Previously on this insight page, I have shared with you my experiences of being a cancer survivor.1 For the last 2 years, I have been a patient in our phase 1 clinic. Just 5 years ago, it would have been unheard of to live 2 years on a phase 1 experimental drug. But with the discovery of new targeted therapies and immunological agents, cancer survivors like me are getting a new lease on life, a lease that will allow me to see my first grandchild, who, by the time this is printed, I will have held. It has been amazing to be a cancer nurse and experience firsthand the advances being made today-not just for me, but also for cancer survivors everywhere. It is common for staff in our clinic to experience many deaths, but more recently, patients are living longer. Occasionally, one or two are even discharged back to their referring physician, especially if they are from out of town.

For many of us, even though we have our primary oncologist in the phase 1 clinic, we see different staff on our weekly visits. However, in our clinic, the one staff member we patients see week after week is the receptionist. In my case, her name is Christine. She checks us in, places our arm band on our wrist, checks our name and birth date, and stamps our parking ticket for a reduced rate. Christine has a warm smile, a soft voice, and a twinkle in her eye when she looks at me. She calls me by my first name; for some patients, she uses Mr or Mrs. She seems to intuitively know who needs to be acknowledged in which way. She genuinely looks as if she is happy to see me and to know I have made it through another week. She even asks, "Has the grandbaby come yet?" If I look like I do not feel well, she tries to find a room for me to rest and be seen as soon as possible. If the clinic is running behind, she goes to see what the problem is and shares what information she can. She offers me water and remains attentive but does not hover. Some weeks, it is more difficult to come to the clinic than others, but I know Christine will be there to check me in. She is a ray of sunshine on the darkest of days. I go to my appointments alone, and during my visits, she has become a major support in helping me wait to be seen especially on the anxiety-filled days I get my scan results. She takes responsibility for bringing in small decorations for various seasons and holidays. I joke with her about her attempts at using plastic flowers.

Last week, when I came for my scheduled visit, Christine was not there. I missed her. For some reason, I did not ask where she was because no one seemed to be around and a new person was checking me in. The next day, however, I learned from a colleague that Christine had died suddenly on the previous Saturday at the stables where she rides horses. She had an acute cardiac event. Even with attempts to revive her, she died.

This week when I visited the clinic, I could quickly see the staff were distraught. Everyone had their heads down, looking as if they were reluctant to engage in conversation. I looked the new receptionist in the eye and said how much Christine meant to me and that I was going to miss her. The woman responded that everyone was shaken. It was a difficult time, she said. It was clear to me that, although the clinic staff are skilled at handling a number of patients' deaths that are expected, they are unprepared for a sudden death of one of their own. When someone dies unexpectedly and that someone provides support to you, time is needed to process the death and loss it represents. One of the advantages of having stage 4 cancer is that it gives people an opportunity to talk about their life and tell people how much they mean to each other and how much you will miss them. Staff need an opportunity to talk about Christine and about how she affected their lives. Sudden deaths of someone too young to die often remind all of us of our own mortality.

Why her, and not me?

As cancer nurses, we have opportunities to use our skills and knowledge in helping others to cope with sudden deaths. We have learned the importance of support groups for staff and the healing associated with rituals such as attending funerals. I have also written previously on the importance of debriefing and what I have learned about it as an essential process to grieving.2 But when we have lost one of our own, we have little experience to step into the role of supporting the staff and allowing ourselves to grieve at the same time; we have little experience in being the comforter and the griever. When we find ourselves in this position, we need someone skilled at facilitating our grieving process. A psychiatrist at St. Christopher's Hospice in London in the 1970s, Colin Murray Parkes taught me that this process is best facilitated by a psychiatrist who is not involved in the direct care associated with patients in the clinic. At our cancer center, our best efforts to deal with this kind of emergency are limited. Our efforts are limited not because we do not mobilize resources when a staff member-a friend, a colleague, a healthy, energetic, and good human being-is lost. In fact, our administrators were vigilant in mobilizing all kinds of crisis services, bereavement specialists, and the employee/family resource center. But rather, they are limited because grieving is a not a limited process. It takes time to develop a trusting relationship that allows us to share our inner thoughts that hit at the core of our being, the core of our being a cancer nurse who comforts and a human being who grieves and sees our own mortality in loss. It is especially notable in the phase 1 clinic, where, as patients, we know that when other patients become our friends, these friendships are time limited. I never believed Christine's life would end before mine. Her life ended too soon. Why her before me? Her life mattered because, with her little kindnesses and her plastic flowers, she touched my life deeply. She made a difference in the lives of so many patients and, surely, in the lives of so many staff. She will be missed.

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