A Special Graduation

An Essay by Dr. Barbara H. Sartell

My student, Nicole Lachman, was harried and pale as she rushed into the re-habilitation facility. Visibly shaken, she blurted, “Her pneumonia is not getting better after her medicine, and now they want to scan her.”

Nicole Lachman and her mother, Patricia Carnevale Prosceno

Nicole was talking about Patricia: her mother, mentor and best friend. Patricia was also a long-time smoker who had been ill for several weeks and had suffered a lingering cough. Nicole and I were taking care of patients together, since it was her first clinical rotation as a nurse practitioner student. She knew that her mother’s symptoms were concerning, and I remember her saying that she hated that being a nurse meant that she understood the seriousness of Patricia’s illness. “But I can tell you right now,” she said, “I do not want to lose my mother. I love her so much. She’s really my very best friend.”

A few months later, Patricia was diagnosed with lung cancer with metastasis to her liver and brain. Her prognosis was not good. One medical

professional told Nicole and Patricia that with no treatment, Patricia would last a few months, and with treatment, she might get two years. I was incensed by this statement, since prognosis and trajectory of cancer is impossible to predict. I have seen families hang their hearts on these timelines only to be disappointed or surprised when they’re incorrect.

Nicole was in a predicament. She was a nurse and a nurse practitioner student, but also, and most importantly, she was a daughter. She wanted her mother to stay in her life as long as possible, and she knew that treatment indicated a difficult road ahead. Still, Nicole and Patricia decided together that they’d opt for aggressive treatment.

During that treatment at the Hospital of the University of Pennsylvania, Nicole managed to work full-time as an assistant director of nursing at a rehabilitation facility. On top of this, she remained in school, taking classes and doing clinical work. Most mornings, in order for her to maintain job hours and take her mother to treatment, we’d start clinical at 4 a.m. I remember Nicole saying on a number of occasions: “I know this is nuts, what we’re doing. I really, really want to graduate while my mother is still here.”

That goal seemed reasonable at the time. But unfortunately, Patricia took a turn for the worse. She became so weak that she needed a wheelchair. She lost her appetite and fell several times at home. The final fall brought her to the emergency room at Christiana Hospital in Newark, Del., where tests revealed that her electrolytes and clotting studies were abnormal. When Patricia woke from a nap and heard the results of the tests, she said, “I’m not dead yet?” In truth, she both asked and declared that statement. She was quite angry.

Nicole was understandably upset by her mother’s words, and the two of them embraced a difficult conversation. They decided there would be no more treatment, and that Patricia would be transferred to the hospice unit at Christiana.

We were still about six months away from the December 2014 graduation. So Nicole’s work colleagues asked if they could surprise Nicole and Patricia by creating a mock graduation in the hospice unit. Within eight hours of us saying an enthusiastic “yes,” a green graduation cap and gown was procured, a cake was ordered, roses were purchased and parchment paper was rolled into a tube and tied with a ribbon.

We invited Nicole to the hospital, where we dressed her in a cap and gown and programmed a YouTube version of “Pomp and Circumstance.” Nicole made her entrance into her mother’s room. Patricia, who knew I was Nicole’s professor, heard me proclaim those special words to her daughter: “By the power vested in me, I hereby confirm your MSN nurse practitioner diploma.”

Patricia clapped. There were tears. Cake was eaten and pictures were taken. It was indeed a special moment. And it was as close as we could get to fulfill Nicole’s wish.

Patricia Carnevale Prosceno left this earth on her birthday in July. Nicole still struggles with the loss and the speed in which it occurred. She takes it one day at a time.

But she perseveres. Nicole, in fact, doubled her clinical time requirements in order to walk across the stage to receive her official diploma in December. I am beyond proud of this brave student. WU






Dr. Barbara H. Sartell is a professor in the MSN and DNP programs in the College of Health Professions at Wilmington University.