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A guiding light: Oncology nurse navigators show patients the way

How to perform a breast self-exam:

• Stand in front of a mirror and inspect both breasts for any changes in shape, color, nipple discharge, puckering or dimpling of the skin.

• Watch closely in the mirror as you press your hands on your hips. Check for any changes.

• Lie down and put a pillow under your right shoulder. Place your right arm behind your head.

• Use your three middle fingers on your left hand to feel for lumps or thickenings in your right breast.

• Press your fingers on the breast with light, medium and firm pressure

• Move your fingers around the breast in an up and down pattern the same way every time to ensure you cover the entire breast.

• Examine these areas: from your underarm to lower bra line; across to the breast bone up to the collar bone; and back to your armpit.

For more information, questions, help or resources, contact the American Cancer Society at or Northside Hospital-Forsyth at northside/com/forsyth.

FORSYTH COUNTY -- Kathleen Gamblin knows being diagnosed with and treated for cancer can be a difficult process with many unknowns.

But as coordinator for Northside Hospital’s Oncology Patient Navigation program, it’s her job to make that a little easier for patients.

Gamblin, a registered nurse, works with oncology patients daily to answer their questions, navigate their continuum of care and remove any barriers to treatment.

She also provides them with emotional support during the trying time.

Like clinical nurses, navigators are trained in nursing school and hospitals but also have extensive knowledge and training in oncology.

Often, they serve in one particular oncology unit, such as the breast care unit.

Their job is to be a personal resource to cancer patients by providing clinical information and education, answering questions about diagnosis, treatments and side effects, helping to improve communication between patients and their care team and monitoring patients’ health and overall treatment progress.

But their work doesn’t stop there.

“We’re checking in on the [patient], making sure they’ve got the result from their tests, seeing if they have any questions and making sure they understand what the follow-up steps are,” Gamblin said. “Especially with breast patients, we follow up with them right after surgery.

“But we also provide that moral support. We do an assessment on our patients to find out if they have any needs in a multitude of areas, and our assessment is pretty comprehensive to incorporate the whole person. We remain that one point of contact throughout their whole journey.”

Gamblin’s typical day beings by checking her phone and email to make sure she hasn’t gotten any new consults or calls overnight.

Then, she said, she and the other navigators meet with the oncologists.

“We all participate in the multidisciplinary tumor boards,” she said. “The physicians gather together along with other members of the multidisciplinary team to talk about a case and a patient and look at a plan of treatment. We’re in there and adding that navigational aspect to it.”

Though their days aren’t overwhelmingly busy, Gamblin said they are doing a lot.

“It’s not that there’s so much to do that it’s overwhelming, it’s more the variety of things that need to be done conflict sometimes,” she said. “It’s about balancing; the navigators work and run a lot and we’re in a multitude of places. We’re in the hospital, then we might get called over to a physician’s office, then we’re back in our office, then we’ve got a tumor board at noon.”

The hardest part, she said, is the emotional aspect of the job.

“We spend a long period of time with these patients; we get to know them, maybe even pre-diagnoses and certainly at the point of diagnosis,” she said. “And then we walk with them throughout that journey. You get to know them really well, and while I think we all try to maintain some sense of self, you do become attached to the patients that you work with.

“That can be really emotional. It doesn’t necessarily mean that a patient’s going to die; it’s just as they’re dealing with things and you’re helping them walk through that, it can be very draining.”

But she said it is also rewarding.

“[It’s] the greatest privilege to be involved with people at probably one of the lowest points of their life,” she said. “I think we all look at it as this great honor to be allowed into that inner circle. I think we kind of balance the two.”