On a typically gray day in 1985, chilly winds from the Pacific Ocean blew gusts of fog over the University of California, San Francisco Medical Center. Terry Healey, a 21-year-old political science senior at UC Berkeley, waited for a group of physicians on the tumor board at UCSF to examine a mass on his face.

Dr. Y, a radiation oncologist, palpated the right side of Healey's face. Hard areas signified that malignant tendrils of a fibrosarcoma had spread into his cheek, lower eye, nose and upper mouth. Dr. Y shook her head, as if to say, "Not good."

One by one, 15 physicians examined Healey. They soon made up their minds about Healey's prognosis, but shared their thoughts only with each other. Until last year, Healey didn't know the tumor board's verdict. All he heard from Dr. O, his oncologist at the time, was that he'd probably lose half his nose, his upper lip and teeth, and possibly his right eye.

"I was lost in confusion and terror," Healey later wrote. "What in hell had happened to me?"

When he awoke after 10½ hours of surgery, not long after his visit with the tumor board, he had lost much of the right side of his face and teeth, but the surgeon had saved his eye.

More than 16 years and 30 surgeries later, Healey got in touch with Dr. O. The tumor board, the physician admitted, had voted that Healey was beyond saving.

Dr. O and another physician angrily told the board there was no way they would let a 21-year-old die, no matter how radical the facial surgery had to be.

The reconstructive surgeries were severe and problematic. After the 30th surgery, Healey had had enough.

Today, Healey is a UC Berkeley grad and a successful businessman living in Alamo, Calif., married since 1994 to his wife, Sue. Last year, he wrote At Face Value: My Struggle With A Disfiguring Cancer for anyone who believes that how you look is who you are. A positive self-image, he believes, must stem from the inner self.

He also wanted to draw attention to the long-lasting effects that a positive and attentive nurse or physician can have on the healing process.

Getting 'back to Terry'

With the widespread loss of primary care nursing, inner healing often must take place without the help of a nurse, however much she or he would like to offer it. In primary nursing, which mostly began in the '60s, one nurse usually remained a constant caregiver throughout a traumatic hospitalization, advocating for the patient and helping to communicate with physicians.

Today's staffing challenges-the legacy of 12-hour shifts, the nursing shortage and common use of registry nurses- >> make it more difficult to maintain that kind of patient-nurse relationship. Emphasizing how much the attentive nurses who cared for him helped in his recovery is one of Healey's passions. Two of his nurses say that primary nursing gave them enough time to pay attention to his needs.

Healey could have continued having plastic surgery, always hoping to "get back to Terry," but the turning point came years ago when a girlfriend he met in the hospital, Dina, left him with a painful goodbye message: Healey was too down on himself to hold her interest.

" 'You've got a number of issues,' " Healey remembers her saying. " 'You need constant reassurance. I can't offer that.'

"I had no idea I had become that insecure. People who are insecure are hard to be around," he realized.

After that, Healey stopped trying to rebuild his confidence by having surgeons rebuild his face. "Dina opened the door to my getting help," he said.

He now helps others by volunteering for The Wellness Community, a national nonprofit group dedicated to providing support services for cancer patients and their families.

Gilda Radner, the former "Saturday Night Live" star who died at age 42 of ovarian cancer, put them on the map, Healey said.

"My overall message is that you can't judge a book by its cover. We all need to be less judgmental. My story isn't about cancer or disfigurement-it's a broader issue. At the end of the day, it doesn't matter how you look. As we age, things change anyway. How you perceive yourself is how others perceive you," Healey said.

Thankfully, he said, nurses at UCSF who cared for him in the early days after the devastating surgery to remove half his face treated him as if he were still whole. His oncologist, parents and older brothers, Rob, Brian and Steve, always showed a positive attitude, too, although on the inside they were perhaps more worried than he about the long-term effects.

After he recounted his story in the book, Healey realized that some of the nurses had unknowingly helped him start reconstructing his confidence.

Going the extra mile

Carolyn Clary-Macy, RN, and Adrienne Low, RN, two of his nurses at UCSF, didn't expect that he'd remember them. They were just doing their jobs, they say.

