Chapter 05: Advancing Nursing Care for Head and Neck Patients in the 1970s
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Identifier
BrewerCC_20061406_C05
Publication Date
6-14-2006
City
Houston, Texas
Interview Session
Cecil C. Brewer, RN, BSN, MS, Oral History Interview, June 14, 2006
Topics Covered
The Interview Subject's Story - The Researcher; The Researcher; Collaborations; Discovery, Creativity and Innovation; Discovery and Success; Professional Practice; The Professional at Work; Overview; Definitions, Explanations, Translations; Understanding Cancer, the History of Science, Cancer Research; The History of Health Care, Patient Care; Technology and R&D; Patients; Patients, Treatment, Survivors
Creative Commons License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 License.
Disciplines
History of Science, Technology, and Medicine | Oncology | Oral History
Transcript
Lesley W. Brunet:
You were talking about the transition from Hilkemeyer to Joyce Alt and the career ladder.
Cecil C. Brewer, RN, BSN, MS:
Yeah, well, there were a lot of things that happened back then. It was very innovative. The career ladder program was started, there was a lot of encouragement for nurses to become involved in professional organizations to become leaders, to publish, to participate in research, to make major level presentations at conferences. We were encouraged to be innovative and be creative. One of my first, after finishing -- after filling about a year or so on general surgery, I went back to head and neck as head nurse. And started some of my early programs in head and neck because that's probably my best knowledge base right now is head and neck cancer. I did a ma -- my first major national presentation to a -- at the University of Milwaukee at Wisconsin. And I forget what year was that. It was in the early -- late '70s. I believe I was the only nurse on the program presented to a college -- I mean a national conference of physicians and health professionals. And I was giving a presentation on treatment of head and neck cancers, and did a presentation for patient who had undergone a radical surgery, and with the assistance and the support of my surgeons here, we were able to photograph and document all of the aspects of the surgery. And I was present for that, and was able to -- that's what I presented at the national conference to a group of scientists; medical doctors and scientists. And I still have that article, but we used to -- we -- it was based on --
Lesley W. Brunet:
What meeting was it? I mean do you know what it was?
Cecil C. Brewer, RN, BSN, MS:
It was the University of Milwaukee at Wisconsin, otolaryngology conference. Head and neck conference. I have it somewhere here, but that was my first major conference back in the mid -- late '70s, and it was historic. It was very historic; historic to me. Oh, you have male nurse, black nurse, major medical conference presentation, doctors.
Lesley W. Brunet:
Doctors. So we have to talk about the nurse/doctor thing at some point.
Cecil C. Brewer, RN, BSN, MS:
And so that really was my -- one of my claims to fame. You know, I was able to travel outside of Texas to Milwaukee and make a presentation to people who -- of high caliber. You know, and they even had the wherewithal to just invite me to do it. And so we did a lot of good things back in the day. I used to go to surgery with my surgeon, Helmuth Goepfert [oral history interview], Byers, Guillemondegui, all those guys. And we would do complete assessments of patients. And this morning, I was just looking through my -- I was looking through for something this morning, I ran across this article. This is one of my first. It was called the partial maxillectomy with split thickness skin graft and insertion of dental [obturator rhinectomy orbital] exoneration and scalp flap is part of the procedure. Now when I did that, this was back in 1977. And it was called in a conference approach to nursing care using standards of care in nursing audit. And what we did there was I totally…I -- this is what we call a total patient care. We went out and found a patient in a clinic who had a certain type of cancer. We followed that patient from a day he was -- first day in clinic until he was hospitalized pre-surgery, went to surgery with him, went through the recovery with him, followed him back to the floor, through his recovery period on the inpatient unit, went through all of his teaching and rehabilitation with him, following him, followed him back for his return appointments to the clinic and several years out. So we got to see the progression of the patient from time of diagnosis through initial hospitalization, through surgery, post-surgery, through recovery, through rehabilitation, and integration back into the community, and follow up. And we did that with -- and that was in the '70s. We did that with several patients. We did the maxillectomy