When Evelyn Badran, CNRN, graduated from high school in 1980, she had no idea that a career in nursing was in her future. Today, nearly three decades later, she is not only an experienced and successful nurse but is literally working on the cutting edge of cancer care. As coordinator of the Gamma Knife suite at the Neurologic & Orthopedic Hospital of Chicago (NOHC), Badran helps treat brain tumor patients with a highly advanced technology that was virtually unheard of 15 years ago.
Gamma Knife radiosurgery is a high-precision radiation delivery system that is used to treat abnormal brain tissue in a single session without surgical incisions. A helmet- like frame is attached to the patient’s head using pins and local anesthetic, allowing targeted radiation to destroy the cancer cells while minimizing the effects on healthy surrounding tissue. Because the procedure is non-invasive and virtually painless, it causes little discomfort or post-operative recovery pain and patients can return to their usual routines almost immediately.
“I know I am helping to make a difference in patients’ lives with the help of this amazing equipment,” Badran says.
While she now spends her days providing state-of-the-art nursing care, her ambitions as a teenager were quite different. Growing up in La Paz, Bolivia, Badran originally wanted to become an architect.
She attended a Catholic high school that required all students to provide community service to a population in need. “I chose to volunteer in an orphanage,” she recalls. “After [my service] requirement was completed, I couldn’t separate myself from [the children at the orphanage]. I just needed to be there and be helping. Somehow it [captured] my heart. In that sense, I knew I had a passion to help people, but nursing was never in my mind.”
Two years after graduating from high school, Badran immigrated to the United States with her brother. Leaving her parents behind, she settled in Chicago, where her aunts, uncles and cousins were living. Like many immigrants, she immediately felt the impact of the language barrier.
“My English was very basic,” she says. “When my brother and I moved here, our uncle told us, ‘You are not going to watch any television in Spanish. You need to get used to the [English] language.’ So that is what we did.”
An avid reader, Badran was upset when she bought a book written in English and found she could not read it. This made her determined to work harder on becoming proficient in her new language. “I started paying more attention. I was very strict with myself. I focused on what I wanted,” she explains. “I had been here maybe five months and I took ESL (English as a second language) classes. By the eighth month, I was reading that book.”
Still, Badran initially found it difficult to adjust to American culture. “Life over here is very different compared to life in my home country,” she says. “I lived in a main city in Bolivia, but it was definitely a lot smaller than Chicago. The way life is over here, it demands more. It seems like you are working all the time. You don’t have time [to do everything you want to do]. In South America, it is a little more relaxed.
“Here families tend to separate, live apart,” she continues. “In my home country, families basically stay together. Parents with [adult] children and their families can all live in the same house. That was another thing that was hard [to adjust to when I came here].”
Despite her early difficulties, Badran grew to love the culture in America. She particularly appreciated the opportunities for education. Enrolling in college, she took the prerequisites for her associate’s degree while trying to decide on a major.
It was friends and relatives who talked her into giving nursing a chance. “They told me, ‘Give it a try. You might like it.’ So I went into it just to try it. It seemed like it went so smoothly for me. I had no trouble getting into nursing school with my prerequisites and I did very well.”
Badran graduated from Chicago’s Truman Nursing School in 1984 and took her licensure exam. Again, everything seemed to go more smoothly than she had anticipated. “I was getting married and I didn’t really have time to prepare for my boards, yet it worked out so easily,” she remembers. “I took the boards and I passed them. I thought, ‘Some higher power is guiding me.’ You need to go where your heart is.”
At the time, Badran was working at Columbus Hospital in a dietary position but soon moved into a part-time nursing job on a medical/ surgical floor that included ear, nose and throat (ENT) patients. It was her first exposure to cancer surgery. “The ENT part of that [unit] was basically reconstructive surgeries for patients with mouth, throat and tongue cancer,” she says. “It was a hard year but it was a very good year for learning.”
In fact, it turned out to be a transformative experience for Badran, who was initially insecure, not believing she had the skills to successfully perform her job. “[At first] I felt like I did not know anything, no matter what they had taught me at school,” she explains. “But the nurses on the unit were so good and they had confidence in me. They would leave me alone to do something that I was so certain I was not capable of doing. Just by doing it, [I learned].”
Badran gained confidence and personal strength working on that floor. She also learned how to care for patients effectively and compassionately.
“There is so much pain involved in the surgeries I used to see in that first year, especially when they were facial,” she says. “[In some cases], the surgeons had to remove a lot of the face and there would be these open areas. I never imagined that I would see something like that. You had to be balanced. You cannot show emotion at that moment. You have to have the confidence to be able to reassure your patients. [As I learned those skill sets], I slowly started to notice that I had more confidence in myself, in my work and what I was doing.
“I would talk to the patients when I was changing their bandages, looking at them without [giving any emotion] away. At that moment, they could not see themselves. You had to not only respect what you were seeing, but you found this peacefulness in the way they accepted this disease and the [disfigurement]. It was so dignified. It made me see a different side of people.”
Eventually, the med/surg floor merged with a general post-surgical one and Badran stayed there for another seven-and-a-half years. “I got my base on that floor,” she says. “It was really intensive and I owe all of my background in nursing to that unit.”
When Columbus Hospital closed in 1998, Badran took a job at the Neurologic & Orthopedic Hospital of Chicago. “The neurosurgery part for me was so scary,” she says. But she again thought she would “give it a try.” And once again, she found the work to be “very intensive and an excellent opportunity for learning.”
When a position opened up for a nurse in the Gamma Knife suite several years later, Badran applied for the job. She admits she had some initial misgiving about working with the technology.
