Joan Muller struggled on Aug. 22, 2018, feeling down in the battle she had recently undertaken against ovarian cancer.
But then the longtime Sanford Health LPN read these words handwritten in black ink on the Aug. 22 page of her new daily devotional:
“Joan, be strong, courageous and amazing like always! Don’t let anything knock your spirit! You are one beautiful soul! Your smile and giggle light up a sorrowful room. We are all here for you, Sweets!”
Encountering that personal message, on that difficult day, did strengthen Muller’s spirit. “This was so uplifting,” said Joan (pronounced JoAnn) Muller.
It seems fitting that when she needed a dose of cheer herself, it came from a co-worker. After all, Muller had spent 37 years lifting the spirits of co-workers and patients with her positive, lively, spunky, “work mama” personality.
It seems especially fitting if you get a chance to watch Muller, 66, interact with her work family at Sanford Obstetrics & Gynecology Clinic in Sioux Falls, South Dakota. On one recent day, soon after Muller had returned to work following time off for treatments, many of the nurses, providers and office staff joked, laughed, praised one another and even teared up together — all within a half-hour.
To put it mildly, they’re close. So Muller’s co-workers considered her diagnosis of stage I endometrioid ovarian cancer last summer as a collective call to action. They launched supportive and fundraising gestures ranging from a T-shirt campaign to a gift basket of hand-painted rocks; from hand-crafted earring sales to that devotional filled in with a personal message from each of them.
A nurse becomes a patient
Muller had been working three days a week for Sanford Health as a float nurse among three clinic locations last summer. All summer, she experienced symptoms from known gall bladder issues and noticed a little increased girth, but then something acted as a red flag for her: post-menopausal spotting.
She didn’t wait and wonder; she had an ultrasound and endometrial biopsy right away to help with diagnosis. The biopsy was negative, but “the ultrasound showed a mass that was larger than a baby’s head on my left ovary,” Muller said.
She had no family history of ovarian cancer, and genetic tests show no predisposition. Her career had prepared her for the news, in a sense, by providing firsthand knowledge of how common cancer is.
“As a nurse, I think I took it in stride. Way better than my husband did. My husband cried for days,” Muller said. He had a sister who died of cancer.
“I was more, ‘This is what it is, we gotta just deal with it. We’ll get through one day at a time.’ ”
Symptoms of ovarian cancer can include vaginal bleeding or unusual discharge; pain or pressure in the pelvic area; abdominal or back pain; bloating; feeling full too quickly when eating; frequency or urgency to urinate; or constipation, according to the Centers for Disease Control and Prevention.
“Listen to your body if things are changing or something doesn’t seem right … if you’re having warning signs,” Muller said.
Surgery and treatment
Soon, Muller became familiar with another team at Sanford Health: the Gynecologic Oncology Clinic team led by Dr. Maria Bell. Bell performed Muller’s ovarian cancer surgery Aug. 8, a hysterectomy with removal of the ovaries. First, though, that same day, a general surgeon removed Muller’s gall bladder in a “two-for-one” surgery, she joked.
Six rounds of chemotherapy followed, one round every 21 days. Muller feels fortunate that she didn’t have nausea or vomiting from the chemo, but other treatment issues plagued her.
“Bone pain was my primary problem,” Muller said. “I have arthritis, and my legs would hurt so much.” In her hands and feet, she had neuropathy, which is symptoms of pain or other sensations caused by nerve damage. She also had fatigue, and being on steroids interfered with her sleep.
Muller took eight months off work. In that time, her co-workers certainly didn’t forget about her.
Personal devotional entries
Fellow nurse Holly Sturtz spearheaded the effort to have co-workers add notes to the devotional “Jesus Calling,” each selecting a day of the year that held particular meaning for them. The book’s teal cover was intentionally chosen to represent ovarian cancer awareness.
“It was her card instead of a card,” Sturtz said.
Sturtz chose Christmas Day for her entry, decorating the page with Christmas-themed pencil drawings as well. “I know how you love Christmas!” she wrote to Muller. “You have the most awesome family gatherings filled with love & memories. You are a blessing to everyone!”