patient, we did it with the -- another patient who had what we called a total laryn -- I mean a total esoph -- a total [laryngectomy] with [esophagectomy] and (inaudible) position. So he had surgery where you take out your voice box and your esophagus because you have cancer, and you replace the esophagus with part of your colon, and reconstruct the neck and everything, so the patient is able to swallow. And it's a two stage operation where general surgeons will operate on the abdomen, and the surgeons are operating above the diaphragm in your throat. And it's very synchronized, but I was able to -- that was one of my major -- I would say contributions, if you will, to head and neck was to work with that particular surgery, and actually be in the operating room when that took place, and actually document every aspect of that patient's care from the time she was in the clinic to also until she was discharged, and to see her recover and go on. I had a number of pictures of that operation. I left those pictures with Barbara [Saddlewhite], who's another person who's been here a long time, and she's in nursing education. Barbara's been here 30 years, and we worked on head and neck together back in the early days, and then when I moved from the clinical side of nursing to the administrative side, I passed on some of the historical pictures and slides over to Barbara, and then over to another person called Ellen McCarthy. Ellen McCarthy and Ellen married, and she became Ellen Limitone. L-I-M-I-T-O-N-E. Ellen retired last year from MD Anderson last -- this past year. She retired after about 30 years of working with head and neck patients. So typically, when people want to work with head and neck, they kind of stayed. It's one of those professions and one of those career paths that once you take it, you kind of stay with it. A lot of people don't take head and neck as a career path because it's seen as one of those "undesirable" type of diseases. Like radical surgery, you know, you're dealing with some unsightly type of events. You know, tracheostomies, and disfigurement, and you know, sometimes back in the early days it was very grotesque. It's much improved today. I asked Ellen McCarthy when she retired, I said Ellen, out of 30 years of practice, cause she asked me to speak at her retirement. So I put the thing -- put several things together and I asked her, “What would your legacy be? What would you say if, to pass on to others who are coming behind you? What has changed and what's different in 30 years?” And she said to me, she said, “You know, Cecil, the cutting is still the same, the putting back is what's different.” Putting the patients back together was what's different. The cutting is still the same, but how they put the patients back together as far as the new techs with plastic surgery, microvascular surgery, and a manipulation of the, you know, the various skin grafting. It's so drastically improved because back in the early days, it was very grotesque, and very painful, and that's a whole other topic on how all that clinical stuff evolved; skin grafting, and flaps, and the techniques we had to use to feed people, and who did -- the tube feedings, and all of those type of things.
Lesley W. Brunet:
Hyperalimentation.
Cecil C. Brewer, RN, BSN, MS:
Hyperalimentation was in its infancy in the '70s. We had some of the first hyperalimentation nurses here. We used to mix that stuff on the floor. We used to fix all -- you know, prepare our medication on the floor. We used to, you know, mix cytotoxic drugs on the floor. This is pre --
Lesley W. Brunet:
Was that controversial? Even when they -- just when nurses started to do that?
Cecil C. Brewer, RN, BSN, MS:
Yeah, it was controver -- initially, when I was 1970-'72 to '84, we prepared all of our medication on the floor without a hood, without the gloves, without all the precautions we take today, we did it with our hands. Obviously we used, you know, aseptic technique. We had, you know, techniques we learned nursing school, but as far as having the knowledge about the potential exposure to all these different things was not there. You know, but we weren't using some of the more powerful drugs that we're using today. But we had psydotoxin, and [5FU], and things like that. But we did all of that on the floor, hyperalimentation was you know, just beginning to come about.
Lesley W. Brunet:
Wasn't the department one of the early successes in -- head neck was pretty -- has been prominent here for a long time. Is that just…
Cecil C. Brewer, RN, BSN, MS:
Head and neck is one of the more prominent departments in surgery; one of the best known in the country. And but hyperalimentation I remember back in the early '70s is very -- its early infancy. And I think one of the first nurses in hyperalimentation is still working here. Her name is Mary Ann [Rapp]. I think she works on nine purple.
Lesley W. Brunet:
Rapp?
