The theory that Kagan builds up from elders’ stories should replace popular assumptions about waging an all-consuming war against cancer or an identity of older people as primarily “old” rather than as individuals shaped by their life experiences. Clinicians who base their approach on popular constructions of what it means to be old and have cancer will offer less-than-satisfying care to patients they fundamentally just don’t “get.” Many of the students and staff nurses Kagan works with, though, have picked up on her research and by-example leadership.

Anna Beeber GNu’00 who is working through the Ph.D. program, has been mentored by Kagan as a HUP staff nurse and through her M.S.N. studies. When most of the other students wanted to enter hot specialties like obstetrics and critical care, Kagan helped the young nurse come out of the closet regarding her interest in geriatrics. “I never knew what it meant to be a nurse until I met her,” says Beeber, who recalls working with Kagan and an old man with a stubborn bedsore. “While the apparent problem for this patient was wound-management, I began to realize that the nursing required was so much more than wound-care. We were evaluating the patient’s response to his illness, discussing his general views about life and feelings about death, and, most importantly, focusing on relieving his suffering. We were not there to treat the problem, but instead to learn about the patient and learn from the patient. With this information, we could then create a personalized plan of care.”

Kagan’s compassionate skill and expertise in gero-oncology have been sought at the bedsides of patients, in consultation rooms with medical teams, in classrooms of nursing students, and in big lecture halls as keynote speaker in Hong Kong, Sweden, England, and elsewhere. Her students and HUP’s ward nurses all speak of her brilliance and unflagging generosity. In 1996, Kagan was the winner of HUP’s Nursing Excellence Award, and she was recognized for distinguished teaching with a Lindback Award in 1996. Margaret Crighton Nu’94 GNu’01, another of Kagan’s Ph.D. students and a former HUP nurse, reports that Kagan has helped change “for the better” how many of the nurses practice there. “They will take that with them wherever they go,” Crighton says. “Everyone admires her.”

Harold Bloom’s notion of genius is not a hairy monster. A literary critic who holds up Shakespeare as the “supreme genius,” he offers his own personal definition. “Because of Shakespeare,” he writes, “we see what otherwise we could not see.” One litmus-test that readers should pose to ascertain whether they have encountered literary genius is, he says,“Has my awareness been intensified, my consciousness widened and clarified?”

It’s ironic that Kagan should, in some sense, be recognized for what the medical and nursing establishments already know deep down: that the individual person is the center of care, that older adults suffer most from cancer and that, therefore, we ought to be listening to them. It’s the human relationships that matter most. And yet it’s these basic and obvious truths that seem hardest to put into practice in our fraying health-care system.

“Sarah has the mark of a true mentor,” says Crighton. “She sees in her students what they can’t see themselves, [and] she has an uncanny way of getting people to see things in a totally new light.” The MacArthur Foundation, it seems, is intent on disseminating a little of that light.

Kagan studies and cares for some of society’s most fragile members, a population that rarely makes headlines as the subject of scientific breakthroughs. “Nor are these patients the customary first choice of nurses and physicians delivering patient care,” notes Strumpf. Old people with cancer are not cute and charming and “tragic” like little kids with cancer, says Kagan, but she finds something deeply satisfying in working with frail elders who over and over again display the fortitude to transcend ineluctable pain and go on living.

Grave illnesses “challenge people to dig within themselves and reflect on the lives they’ve led and try to use what they’ve learned,” says Kagan. How they respond “varies from individual to individual, but I think that as a result, I get to hear a lot of great stories—I get to know a lot of people in times that are very, very trying for them but which create opportunity and a sense of triumph. People tend to display the best in themselves when they feel as though they’ve accomplished something they believed was impossible.” That achievement can be anything from going back to work to caring for a grandchild through profound chemo fatigue or simply sitting up in bed after an arduous recovery from major surgery. Sometimes it means facing death, when it can no longer be pushed back by modern medicine. It’s not big science and high technology—it’s listening to patients, one story at a time, that can transform health care.

Kagan looks into the face of pain, decline, and death—and all the wounds of the human condition—and she doesn’t blink. She even finds joy there. “We may be weird, but we’re worth it,” she once told Beeber, encouraging the young nurse’s love of caring for the faded blooms.

“What I’ve learned is that each person’s sense of suffering is unjudgable,” Kagan says, “and being able to help people past that moment of suffering can be incredibly rewarding—the joy that you share with someone who says, ‘My pain is half of what it was last night, and I feel sooooo much better. Thank you.’”

Peter Nichols CGS’93 is the editor of Penn Arts & Sciences.

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2004 The Pennsylvania Gazette
Last modified 02/27/04

Sarah Kagan’s “Genius Idea”
By Peter Nichols
Photography by Addison Geary

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