Day In Life

Social worker Cindy Tinker Hancock, LMSW, imagines the internal monologues that pass through the minds of people she encounters at Vanderbilt-Ingram Cancer Center (VICC).

“Wait a minute—how did this happen?” she wonders aloud, slipping into a patient’s shoes, “I have a stage IV diagnosis and I can’t work.

“I need to apply for disability or for a Social Security supplement. How do I do that?

“How do I pay my light bill, keep a roof over my head, keep a car in the driveway?

“I’ve got young children—how do we talk to our kids?”

For the patients Tinker Hancock sees, serious medical problems may be compounded by longstanding poverty or sudden financial upset, debilitating anxiety or depression, strained family relations or complete lack of family and friends who are able to provide assistance.

8:30 a.m.: System login

Tinker Hancock arrives at her desk on the first floor of the clinic. It’s in a tidy cubicle, tucked amid a couple dozen identical cubicles, in a cavernous room dubbed “Cube City.” She will alight here many times throughout the day to use her phone and computer, but otherwise she’ll be moving about the clinic, clutching her work phone and checking for messages.

The patient and family areas of the clinic are neat and welcoming, while backstage the staff-only corridors and service elevators appear strictly utilitarian. Cube City is somewhere in between. There’s a cartoon pinned on the outside of Tinker Hancock’s cubicle: a blowsy, crusty fairy, wand in hand, addresses the viewer—“Listen, honey, the title is SOCIAL WORKER, not miracle worker.” A colleague gave Tinker Hancock the cartoon, and another colleague later contributed the full-size wooden wand that’s displayed next to it, a pink stuffed star at its tip.

“A lot of times people seem to think that social workers have a way of working magic—I tell people the wand is busted,” Tinker Hancock says with laughter.

She logs onto StarPanel, Vanderbilt’s electronic medical record system, and checks her message basket.

At this point in the morning, there’s no telling what the day will bring. “No two days are ever the same. Flexibility, open-mindedness and a lot of prayers throughout my day is what it takes to do this work,” she says.

She provides psychological counseling to patients and families as needed and wields an array of resources and connections to help address any issues that might otherwise interfere with treatment and recovery. In addition to serving patients at the clinic on campus, Tinker Hancock assists patient care teams at satellite clinics.

9:10 a.m.: Typing for talking

Tinker Hancock speaks on the phone with the brother of a woman in her 60s requiring follow-up care for a squamous cell cancer of her tongue. The patient is poor, lives far from Nashville, and when she travels to the clinic she needs help with lodging. She’s been turned down for accommodation at Hope Lodge Nashville, which offers guest rooms free of charge to assist cancer treatment. To qualify, guests need to be able to communicate to staff any medical needs that may arise. The patient is unable to speak.

The patient thinks she has a solution. On her laptop computer she’s downloaded some software that speaks whatever she types.

With this information, Tinker Hancock is able to intercede, and Hope Lodge gives the green light.

10:40 a.m.: Nutritional quandary

Tinker Hancock’s cell phone rings. Deb Griffith, a nurse practitioner, would like her help sorting out the domestic situation of a man in his 70s who’s experiencing a bumpy recovery after treatment for cancer of the tongue and tonsil. Today he’s refusing to be admitted to the hospital. Tinker Hancock visits him in the clinic.

Thin and continuing to lose weight, the patient has trouble communicating due to the condition of his tongue. Tinker Hancock reaches his son by phone and learns that he’s planning to move in to assist his father. She puts Griffith on the phone with the son so that she can voice her concerns.

The recommended nutrition drinks don’t seem to be working in his father’s case, so the son has hit on an alternate plan, involving fresh fruits and vegetables and a blender.

Tinker Hancock updates the patient’s health record. Electronic documentation constitutes a significant part of her job.

1:00 p.m.: Hotel rooms aren’t cheap

Tinker Hancock is on the phone with the sister of an intellectually disabled patient. The patient has an advanced nasal squamous cell carcinoma. Surgery would likely entail the loss of one or both of her eyes. Keeping the patient comfortable is the sister’s priority. The patient lives several hours from Nashville, and in order to keep an upcoming clinic appointment, she and her caregiver need assistance for a night’s lodging in the city.

“Even at a discount, hotel rooms in this area are not cheap,” Tinker Hancock says, having arranged lodging at a nearby hotel at no charge to the patient and her caregiver. (The assistance in this case comes from VICC’s Caring Hearts Fund, which is supported by community donations.) Getting this worked out is a huge stress reliever for all of them.”

2:45: Adventure cycling

Kenneth Jones Jr.’s recovery from prostate cancer is proceeding well. With today’s 12-month check-up completed, the 74-year-old is now waiting in a meeting room, having asked to see Tinker Hancock.

Before going to see him, she looks up his record, then recalls exactly who Jones is, upon seeing that last year he habitually rode his bicycle from Ashland City to his clinic appointments at Vanderbilt.

“Hello. How are you?” she asks, entering the meeting room.

“I was well but I got over it,” Jones says, quite chipper. He had pedaled in yesterday evening to make today’s appointment.

He’s concerned that it would be overdoing it to pedal back the 20 miles to Ashland City tonight, only to have to return by bicycle tomorrow morning. He explains that earlier today he arranged another needed clinic visit, for tomorrow.

Tinker Hancock is the consummate listener, effortlessly engaged.

“If I can’t get a room tonight, I’ll go out here by 100 Oaks and see if they’ve got a tent and sleeping bag. I was going to buy those anyway. Because I like to go camping,” he says.

“Do ya?” she replies.

“And if I could find a place just to pitch that tent for the night, where I won’t get thrown in jail for camping in the city limits—do you know what I mean—that would be a big help.”

The conversation touches on Jones’ material circumstances. He lives without running water or heat, with electrical power provided by some solar panels and a portable generator.

Tinker Hancock steps away to see about a room for the night.

“She’s a really nice lady, isn’t she? She doesn’t get excited about too much,” Jones says.

Tinker Hancock returns, having arranged a free room for Jones for tonight at nearby Scarritt Bennett Center.

3:50 p.m.: Cost-prohibitive meds

In a workroom full of computer monitors, Tinker Hancock talks to an oncologist who needs some help getting medication for an indigent patient.

The doctor says, “This is the best social worker in the Medical Center. Maybe Tennessee. Potentially globally,” prompting laughter from Tinker Hancock.

In a room down the hall is a very ill lung cancer patient in his early 30s. He and his girlfriend are mulling whether the time has come for him to enter hospice care. The more immediate issue is that, being unable to afford the co-payments, he hasn’t been getting his prescribed pain medications.

Having undergone major cancer surgery in 2012, the patient credits his Vanderbilt surgeon for extending his life.

Tinker Hancock quickly arranges for free pain medication through a program provided by the Vanderbilt Pharmacy. Following a brief procedure to remove the fluid that’s built up in the patient’s abdomen, he and his girlfriend depart for home.

5:40 p.m.: The Village People

Calling it a day, Tinker Hancock answers a question about the emotional toll of working at a cancer center.

“No cancer is pretty, but where there are young patients with young children, and they’re in the process of dying, or they have really hard family dynamics that are ugly, there are moments when I come back here and say to myself or to a colleague, ‘Cancer sucks, it just sucks.’

“To have this team of professionals and see them rise to the occasion to take care of these folks to the best of their ability … I say that we are the village people, and it takes a village to do what we do every day.

“It’s a calling for me, it’s not just a job.”