Why Giving Matters: Honoring Nurses Today—and Every Day

When Rosemary Dixon was diagnosed with metastatic lung cancer in 2017, her disease had unfortunately spread to her brain—a common site for secondary tumors of this type. After she and her children consulted with physicians at a Bay Area medical facility, they agreed to have her undergo whole-brain radiation to treat the metastases. The therapy is common in cases such as these and undoubtedly extended Rosemary’s life, but it came at a cost far greater than anticipated.

Shortly after beginning treatment, Rosemary started to exhibit cognitive changes as well as physical problems, including issues with gait and movement, short-term memory, sleep, and energy—symptoms that had not existed prior to radiation. Surprised and concerned at the extent of the changes, Rosemary’s children sought answers from their mother’s care team but received few concrete answers. Unfortunately, the symptoms only worsened in the months that followed.

Convinced that something was “not right,” the Dixon children scoured the Internet, joined chat rooms, asked questions, did their own research … anything they could to try to understand the changes they saw occurring in their mom. They knew something was going on beyond their mother’s original cancer diagnosis, but they didn’t understand what. Until they came to Stanford.

“We’d been feeling like something was inherently missing in our mother’s care, that there was further expertise and insight we needed but couldn’t find,” says Kathryn Louise Dixon, the youngest of Rosemary’s four children. “Thankfully, we were able to have our mother seen at Stanford, and as soon as we met with her care team there, we felt like we had been thrown a lifeline.”

One caregiver in particular proved invaluable to the Dixon family: Gwen Coffey, NP-C, a nurse practitioner in Stanford’s Neuro-Oncology Program. In addition to helping to guide and deliver Rosemary’s care, Gwen was a compassionate, informative, vital partner to the Dixon family throughout the two-year course of their mother’s treatment at Stanford. In fact, Gwen’s attentiveness, dedication, and skill as a clinician inspired the Dixon children—Alicia Dixon Docter, Barry Gene Dixon-Loya, Sally Jane White, and Kathryn—to create a gift fund in her honor after their mother’s passing.

Delivering Care and Compassion at Stanford

After meeting with Rosemary, neuro-oncologist Seema Nagpal, MD, clinical associate professor of neurology and neurological sciences and clinical associate professor (by courtesy) of neurosurgery, and Gwen quickly determined that the cluster of symptoms she was experiencing was the result of the whole-brain radiation she had received. While Dr. Nagpal and Gwen confirmed that the treatment was indicated, it also was damaging.

“We knew Rosemary had an irreversible problem caused by her treatment, and since there is no effective way of reversing that problem, our goal was to be creative in managing her various symptoms,” says Dr. Nagpal. “We’d be watching the brain to make sure there weren’t new metastases but also watching for active neurologic symptoms that needed to be managed.”

The Dixon children knew their mother’s lung cancer had spread to the brain and was advanced, with few treatment options. But it was the extra compassion and attention they received at Stanford—caregivers who would answer their questions quickly and thoughtfully, communicate fully and honestly, and treat their mother’s progressing neurologic symptoms to the best of their ability—that gave them peace.

Honoring a Care Team

The Dixon family has established several gift funds to support cancer research and patient care led by the caregivers involved in Rosemary’s care. These include thoracic oncologist Joel Neal, MD, PhD, associate professor of medicine–oncology; radiation oncologist Richard Hoppe, MD, the Henry S. Kaplan-Harry Lebeson Professor of Cancer Biology and Radiation Oncology/Radiation Therapy; and Dr. Nagpal. But one fund is especially important to them: the Rosemary Dixon Patient Care Fund, or “Gwen’s Fund,” as the family affectionately refers to it, which was established in recognition of Gwen Coffey, the nurse practitioner who played such a vital role in the care of Rosemary—and, by extension, her children.

“Gwen changed the course of our journey entirely,” Kathryn says. “Every person in our mother’s care team at Stanford was fantastic, but through the course of her treatment, Gwen really became our lifeline, our anchor—not just for our mother, who was so grateful for Gwen’s care, but also for my siblings and me. We were in the thick of a huge, terrifying storm and we needed some guidance, some understanding, and some insightful, fact-based, reliable support. And Gwen was there for us every step of the way.”

Gwen provided the Dixon family with vital education and insight into their mother’s condition—about what was happening on any given day, and what was likely to happen in the future. The family says that Gwen was able to understand what was occurring with their mother on a clinical, cognitive, emotional, and physical level, and that she was able to clearly communicate to them what to expect in the coming days, weeks, and months. The information was frightening and sad, yet it let the family prepare—and, perhaps most importantly, it gave them the peace of mind of knowing that they were doing everything possible to help ensure their mother’s quality of life.

“Gwen was so caring, loving, and compassionate in caring for our mom,” says Rosemary’s daughter Sally. “Her gentleness in explaining her care plan to us helped us feel assured and comfortable.”

Rosemary’s daughter Alicia adds that the emotional support Gwen provided was invaluable to the family. “During the course of her illness, Rosemary was able to open up with me about how she was feeling,” she says. “I am so glad Gwen created the space for her to share her emotions during this very tough time.”

Gwen’s colleagues also recognize her rare gift. “Gwen is empathetic and very intuitive,” Dr. Nagpal says. “She has an incredible understanding of how people work and how people are motivated and can very quickly get to what patients really need and what might be holding them back, socially or emotionally, from an optimal outcome.

“There are many times when I will ask her to see a patient or family member because I know I’m missing a piece of the puzzle beyond medical issues,” she adds. “Gwen can zero in on it right away. She’s a true partner and one I’m very lucky to work with.”

The Rosemary Dixon Patient Care Fund

Gwen’s Fund has been established to support training and education related to the day-to-day, palliative, and/or end-of-life care for patients with brain cancer. It will be overseen by Gwen in collaboration with Dr. Nagpal.

Gwen and the Dixon family envision the fund initially being used to educate nurses specifically about brain cancer, including the effects of whole-brain radiation. “We want to educate nurses on the patient experience and provide the necessary resources to better guide patients and their families through this journey,” Gwen says.

They also plan to extend this guidance to family members of patients with brain cancer so they have a roadmap, as the Dixon family did. “We want to help keep other families from having to go through those ‘2 a.m. surfing-the-net moments,’ as we did prior to coming to Stanford,” Kathryn explains. “To provide families with specific, condition-based information to help them navigate, and in turn bring meaning to, end-of-life experiences.”

“I am thrilled that we are able to honor Gwen and her accomplishments and that she will be passing on her talents, knowledge, and compassion to other medical staff,” Sally adds. “The effect she had on our mother’s care—the effect she’s had on so many people’s lives—is beyond compare.”

For her part, Gwen feels humbled to have a fund created in her honor. “I feel very honored and appreciative that what we as nurses do is being recognized in this way,” she says. “But there’s also a responsibility that I do something great with this fund so I can honor Rosemary and her family in the way they deserve. I want to do everything I can to help ensure that other patients and their families are able to receive the education, support, and care they deserve when facing end-of-life situations.

“As hard and intense as these situations can be, they can also be incredibly meaningful and beautiful,” Gwen adds. “It’s our duty as nurses to help patients and their families find as much meaning and beauty as they can.”

The Dixon family encourages others to contribute to the Rosemary Dixon Patient Care Fund or any of the funds they have created to support thoracic cancer, neuro-oncology, and radiation oncology research. For information, please contact Karen Mitchell at karen.mitchell@stanford.edu.