Another entry Muller treasures dates back to her first day of work at what is now Sanford Health in 1981. Marilyn Hegg, who still works for Sanford Health, oriented her on May 11 that year. On that day’s page, she wrote: “5/11/81 — The day I met you! Always the happy, wonderful person — you will have the faith, persistence to solve this problem!! We are praying for you and know you can conquer this!”
Cancer ‘messed with our JoMomma’
Meanwhile, Staci Feikema, another nurse at Sanford Obstetrics & Gynecology Clinic, decided T-shirts were called for. So she worked with others to come up with a design — via group text while she was on vacation, no less — and found a company to print them.
The T-shirts bear the message “Love, courage, hope” in characteristic teal on the front, and read “In the fight against ovarian cancer because it messed with our JoMomma” on the back, referring to the nickname Muller’s co-workers have for her.
The shirts raised money for Muller in two ways. First, half the price of each shirt that Muller’s family, work family and friends bought went to Muller. Second, her co-workers paid $1 each Friday in October to wear the T-shirt with jeans to work. Between shirt sales and additional donations, more than $1,600 went to Muller.
“And people still wear them on Fridays,” Feikema said. “We care about each other and what we’re going through.”
She found herself on the receiving end of that care at one point, too. “My dad had a massive heart attack, and the support was through the roof,” Feikema said.
‘Our crafty physician’
Dr. Ashley Briggs — “our crafty physician,” Muller says — contributed her considerable creativity to the cause as well.
The Sanford Health obstetrician-gynecologist has worked with Muller during the entire 15 years of her practice. A conversation with them revealed the obvious affection they have for each other and the sense of family each feels here. On that day, Muller wore a pair of teal teardrop earrings, a symbol of Dr. Briggs’ support.
Soon after Christmas, Dr. Briggs began selling handmade earrings for $10 a pair to co-workers, with proceeds intended for Muller. Some are crystal teardrops; others are cut out of leather. All were crafted by someone who is motivated to help others, especially Muller.
“I wanted to be there for her like she’s always been there for us,” Dr. Briggs said.
‘Positivity and a little bit of that sass’
Beyond Muller’s nursing and mentoring contributions to co-workers, she has been known for her “inspiration boards” hung up at work — noting birthdays and work anniversaries, along with comments that may be inspirational, motivational, team-building and, since it’s Muller, humorous.
“She always brings positivity and a little bit of that sass,” Dr. Briggs said.
It’s worth the effort for Muller to support her co-workers. “There are days you spend more time with your work family than you do at home,” she said.
Dr. Briggs appreciates it here, too. “I wanted to find a place I’d stay forever for my career, and I’ve found that here,” she said.
That sense of home and family seemed to overcome Dr. Briggs when, that same day, co-workers gathered to support Muller with a “team photo.” As tears threatened, Dr. Briggs couldn’t finish her speech while presenting Muller with a check for $1,000 — all from earring sales since the beginning of the year.
Muller’s response? It seemed classic JoMomma, starting off with a joke: “I do have a Sanford bill to pay.”
But then, “Thank you for helping me. This means a lot.”
And tearfully, “I’m glad to be back. I love you guys!” Then hugs. Lots of hugs.
Hallmark movies and Facebook
During Muller’s time off work for treatment and recovery, she wasn’t exactly idle.
Yes, she admits to watching a lot of Hallmark movies, but sitting around usually doesn’t suit this busy woman.
“For me to sit still and read a book and have a heating pad on or an ice pack was a challenge,” she said.
She went to Sanford Wellness Center for warm-water aerobics classes two or three times a week, which can bring relief to people with arthritis and bone pain. “It’s very soothing,” she said.
Muller is a seamstress and crafter at heart, and the neuropathy interfered but didn’t completely stop her from sewing, especially for her grandkids for Christmas.
Muller also stayed active on Facebook during her cancer journey, updating her friends on there — who outnumber the population of many small towns — with photos and milestones along the way. They, in turn, have been more than supportive.
“Like my minister said, ‘You’ve got so many people following you, it’s like a whole city is praying for you.’ The power of prayer was there,” Muller said.
