Location: San Francisco, CA
The things that first appealed to Sara Lezin about working in a burn unit were not, in fact, what made her stay. Armed with a BSN/RN from Duke University, Sara jumped at the chance to serve as a nurse at the Jaycee Burn Center at UNC Medical Center in Chapel Hill (“I root for both teams,” she says of her ties to fierce rivals Duke and UNC-Chapel Hill) because she figured that working in a trauma center would give her good nursing experience that would be transferable elsewhere. She also found it an interesting and unique experience to work in an ICU that has both pediatric and adult patients.
But what ended up being the most intriguing and sustaining aspect of her work with burn patients was the fact that they did not represent a random slice of society. “There are common risk factors that lead people to get burned,” Sara says. “The most significant predictors of a burn injury are illiteracy and poverty – this is true across all burn centers.” Sara really valued working with this underserved population because it was the driving force in her decision to pursue a career in medicine.
Sara studied both biology and environmental science at Colby College in Maine (about as far as she could get from her home in Santa Cruz, California) and was interested in the intersection of the environment and medicine. “But I was not sure how to fit that into a career,” Sara says. An environmental injustice class that highlighted the disproportionate health disparities across ethnic groups particularly sparked her interest. Learning that, as she says, “health outcomes are largely predetermined by race and zip code” reinforced her desire to “work in health care in some capacity. That course also led to a unique study abroad program that focused on global health from a comparative perspective, and had Sara traveling to and studying health systems in the United States (New Orleans), India, Argentina, and South Africa.
The job at the burn unit, her first out of nursing school, was the perfect fit for her interests in environmental health and her desire to work with underserved patients. It also reinforced her belief that empathy is at the heart of good patient care and is an essential part of her job. But it was that same empathy that ultimately led to her needing to take a break. Sara says that working with burn patients is “exceptionally demanding and draining emotionally, physically and intellectually.” Patients often arrive in a really acute state (each center has its own process, but at Jaycee Burn Center the patients often bypassed the emergency room and were brought straight to the burn unit by ambulance or airlift) and many are placed in a medically induced coma for months. The wound care, that is primarily done by the nurses on staff, is extremely demanding and extensive. “But we get to do the work with the patients and see the transformation,” Sara says. “Few things have been more fulfilling my life than discharging a patient after months – some over a year – of intense treatment.”
Sara has since worked in different kinds of nursing, including volunteering at a treatment center for addiction, but she says that “nothing has come close [to her work in the burn center] in terms of being remotely as rewarding.” The flip side is that the emotional investment cuts both ways. “When there is a bad outcome,” Sara says, “It is just heartbreaking.”
Sara transferred to a burn unit in San Francisco when she moved there to pursue a Masters as a Nurse Practitioner from the University of California San Francisco (UCSF). She recently transitioned to going to graduate school full-time and had to stop her work at the Saint Francis Memorial Hospital’s Bothin Burn Center. The break was not just for practical reasons like the demands on her time. “I think I was suffering from empathy fatigue,” Sara says, looking back with the added insight of some of the classes she has since taken for her NP degree. She now appreciates that moving forward in her career, she needs to balance empathy (what she describes as “climbing into that hole with the patient,”) and self-preservation. “I need to create a shield,” Sara says. “Not a wall, but a shield.” She still feels that empathy is a critical component of health care, but, she says, “I need to make sure it is sustainable. I want to make that connection, but protect myself from burnout.”
She also hopes to always remain cognizant, no matter what path her career takes next, of the fact that every normal day of work for her is often a patient and a family’s very worst day. “It is humbling to help a family in their most vulnerable state,” Sara says. “And it is a privilege to be a part of that experience for them and hopefully bring them comfort and help them navigate it.” Sara does not know where she will work next but she is “hopeful to continue to provide care to at-risk populations in some capacity.” She has recently become interested in managing and treating the HIV-AIDS population, both domestically and globally.
Whatever she does, it is clear it will be with an understanding of the contributing structural and societal factors that underlie the health problems she is tackling and will be in keeping with UCSF’s mission to serve the underserved. It will also include Sara’s patient-focused sensitivity and empathy, but ideally coupled with the shield she is developing for herself so that she can enjoy a long career doing what she does so well. As someone who has benefitted from oncology nurses and health care providers who were privy to many of my very worst days, and who made those days better by the empathy and compassion that Sara has in spades, I know the patients who have already benefitted from her care and those she has yet to treat are lucky that Sara chose to pursue a career in health care.