by KELLI FONTENOT
Published in the July 2008 edition of Women In Business, a publication of The Dalles Chronicle
Taking Heart
Nina van Es, Celilo nurse practitioner
On weekends, Nina van Es retires to her house and 40 acres outside Lyle, Wash. A recording of soft Hawaiian guitar fills her living room as she binds a new memory to a page in her journal. She concentrates hard, layering pieces of tissue paper in her notebook, sometimes adding magazine clippings and pressed flowers from her yard. The fragile shapes and vibrant hues in Nina's collages reflect events she can't describe with words.
These tranquil moments help take the focus off the difficult experiences she sometimes deals with as the nurse practitioner of the Celilo Cancer Care Center.
"I do it if I want quiet time," Nina says. "I do it as something to keep my hands busy when I am processing stuff. Sometimes days here are hard."
The path of a cancer patient is a difficult one, but often, so is the path of the caregiver. When a patient has incurable cancer, doctors can only try to manage symptoms and make the patient as comfortable as possible.
"People pass on after you've treated them for years, or you've gone to funerals, and you have to have something that you can do to help yourself through that, because caregivers grieve. If you know somebody close for seven or eight years, you grieve when they're gone."
Still, Nina insists cancer is not a death sentence.
She argues instead that life is a death sentence.
What matters is not whether you are going to die – death, Nina says, is inevitable -- but the way you choose to live your life. Sitting in her examination room, she glances matter-of-factly out the window and points out that the grass dies every year.
"We're just going to be like the grass, and that's just fine."
If you live your life with that knowledge, Nina says, the concept of death doesn't need to be frightening or depressing. It's how you use the time you have left that counts.
For Nina, this means working at Celilo, gardening, and spending as much time as possible with her husband and two sons. She also teaches a sociology of aging class at Columbia Gorge Community College. Because she wants her students to learn about human experience, she asks them to conduct needs assessments of senior citizens each year.
"It's incredibly satisfying to somehow make a difference, to help," she says. "I love teaching because it's the next generation. I can pass on what I've learned from 25 years in the trenches."
For each assessment, the students must interview their seniors and ask thoughtful, open-ended questions. Nina encourages them to ask, "What do you value most?"
Nina values heart.
Not the organ, but the courage and strength she sees in her patients every day.
"Something that has heart. Something that has great significance. Something that has meaning. Something that is more than just superficial. Heart."
Heart can be translated into different things. For Nina, heart means living life as well as possible. Heart means living in the present, feeling the wind on your face and taking time to appreciate the beauty in everyday sights -- grass, music, the shock of color in a geranium, the elegant movements of deer. Heart means the courage necessary to defeat even the greatest challenge.
"People have heart. When you look at somebody who is going through chemotherapy, or they sit in this chair and they get a diagnosis of cancer, they reach deep in order to adjust to that diagnosis and then to find the grit to say, 'alright, this is not going to be fun but I'm going to do it,' and you can see it in their face. That's heart."
That kind of determination inspires Nina to include passion and energy in her own life.
She jokes that she doesn't feel the need for heart when she shops for groceries or passes through airport security, but at work and at home, heart is a vital part of her life. There are people without heart "who are truly dead," and there are people close to death who Nina says are radiant and alive.
Over the years, Nina has gained a deep respect for human nature and spirit in her work. She has also realized how important self-expression can be for healing after an illness.
Like any other center, treats patients using chemotherapy and radiation, while also prescribing alternative medicines such as acupuncture and Chinese herbs. The center, sharing Nina’s belif, also encourages patients to use guided imagery and journal writing as therapy.
"Finding a form of expression is actually key, because all human beings want to be heard. They want to be listened to," Nina says. She says self-expression is a counseling strategy, a way "for them to process things."
With journals, patients can assess their daily progress and make judgements. Nina is deeply connected with her patients even when she processes things on her own time. Whether she is updating her collage journal or harvesting thyme from her herb garden, Nina's pasttimes simply give her a way to focus. Her own self-expression involves living in the moment, moving on and planting new seeds.
"When I do gardening, I'm resting," Nina says. "It's being present with the plants, and I'm not thinking about a whole heck of a lot of things. I'm not trying to solve the world. The lavender needs pruning and the deer have eaten it."
Sitting on the front steps outside her three-story house, she lifts up a piece of a once-lush green vine that the deer have nibbled to tiny stems. She looks at the remaining leaves for a moment, raises her sharp eyes, then smiles and starts shaking her head. With the knowledge that nothing is permanent, that the grass dies every year, Nina chooses to enjoy her restful weekend in peace.
After all, as she has said before, "It's not sad. It doesn't have to be. It's just life."