Cecil C. Brewer, RN, BSN, MS:
R-A-P-P. And then we had some other folks who worked, and that's under -- I can't remember all these people's names, but hyperalimentation was mixed in a bottle and had all these different elements in it, and we had to regulate the patient with insulin and all that. That was very infantile in the '70s, very infantile. That's right, '70s was an explosion of knowledge, and science, and development in the '80s. And in the latter '80s it became more mature. It flowed into the '90s, and you know, it got more sophisticated. But a lot of the primary treatments, and the root cause, if you will, a lot -- to me, a lot of it sits in the '70s because we were doing things that we should -- and we didn't know. Like I say, take for instance cytotoxic precautions. What you're talking about when you say mixing drugs, and mixing different types of medication. Well, we call that cytotoxic precautions in the late '70s. We started talking about cytotoxic exposure. Well, the people who already worked with it haven't been exposed. But we started talking about, “Oh, we better start wearing gloves.” We started wearing gloves and doing -- and taking those types of precautions until -- universal precautions until, what? Almost 1980. Up until that time, you handled your medication with any washed hand, you handled it with your hand, and you handled a patient's body fluids, and you know, the patient's you know with your hands. You know, we had a sterile glove, but you just didn't open up a pair of sterile gloves just to handle something. And you would be used -- techniques, you had various techniques you would use so you wouldn't over expose yourself to radiation, you know, exposure. You had -- you know, we're giving patients needle implants, and (inaudible), and they had hot urine from I131 injections and -- but you just -- you learned how not to spill these items on yourself, but you were handling them without gloves. And then we -- and then gloves became universal precaution and the need to wear protective stuff came into being in the very, very late '70s.
Lesley W. Brunet:
Was it before AIDS?
Cecil C. Brewer, RN, BSN, MS:
I don't know the exact date for it. I guess we can look and find out, but gloves were not a part of normal -- day to day practice until very, very late '70s. I know because I recall when we had a patient who would -- in head and neck that would have what we call bleeds. You know, radical surgery, radiation, skin's sloughing off, become necrotic, vessels become exposed, vessels burst. And you will always be put them with a patient called -- we called it a corroded precaution because their corroded artery might become exposed to a radical (inaudible) section where they're also having radiation. And the hope was that in the -- that it wouldn't happen, but if it did happen, you would have seconds to respond to that patient to stop the bleeding, and there would be massive amount of blood. And what you'd have to do, you'd have to take your hand, and some gauze, or whatever at the time you could get your hand on to put pressure on the bleeding spot that you would have your -- almost every -- once you've got -- if you put your raw hand there on that, you couldn't remove it until a patient, after that bleeder was tied off or that patient after surgery. Many times, we would have to jump on top of the bed with the patient, holding the patient, ride down to surgery with the patient, and until the -- and wait for the surgeon to get ready for surgery and then at a strategic point, you would let go, and the surgeon would take over. And then you go out, and you clean up. So that was pre-AIDS. AIDS didn't come until the '80s. That was pre-AIDS, you know, and with AIDS and all that coming to MD Anderson in the '80s, that's a whole other story, you know. But that was when universal precautions, wearing gloves, cytotoxic precautions. Back -- I remember back in the late '70s I believe, Joyce Alt and Roger Anderson started a study called cytotoxic precautions. They were looking at exposure -- potential exposure of healthcare workers to various cytotoxins; urine, any excreter. And I remember all the nurses had to fill out a questionnaire every time they logged -- they clocked in and clocked out, you have to -- did you handle, you know, chemotherapy today? Did you handle patient bodily fluids today, et cetera? That study -- I don't know what the end result of that study, I don't know whether they ever completed or not, but I was a very innovative thought early on that could be cytotoxic immunogenic activity that possibly could occur if you were exposed over time to certain things; certain cytotoxins at MD Anderson. That was Joyce Alt [oral history interview] and Roger Anderson [oral history interview] study.
Recommended Citation
Brewer, Cecil C. RN, BSN, MS and Brunet, Lesley W., "Chapter 05: Advancing Nursing Care for Head and Neck Patients in the 1970s" (2006). Interview Chapters. 901.
https://openworks.mdanderson.org/mchv_interviewchapters/901
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