundreds of breast cancer patients, Knowles has been given the “Oncology Nurse Navigator of the Year Award” by the Academy of Oncology Nurse Navigators and the Health Monitor Network.
“We decided to create an award program to recognize a health care professional that is patient nominated,” said Dave Dolton, vice president of Health Monitor Network, the nation’s leading patient education publication.
Knowles was chosen for the award from hundreds of nominee after several patients told the judges she does all the little things – and the heavy lifting – for them, Dolton said.
“The patients say it better than us; they talked about her work going above and beyond,” he said. “And for us, oncology nurse navigators are amazing people. We would like to recognize all of them, but this award only goes to one amazing individual that does great work.”
For those who work with Knowles and for those who are her patients, her work is critical and the national award is justly deserved.
Admired for her patience, kindness and passion for the job, Knowles is also known as the lifeline in a cancer patient’s journey to help wrestle with insurance challenges, to find medical specialists, and to get additional testing scheduled.
She is, said Luanne Greer, a beacon of hope in the darkest hour.
“If not for Miss Michelle I do not know what I would have done,” said Greer, one of Knowles’ very first patients and one of the people who nominated her for the award.
“I was a single 55-year-old woman when I was diagnosed, and Michelle was there for myself and my adult daughter all the way.”
Christie Fellows can’t talk about Knowles without getting emotional. “She saved my life,” Fellow said. “I’m a 38-year-old and I have breast cancer. I was diagnosed in March and I was told I had about three months to live and that I wouldn’t live until the end of the year – and I’m still here because of her.” Fellows said her family doctor in the Bitterroot Valley saw something curious in her mammogram and her doctor scheduled a follow-up exam – only it was two months out. But because Fellows had gone through Advanced Imaging on the CMC campus, her mammogram and subsequent biopsy report was shared with Knowles, who immediately picked up the phone to talk with Fellows. “This woman saw how young I am and she didn’t know me, but she took it upon herself to show other doctors my lab work and what worried her about it, and from that point on I’ve been on an incredible journey where Michelle has bent over backwards to help me,” Fellows said. “If I had waited those two months for the follow-up exam my doctor made, I wouldn’t be here, I would be dead.”
Like she does for all her patients, Knowles clearly explained in detail the type of cancer Fellows was diagnosed with, and empowered Fellows to make the best medical choices available to her.
Knowles’ soothing presence and expansive medical advice carry extra weight because she personally and intimately knows what the terrifying journey of a breast cancer diagnosis and treatment is all about, wrote several of her patients in the award’s nominating letter.
Knowles’ sister, Sherri Smith, was diagnosed with the disease at age 30, and for three years Knowles was at her bedside and in the many doctor’s offices Sherri visited fighting the disease that ultimately killed her. Four years later, Knowles herself was diagnosed with breast cancer and learned that she carries the BRCA-1 genetic mutation. “Everything I went through, she went through 15 years ago at the same age,” Fellows said. “This woman held her head up high and said to me ‘You can do this. Look at me. I’m still here and 15 years ago I was told the same thing you were told.’ ”
Not only is Knowles’ counsel a familiar sight in and around the oncology offices, she is a constant presence in the pathology and radiology departments.
“Four years ago when I started this job, I understood and agreed with many of the doctors that we needed someone to look at all the pieces of patients’ care – that we needed a multi-dimensional piece,” Knowles explained of her job.
“It is important to make sure that we know what the radiologist sees is what the pathologist sees.”
As a counselor, a nurse, an advocate and navigator, Knowles believes her job is not to just hand-hold, but to make sure everyone involved in a patient’s care has all the pertinent pieces of data in which to make the best health decisions for that individual.
The collaborative process fits with CMC’s agenda that the patient comes first and that patient is treated as whole person – not as a case number or a disease.
“This whole concept of nurse navigator has been around for a while,” said Bruce Britton, a CMC pathologist. “We were anxious to get one going here and to the administration’s credit, they took a chance and agreed to hire someone. Financially it might not make sense, but it’s good for the patients,” Britton said. “The administration went for it, and we are better for it.” From Britton’s standpoint, the whole journey of a patient’s diagnosis is a complex process that involves a multitude of specialties and various tests. “People tend to focus on their own specialty and a lot of their information can get sequestered,” he said. “Michelle does a great job integrating all of the clinical information so we aren’t individually working in a vacuum, which helps all of us.”
Behind the scenes and away from her office where she meets with patients, Knowles chases down patients’ pathology slides that might be on their way from across town or across the country. She confers with oncologists about patients’ treatment plans, and discusses a patient’s mastectomy concerns with plastic surgeons.
With each passing year, new treatments are available and cancer patients who have been given a grim diagnosis have every reason to be optimistic, Knowles said. That in part is what helps keep her on track and energized about her work.
“Care issues are different and our treatment is getting better,” Knowles said. “We are dealing with people who are maintaining and living a productive life, and survivorship is a big piece. We have to start thinking about a different kind of care for oncologists to continue to see these people, or they will be crushed. And we only have enough oncologists to treat people who are recently diagnosed.”
It’s the kind of conundrum that Knowles welcomes and she’s eager to help navigate that part of her work toward a solution. But its the hand-holding – and sometimes the full-on hugging – required of her job that makes Knowles feels the most productive. “A lot of times I just listen to people and listen to their fears and make sure they have someone who is there for them to help them out of that icky dark place.” It is a job without end, one in which the workday is never done, but a job wholly worthwhile, Knowles said. “I have my demons. I’m the older sister and I wonder why I am still here and Sherri is not,” Knowles said. “To channel that and put my knowledge to good use helps me deal with my own guilt and with my sister’s death. I carry on because of her, and I carry her with me every day in this work,” she said. Her agenda, if there is one, is to make a difference in the lives of people in the community, Knowles said. “I want to inspire people to help themselves and to get their needs met,” she said. “I want to help people with the things I learned the hard way when I was a patient and when I was helping my sister.” The most important lessons of all, she said, is learning how to live with a diagnosis or a disease. “Cancer teaches you to face your fears. And that you have to rally. You have to learn that every day matters, and to make the most of it,” she said.