Senior Fellow: Sarah Kagan

Sarah Kagan

Photo by Candace diCarlo

When Sarah Kagan came to Philadelphia from San Francisco in 1994, and was greeted by an ice storm that blanketed the city, she wondered fleetingly if she had made the right move.

Nine years and several more ice storms later, the associate professor and Doris R. Schwartz Term Professor in Gerontological Nursing has stayed at Penn’s School of Nursing because she is able to connect all of the aspects of her profession that she values. “I really came to the place saying, ‘Wow, Penn is the one place that I can see having support to integrate research, education and practice in a way that’s uniquely mine,’” she said.

Kagan still makes her early-morning rounds for her two appointments within the Health System—one as a practicing nurse, one as a consultant—teaches classes at Penn Nursing on care for older adults and actively participates in research, such as her recent study on e-mail communication between patients and health care professionals.

For her efforts, Kagan, 41, has received numerous honors and teaching awards, including recognition for her illuminating work with older adults, particularly those with cancer.

Now, she is adding one more accolade to her list, because earlier this month, she was named one of 24 recipients of the prestigious MacArthur Fellowship.

Q. Where were you when you heard the news about the fellowship?
A.
Sitting right here [in my office]. I hung up the phone and I noticed a voice mail and I hate voice mail, so I immediately picked it up and it was Jonathan Fanton, who is the president of the MacArthur Foundation.

What was weird is that even though I didn’t remember his name, his voice sounded really familiar. We were at the University of Chicago at the same time. And then he said it. And I couldn’t say it out loud! This is the most impressive honor I could imagine. I’m really still baffled by it. I’m so honored, but at the same time so overwhelmed.

Q. How did you decide to focus on gerontological nursing?
A.
Somewhere in my first degree, I sort of realized that nursing had much of what I enjoyed. It involved relationships with people, application of science, and the opportunity to provide service.

I went on to get a second upper division bachelor’s degree in nursing and then I moved to California where my mom’s family is from—the San Francisco Bay area—and I knew that I liked to work with older adults. I interviewed at a number of area hospitals and was intrigued by a nurse manager on an oncology ward, who said if you want to work with older adults, you need to come and work with me, and I’ve been doing it ever since.

I’ve never been able to give up my patients. They are the people who teach me the most, who give me most of my ideas not only for the research that I do, but also for [the] content that I teach.

Q. What are the guiding principles in your work?
A.
I don’t see gerontological nursing as care of people who are chronologically old. I see it as the application of gerontological principles about functioning in daily life and responses to help in illness as you age, no matter what age you are, as something that’s then transportable across the lifespan.

The nice thing is that I think I’ve been listened to in the right places, and the miraculous thing is that the MacArthur clearly saw that as well, which is mind-blowing.

Q. It’s clear that your research, practice and teaching all intersect.
A.
Absolutely. I’m not someone who likes to live in little compartments. I do try to see everything in my professional life fitting together. That means that the intellectual work that I do is as much a part of my daily practice, as is my daily practice part of my intellectual work. Integration is very much part of how I live every day.

Q. What are some common misconceptions that peo-ple have about growing old, or about having cancer and being old?
A.
One [myth] is that you lose your memory and you lose other functions as well, and that tends not to be true. What tends to happen is that your functional reserve, that is, the extra reserve that helps you deal with something that’s more extreme, declines, but loss of global function is not really part of normal aging. It’s not normal to lose your memory, it’s not normal to be confused.

Q. How do you think these myths about aging developed?
A.
I think part of it is probably historic. We have increasing amounts of science that help us understand normal aging, pathological aging, and aging-related disease. [But] we haven’t always had that, and if you think about what is meant to be old in our society, ours is a very sort of moral work ethic that involved doing well, living well and then dying well. There are some of those threads that saw disease as a failure [and] loss of function as punishment.

Q. Do you see that happening still?
A.
I can’t tell you how many patients I care for say, “I’m really tired of the questions: ‘So, what did you do to cause your cancer? Well, did you smoke too much?’” It’s amazing the extent to which our deeply held beliefs come out in the face of what we perceive to be crisis or tragedy.

Probably the number one myth that I would say relates to being old and having cancer is: If you’re old and have cancer, you’re going to die. In fact there are many people who are living very long lives after cancer or with cancer as a chronic but controlled illness.

Q. Is it accurate to call it a “fight” against cancer?
A.
I think that we have a lot of cultural metaphors that may not fit everyone and the “war on cancer” or “fighting” cancer is a good example of that. Many older people are sort of struggling with the war metaphor, because they see the end of their natural lives are being relatively more proximate to them then it was 30 years earlier. Rather than giving up your life to fight cancer, hoping that you’ll win, in order to return to your life, you can think about, “How do I coexist with this illness, with this disease so that I might be able to go on with my life and not lose time?”

I think that something I’ve become very sensitive to is the notion that people need language that reflects their own experiences and we need to help people give voice to their experience but also to give them the language that helps them out of uncertainty and out of confusion or disbelief, when it is quite natural to feel that way.

Q. Finally, the big question—what do you plan to do with the money?
A.
I haven’t a clue. I’m not sure that money is nearly as important to me as the attention that it brings to nursing and older people with diseases like cancer. I could not have bought this kind of credibility and visibility, in part because the media stuff is not really me. The visibility, the credibility, the opportunity to talk to people who never before were interested in talking to someone who took care of old folks with cancer, is incredible.

Luckily, [the stipend] doesn’t start until Jan. 1, so I don’t even have to face the first check yet, which is good because I would probably fall over in a dead faint.

On the cover: Kagan with a portrait of nursing pioneer Alice Fisher, the British nurse who founded one of Penn Nursing’s predecessors, the Philadelphia General Hospital training school.

Above: Kagan discusses wound management with Cheryl Bobrick (left), nurse manager of the Rhoads 3 Patient Care Unit at HUP.

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Originally published on October 30, 2003