The 2004 MacArthur Foundation Fellow and nursing professor calls on clinicians to listen to patientstalk about what hurts, where the itch is, how tired they are, what theyve done about it, and how illness has changed the way they live.
Behind the open door of Dr. Sarah Kagans tiny office, stuffed sideways among shelves crowded with titles like Nursing Care of Older Adults and Osteoporosis and Cancer Care Nursing, is a fat tome by literary critic Harold Bloom entitled Genius. Outside her door, in the waiting area of Penns Center for Gerontologic Nursing Science, are little baskets and vases of dried flowers. One bunch hangs upside down from the handle of a file cabinetfaded, brittle, but still holding a blush of beauty.
Blooms book and the bouquets are gifts that came to Kagan, the Doris R. Schwartz Associate Professor of Gerontological Nursing, last October when she was named one of 24 MacArthur fellows. At age 41, she is one of the youngest recipients. The fellowships come with a no-strings-attached stipend of $500,000. Kagan is only the second nurse to receive a MacArthur over the more than two decades that the foundation has been making its annual investment in Americas most original thinkers and doers. The first was Penn alumna Dr. Ruth Lubic NHP55 who was recognized in 1993 for her pioneering work in a Bronx birthing center.
Kagan seems baffled that she should be singled out for the honor and enjoys colleagues irreverence over the fellowships popular sobriquet, genius award. During last falls annual conference of the Gerontological Society of America, not long after being overtaken by MacArthur celebrity, she shared a hotel room with two nursing professors who had agreed to rise with her at five oclock each morning for exercise. When the alarm summoned the bunkmates from sleep in the pre-caffeinated darkness, a weary, pillow-muffled voice called back, Whose genius idea was this?
Ive developed a media-friendly alter ego who no longer complains when her photograph is taken, says Kagan brightly, and Im also learning not to blink People have this big-hairy-monster notion of genius, but Im still the same kind of weirdo thinker I was before. Its just that the MacArthur Foundation blessed it.
The academic journals still turn down submissions in which she tries to think past current assumptions and business-as-usual clinical practice, the very thing that caught the eye of the MacArthur selection committee. The foundations website states, In an era when health care systems show ever-increasing signs of strain, characterized by nursing shortages, physician overload, and consumer bewilderment, Kagan surfaces as an energetic and creative countervailing force.
Kagan has short, wavy, brown hair and a patch of freckles across her nose and under her large eyes. She grew up on a family farm in Lower Michigan, not a Midwestern spread handed down from an earlier generation but one started up by her parents during the countercultural romanticism of the 60s. Successful isnt really the issue, she explains about the farm. Its, Did you survive or not? My everyday life was arguing with my mother about whether she was going to do morning chores or I was going to do them.
Before finishing high school, she walked, SAT scores in hand, into the office of the admissions director at Kalamazoo College, which was near home. I wanted something more interesting than high school, she told her and asked to be enrolled. In sophomore year she transferred to the University of Chicago. No one ever asked for a diploma, and I never felt it to be required. She wandered through Chicagos curriculum in search of herself, declaring a behavioral-science major in her senior year. It wasnt until after graduation that she decided to pursue a nursing career, in part because she liked its blend of science and service. What I really loved was hearing peoples stories, and I particularly enjoyed working with older peoplein part, I suppose, because they have more stories to tell.
She went back to school and earned a B.S.N. from Rush University and an M.S.N. from the University of California, San Francisco. As a graduate student, she worked the night shift as a staff nurse on a cancer ward but came to Penn after completing her doctorate at UCSF in 1994. Penn is the one place where I can integrate research, education, and practice in a way thats uniquely mine.
According to Dr. Neville Strumpf, director of the Center for Gerontologic Nursing Science, Sarah is unusual in her blend of practice, scholarship, and teaching. Most academics are just thatpretty academic and not at all rooted in the real world. Kagan still carries a beeper, makes hospital rounds most days, and is a frequent on-call resource for doctors and nurses facing tough cases.
Ann Luther, a clinical nurse specialist at Vanderbilt University Medical Center, points out that nurses with the highest academic credentials are usually the most removed from the patients bedside. Yes, Sarah has a Ph.D., but she knows what a composite resection with a microvascular free flap is and the potentially debilitating effects of this surgery on an 80 year-old patient, she says. In other words, the practice component of nursing is central to her [scholarly] practice, not an afterthought.
At Penn, Kagan has two clinical appointments: as a Gerontology Clinical Nurse Specialist in Medical Nursing at the Hospital of the University of Pennsylvania and with the Department of Otorhino-laryngology: Head and Neck Surgery. She is also part of the Abramson Cancer Center. An advanced practice nurse, she consults with patients, families, and medical teams on the complex needs of mostly older adults and on wound-management and other symptoms associated with cancer, particularly head and neck cancers. Dr. Lynn Schuchter, a physician in the medical schools hematology/oncology division, often calls on Kagan for help with patients suffering complications from ulcerated cancers and similar problems. She describes Kagans particular gift as wound care, but so much more.
The nurse-scholar is currently at work on her second book, a study of cancer in the elderly aimed at medical professionals as well as a general audience, and is co-teaching three courses this semester: one on nursing care of the older adult, another on dementia, and a third comparing health care in the U.S., Hong Kong, and China. To balance the stress, she likes to pull from a stack of trashy novels on her bed stand or curl up with her three cats or bake cookies and brownies for her students. Chocolate makes everything better is the manifesto she hurls in the face of a full and busy life.
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