“On my first day of orientation, when I was observing the first patient, I saw how the doctors injected [the local anesthetic] and how the frame is held [on the patient’s head],” she recalls. “Then they started putting the pins in and I thought, ‘Oh my God, they are screwing these screws into the patient’s head!’ I was wondering if I could do this. It’s very scary when you see it [for the first time]. But then the patients were OK. They were comfortable, because they had a numbing medicine administered. Really, the numbing injections were the hard part for them, because they seemed to feel that more [than the actual procedure].”
On the second day of training, Badran held the frame while it was being fitted to the patient’s head. She remembers that day as being a bit difficult as well. “They placed the frame and I was doing the patient care. It felt OK, it felt good. At the time, another nurse was working with the physicist with the [Gamma Knife] machine; I was observing. As time went by, I began to learn more and more about the machines, the radiation and the delivery. I asked the physicist questions. I wanted to know how these machines worked. I wanted to know the mechanics of it. He explained it to me.”
The procedure is used to treat brain tumors, both malignant and benign, as well as trigeminal neuralgia. “It is fascinating,” Badran says. “All these [individual radiation] beams come together at one [targeted point where the unhealthy brain tissue is] and that one point has such an intensely high radiation. But the beams that go to the healthy part of the brain do not injure the brain. They spare the tissue compared to that full amount where all the beams meet.
“For patients who are young, [traditional radiation treatment to the brain] has been known to cause dementia later in life,” she adds. “Gamma Knife treatment is a way to spare younger patients from that. It gives them more of an opportunity to [live a normal life].”
Badran, who is a certified neuroscience nurse, worked on the Gamma Knife unit for a year before moving up to the coordinator’s position over five year ago. Her role begins when a physician recommends the Gamma Knife to a patient. She coordinates pre-testing, communicates with the patient’s insurance provider and helps the patient understand exactly what to expect. She also provides hands-on patient care, administering oral and IV sedation when needed and giving emotional support by remaining with the patients throughout the procedure, reassuring and comforting them along the way.
“As the liaison between the doctor and the patient, I make sure all the patient’s questions are answered in advance,” she says. “I am with the patients when the frame is placed on their head. When their treatment starts, we are always with them, removing them from the machines [at the end of the procedure], always making sure they are safe and that everything is in order. We monitor them when they are in the treatment. We watch not only their vital signs, but we actually watch the patient through the camera [as they undergo the procedure].”
Because the treatment is so specialized, many of her patients are referred to NOHC from other medical facilities, including Chicago’s primary public hospital, John H. Stroger, Jr. Hospital of Cook County. Referral patients must be seen by a neurosurgeon at NOHC before they are scheduled for Gamma Knife treatment.
“The neurosurgeons over here review the data and make a decision,” Badran says. “When they say yes, then I get in communication with the other hospitals. I talk to the patients. I arrange for them to come over here for the tour. They see the radiation oncologist over here, who explains the radiation part and the effects of it. Then we schedule them in.”
The treatment itself can take several hours, Badran notes. “Most of the patients are here all morning, because there are several steps that need to be done before and after the procedure: the admission, the measurements of the head, the frame placement, planning, treatment and then recovery. We tell our patients to plan to be here a 12-hour day.”
Patients with malignant tumors may need to have more than one treatment. “We can re-treat areas that were targeted before,” Badran explains. “For instance, when patients have metastasized cancer, we treat the metastasis we see on the brain. When they come for followup, if the doctors do find new spots on the brain, then we can treat those spots again.”
The medical staff at NOHC has high praise for Badran and her work. “Evelyn is smart, organized and compassionate,” says the hospital’s chief of surgery, Gail L. Rosseau, MD. “She is an ideal nurse, both in terms of her clinical expertise and her compassionate care of patients. I frequently say to patients, ‘If I were having this procedure done, I would want to have Evelyn as my nurse.’ “She is also really a fine administrator and leader. She is moving the entire hospital forward by taking charge of this radiosurgery aspect of our practice.”
Chicago is an extremely diverse city and that diversity is clearly reflected in the patient population Badran treats at the Gamma Knife suite. “We have treated people from every race, every social and economic background,” she says. “The youngest patient we have treated was 14 years old. The oldest was probably close to 90.”
The fact that Badran is bilingual and has firsthand knowledge of the immigrant experience is a huge asset, says Rosseau. “She is able to communicate with patients who don’t speak English as their primary language in a way that makes them immediately feel comfortable. I scheduled a [limited-English-speaking] patient today who was actually an inpatient at another hospital. When she was able to talk to Evelyn by phone, it made a huge difference. Beyond the language and communication aspect, Evelyn also brings an empathy that one can only have if one has [experienced different] cultures from being both within them and outside of them.”
For Badran, one of the more challenging aspects of her job is working with brain tumor patients whose conditions are terminal yet they believe this treatment will provide a cure. And even if the patient’s prognosis is good, there is no guarantee that the cancer will not return. In both scenarios, she must handle the delicate communication process of gently explaining to patients and their families what they can realistically expect from the treatment.
“We are hoping that [the results of the treatment] will last a long time and prevent the cancer from regrowing. [Although the treatment may not be able to completely cure them,] it helps prolong their lives,” Badran explains. “It does makes some of the tumors disappear, but some malignant tumors are very aggressive and hard to control. By doing this treatment we are stunting [the tumor’s] growth. What we are doing is slowing it to the point that if it is going to grow again, it is going to grow ever so slowly.”
Yet despite these challenges, her work also has great rewards. “The best part of my day is when the procedure is over and [I see] my patients get up and get ready to go home,” she says. “They are eating and laughing. They give me a hug and say, ‘You know, it was not as bad as I thought it was going to be. You made that possible, made my day lighter, and now I am going home.’”