Honorable Mention Essay

Breaking Blockades

By Charles A. Rossier, nominating Marilyn Bruderer, APRN, of the
VA Medical Center Manchester in Manchester, New Hampshire

I was diagnosed with stage 4 prostate cancer in March 1998. I had prostate surgery. The urologist came to me in the recovery room and told me he was going to castrate me in three days. Before removing my prostate, he discovered that my cancer had spread beyond the prostate. The next morning he told me I had three to six months to live. A parade of oncologists, radiation oncologists, and urologists confirmed the prognosis in my hospital room.

When they left, I called the VA Medical Center (VAMC) in Manchester. I asked to speak to an oncologist. I received a return call and was given an appointment with the oncologist. She told me there was medication that might extend my life for two to five years. For the next seven years, Marilyn injected me every three months and renewed my prescriptions for the injections and pills that I took three times a day. Every six months she examined me, including digital rectal exams. In addition, she scheduled and reviewed blood tests to check on side effects. When I was in the emergency room with a gallstone attack and couldn’t go to the oncology floor for my three-month injection, I called Marilyn and she brought the hypodermic to me in the ER.

The VAMC is noted for inefficiency and bureaucratic logjams. Many times during the past 10 years, I had problems getting pharmacy prescriptions. When all else failed, I called Marilyn. She immediately called the pharmacy and arranged to get me what I needed even if she had to go down to the pharmacy and pick it up herself. She advised me on the progress of my treatments after the five-year deadline for medication effectiveness had expired. She convinced me that the treatment would continue to prevent recurrence despite the statistics telling me otherwise. She called me her “miracle.”

After seven years, I was diagnosed with esophageal cancer. I had a transhiatal esophagectomy at the VAMC in Boston. They sent me home with a feeding tube, a pump, and a few feeding bags. I had to get more at the VAMC Manchester. The pharmacy there gave my wife grief. They told her the pump was the wrong kind and that they didn’t have the correct pump. My wife called Marilyn.

After calming my wife, Marilyn located the correct pump and got it to my wife before I starved to death. After we got the new pump, we found that the feeding bags were incompatible with it. My wife was told they didn’t have any bags. Another call to Marilyn and she found the correct bags.

When the VAMC refused to allow a visiting nurse to provide post-surgical care at home, my wife called Marilyn. The next day a visiting nurse arrived to change my dressings and teach my wife how to feed me and change my dressings. Marilyn got authorization for two months of home care. I fainted while in the waiting room for a routine blood test, and Marilyn came running from the oncology floor to my aid.

Recently, my neighbor was diagnosed with a glioblastoma. Although his treatments are not at the VAMC, he gets his prescriptions at the VAMC. He needs an experimental chemotherapy to enhance the effectiveness of his radiation treatments that were to start immediately. The VAMC pharmacy refused to supply it. His primary care provider refused to prescribe it. He and his wife were tearing their hair out. The radiation oncologist could not start the radiation treatments without it. I called my life support—Marilyn. She cut through the VAMC bureaucratic blockades and got him the prescription in time to take it with his radiation.

For 10 years, Marilyn has supplied my wife and me with the support necessary to give me hope of waking the next day and watching the sun rise. Now she has given that hope to my neighbor. Marilyn is the rock that keeps me in the world of the living.