"The basic kind of people who go into nursing are people who go the extra mile. For the most part, it's the aspect that brings you into nursing in the first place. There are people in nursing who don't go the extra mile. Maybe it's harder now because they have more patients," Clary-Macy said.

She said that Healey ran into a number of bystanders-sometimes even physicians and nurses in other states-who didn't show a lot of sensitivity. By their manner, you would have thought they saw him as just a specimen, Clary-Macy said. "That's the other extreme."

Healey said he felt protected in the hospital after his surgery. Once he'd recovered enough to go out, though, "jaws were dropping." Yet, he said, in the hospital, nurses would show up with big smiles on their faces. "However they were trained to deal with patients that way, it made a big difference," he said.

In At Face Value, Healey describes how after the radical surgery to remove half his face he was immobilized while his physician had part of the skin from his chest attached to his face in a delto-pectoral flap.

It looked as though a bear had clawed his chest, and he had to be still for two weeks while the facial area built up a blood supply. Only then could his oncologist reattach the skin to his chest and sever the connection.

During this time, Clary-Macy brought him a Walkman and some "tempered punk" she thought he might like. Much later in his recovery, she invited him to a UCSF Christmas party.

Low, who knew Healey was a practicing Catholic, prayed with him. "I don't think he knew the extent of his surgery at the time. It was devastating surgery, but he's really risen above it," she said. "I like to pray with patients, but I always ask first. I like it because it's a way to bring peace and solace that surpasses all understanding.

"[Prayer] doesn't have side effects, and it's not just for chaplains. Offering spiritual support in the form of prayer to one who is troubled is also a way of seeing a patient as an individual. I see it as taking a risk, but one [that's] well worthwhile if it can soothe a person's soul and spirit. It doesn't change the situation, but it changes you," Low said.

"I just was being a friend," Clary-Macy said. She's still in touch with about half a dozen patients from that time; one of the patients is a godmother to her son.

"When a patient is in the hospital for months, you really get to know them. They're vulnerable in that state. Their whole soul is open to you because of what they're going through," said Clary-Macy, who now works in thoracic surgery
at UCSF.

A problem she hadn't thought of emerged in Healey's book. At 21, as a good-looking guy with half his face under reconstruction, Healey feared he'd never be attractive to women again. At one point, he imagined that the party invitation might indicate that Clary-Macy was romantically interested in him.

She asked him after she'd read his book, "Was I leading you on?" "No, no," Healey said to her. "You didn't lead me on. It was just wishful thinking."

Clary-Macy said, "It was more of an outreaching-[I was trying] to be kind. Which is what nursing is all about. I was trying to see him as a person, not a sarcoma."

Healey said the nurses' behavior was appropriate. "They never made me feel sick or like I was going to die or that I looked bad."

They were active, he said, unlike the reactive nurses at hospitals in other parts of the country where he had subsequent reconstructive surgeries.

After At Face Value was published, Healey couldn't find some of the other nurses who'd been "awesome" to him in those early days after his surgery or when he underwent radiation.

Striking a chord

Clary-Macy has precepted "tons of nurses." She was one of three nurses nominated for distinguished nurse of the year because of her ability to see the patient as an individual. "It would be a sad thing if you don't see that [as a nurse]. You can't be a patient advocate otherwise."

Low now works with frail elderly people, mostly of Asian descent (but with a growing number of Caucasian and other ethnic groups), at an agency in San Francisco called On Lok Senior Health. "I find myself thriving there. I can spend that kind of time with the patients, and I feel like I know them."

The core message in Healey's book strikes a chord with the nurses. "I learn so much from patients. They give back, like Terry gave back," Low said.

Low believes Healey was ripe for self-discovery and reflection. As Holocaust survivor Viktor Frankl wrote in Man's Search for Meaning, there are three ways to find meaning in life: by doing a deed, experiencing a value or suffering. Healey has done all three.

"We are lucky that Terry is working so hard to bring this [message] to light. He's not into making huge amounts of money on the book, [he] just [wants to] help people, including the medical world, realize how drastically their attitude can impact their patients.

"Maybe we will improve the care people in the future receive. I hope so," Clary-Macy said.

Contact Mary Hopkins McDonald at marym@nurseweek.com