And she also hopes to make a difference for them with her posts, too. “People can learn, and you can share your story. … Others may be blessed by what you say and may be touched.”
The painted rock project
Muller found inspiration in another project Dr. Briggs had taken on for her: painted rocks.
Dr. Briggs had gone to a local rock quarry to buy some small rocks. After hearing what she had in mind, a woman working at the quarry who had also had ovarian cancer gave the rocks to Dr. Briggs for free. Then in a break room, Dr. Briggs guided her co-workers — especially the less-artsy ones — as they each painted a rock for Muller and signed their name on the bottom.
Dr. Briggs brought a basket containing all of the rocks — decorated with everything from ladybugs to inspirational messages — to Muller’s rural farmhouse. There she could enjoy the personalized artwork during her treatment and beyond.
“You just can’t help but feel good when your co-workers are doing this much for you,” Muller said about all of their gestures.
As Christmas approached, Muller and her sister adopted the rock idea. They painted rocks to present to family who visited during the holidays. “This time, I was the giver,” Muller said.
‘Goal to get well to come back to work’
At 66, Muller could have decided to retire after her diagnosis. But she didn’t. “For me, it was a goal to get well to come back to work because I didn’t plan on going out this way, with having cancer. I want to retire when I want to retire.”
So Muller returned to work three days a week, half-days to start, on April 1. As you might expect, she was greeted by “a lot of hugs, a lot of well wishes, a lot of support. They ask me how I’m feeling,” she said. “Everybody’s been very caring.”
She’s grateful to be back to work. “I think it’s good, emotionally, that I have something to look forward to. I love working with patients,” Muller said as she surprised herself by tearing up.
“I think when you enjoy being a nurse, that’s part of you. You give and you receive.”
Support from patients: ‘You’ve got this, girl’
Since she’s been back, she has received support from patients in addition to co-workers. For example, she brought a patient back to an exam room one day. “The first thing she said to me: ‘I love your hair!’ And I’m like, ‘It’s kind of the chemo effect, but thank you very much,’ ” Muller said.
“The patient went on and on about my hair. And then she came to find me after I had roomed her and said, ‘You’ve got this, girl, you’ve got this. You’re going to do good, and I just have a feeling you’re going to get through this cancer, and you’re going to bless a lot of patients.’ ”
“I think that was a God-wink,” Muller added. “I think God sends people to send you messages, and that patient was so uplifting to me as an individual. You know, I am caring for her, but she cared for me.”
Muller has been with Sanford Health long enough that she’s taking care of — and being remembered by — a second generation of patients now. She recently received a high school graduation announcement for the son of a patient. The sticky note on it said, “We had to remember our delivery nurse and invite you to graduation.”
“Your patients become your friends because you’ve been through so much with them,” Muller said.
Another patient gave her baby daughter the middle name of Joan, pronounced Muller’s way, in honor of her.
“Not everybody in nursing can say that they have that bond with a patient,” Muller said. “It’s a blessing to work in women’s health.”
‘There’s a purpose’
It’s clear that a big part of Muller’s life has been her faith. It helped her through treatment and adds a sense of purpose to her cancer journey.
“I’m a very spiritual person, and so I just feel that God is going to use me in some way. Whether it’s going to be to counsel patients, or support family or friends going through cancer, I’m not sure,” she said. “There’s a purpose. I always feel that God directs your path.”
And Muller has reached a conclusion about nursing care: “I think we should hug more.” When she experienced the receiving end of nurses’ care at Dr. Bell’s office, it included “lots of hugs,” she said.
“When you’re taking care of a patient, and you have that touch, it gives emotional healing also. I think as a nurse, we need to look at some of our patients and say, ‘What are their needs?’ Whether it be physical, emotional, spiritual. I think we sometimes just need to have that touch of, ‘I care,’ ” Muller said.
Caring, support, love — these elements seem to thrive among Muller and her co-workers.
“After you’ve worked at a place for 38 years, it’s such a part of your life, and I’m glad to be back, able to hopefully make a difference in someone’s life.”
Clearly, her co-workers and patients feel she’s already been doing that, every day of her career.