Keren Arfi hoped to be a midwife, but after losing a grandmother to colon cancer, and then two more relatives to illness, she changed course and now dedicates herself to palliative nursing care.
While Keren Arfi was in nursing school nearly two decades ago, three tragedies befell her and would alter forever the direction of her career and calling. Her father-in-law was diagnosed with lung cancer and died shortly afterward. Within six months of that – and six months, too, since her graduation from nursing school – her grandmother was diagnosed with colon cancer. Her grandfather passed away soon as he understood his wife became terminally patient and made Arfi promise him that she will take care of her grandmother at home. Her grandmother died three months later at home.
“It was obviously a very difficult time for me,” she recalls, “and I decided then I wanted to help the dying rather than those coming into this world.”
She particularly had an interest in helping care for cancer patients.
“I feel that once you have a cancer diagnosis, it changes you forever,” she says. “Your life will never be the same again. You are dealing not only with the physical aspect of your body and its illness but also grief and loss because you lose your security. You’re no longer innocent.”
For the past 16 years, Arfi has worked as a palliative nurse at the community health services in Israel and at Shebba Medical Center. It has, she says, been a pivotal time in oncology, and specifically for treating women with metastatic breast cancer, because of better drugs that allow for a better quality of life.
“Twenty years ago, women died within one or two years of their diagnosis,” she says. “But with the new generation of drugs and personalized medicine, there’s a difference. There is still the presence of death, and women with the disease can be confused that the bad side effects mean they are dying. But they aren’t. I help many of them with these thoughts and feelings, and naturally, with their fear of dying. That never leaves anyone, really. I’ve seen even women in their nineties struggle with an intense fear of dying.”
In working so closely with patients at a difficult and emotional time, Arfi has grown close to many women, and says that in some cases, she cannot distinguish between her work and the friendships that have grown out of it. She describes in particular one woman with metastatic breast cancer whose doctor had convinced her to continue with chemotherapy although the benefits appeared slim. The woman ended up in the emergency room with difficulty breathing, and died just ten days later.
“She and I had talked about discontinuing the treatment,” recalls Arfi. “She was so exhausted and had no strength. Her spouse was angry with me because I suggested that chemotherapy would harm rather than help. In the end, I offered her palliative care so that she would not suffer.”
It is work, she acknowledges, that requires a certain understanding of – and patience with – life and its many challenges.
“When I think about my decision to not have a career helping bring new life into the world and rather to help those departing,” she says, with some quiet humor, “I must admit, I do sometimes think of myself as the ‘Midwife of Heaven.’”