The Department of Health last week published what it called a "milestone report" on cancer nursing. Its first principle is that every patient should be attended by nurses who are "caring and competent". The ordeal of a close friend of mine suggests this is not always the case. Amid all the talk of a crisis of care in the NHS, particularly in cancer treatment, it isn't fashionable to criticise nurses. I recognise how pressured they are and that some of the suffering endured by my friend - who has just completed six months of chemotherapy - is attributable to lack of resources and administrative failings.
But some of her suffering has undoubtedly been caused by nurses' basic incompetence or apparent indifference: failure to change dressings; not bothering with sterile conditions in key procedures; talking loudly about test results in the corridor instead of discussing them privately; even asking about meal preferences when the patient is vomiting. More worrying still has been a basic insensitivity, a lack of compassion and an absence of human warmth.
Of course, nurses cannot take away the physical and mental horrors that accompany diagnosis of cancer and its treatment. Nor can they, or the consultants for that matter, tell a cancer patient precisely how long they will live, what the quality of their life will be like, or whether they will still hold down the high-powered job they had before they got ill. And nor can they always offer the in-depth conversation and reassurance that many patients need when they feel scared and vulnerable.
Nevertheless, they could remember that each person feels acutely the loss of their precious independence, former good health and, in the case of my friend, their beauty. In the months my friend has been undergoing treatment, she has never been asked how she feels about her diagnosis or how she is coping with declining independence, relative isolation and a changed self-image.
Instead, as on lots of hospital wards, cancer wards seem charac terised by an incessant, joking banter that passes for cheering patients up. Some of it is genuinely and warmly meant, and counters what otherwise would be a sad and pessimistic atmosphere.
But some of my friend's experiences have been so crass that they beggar belief. Loud voices across the ward as nurses recount something strange a patient might have said ("Listen to her, she thinks she's going back to work after all this."). Or, as the screen goes round a patient, the whole ward hears: "We're sorry, we're going to have to take the other breast off this afternoon. Do you want to phone anyone?" Or a patronising reply to a question about treatment ("old worry boots"), accompanied by eyes rolled upwards in mock irritation.
An absence of compassion seems at the root of such insensitivity. Small demonstrations of tenderness, affection or concern are rare among nursing staff. Instead, in my friend's case, it has been junior doctors and consultants who have shown kindness and care.
By the end of six months, patients themselves have learned to be passive or even to adopt the banter if they are not to be seen as "difficult". They have learned not to ask irritating questions, or to push for proper answers. But at that point, when there is no indication whether the chemotherapy might prolong life, the last course of treatment is a momentous milestone and the start of a new phase of psychological and physical adjustment.
In my friend's case, the last treatment was marked by an unceremonious indifference. As she told me, she only wanted them to acknowledge the end, perhaps to say "well done" for surviving and to explain what would happen next. Instead, she left to a casual: "Oh, you're off then? See you when we see you."
My friend and those supporting her have learned at times to make light of the horrors of cancer, even to joke about them. But nurses seem to have become immune to what patients go through. Perhaps they become insensitive as a form of professional immunisation; perhaps the ravages of cancer and its treatments become too much to bear.
Whatever the reason, my friend began her treatment with the same cheerful stoicism, optimism and careful planning with which she runs her life and career. At my last visit, she seemed mentally and physically defeated. I know she will bounce back. But why, on top of coping with a cancer diagnosis and the most barbaric treatment, did she have to run the gauntlet of indifference and insensitivity?
• The health department's report, The Nursing Contribution to Cancer Care, can be found at www.doh.gov.uk/cancer
