Angela Snyder

Angela's nomination by a coworker follows:

Angela Snyder works as the nurse practitioner for the Quality of Life Service. I have worked with Angela for several years. In her work with children with progressive and incurable cancer Angela has demonstrated to have excellent communication skills with patients, families, and their St. Jude care providers. One example is the care of a 19 year old young man dying from acute leukemia. This patient was on palliative chemotherapy and his death was approaching quickly. He had expressed a desire to be admitted to the critical care unit and be placed on mechanical ventilation. His doctors, however, felt that the use of such therapies would be harmful but could not help him understand that placing a DNR order in the medical record was necessary. Naturally, this conflict was creating great moral distress among St. Jude care providers.

Fortunately Angela had developed a close relationship with this young man. She had earned his trust through multiple previous interactions with him in which she demonstrated a sincere interest in his well being. She was also able to create a non-judgmental atmosphere in which he could express his innermost thoughts and feelings. In this setting he communicated to Angela that he really did not want to end up in the critical care unit on a breathing machine but felt that deciding against that meant “giving up on God” to perform a miracle. This boy’s decision to use artificial life sustaining therapies was, in his mind, a spiritual one. A decision that required great courage on his part. Through carefully guided conversations Angela was able to reframe his experience. He was able to understand that his doctors felt such therapies would not be beneficial and that withholding them did not mean giving up on God. In fact, he was able to understand that putting his life in God’s hands completely was a greater expression of his faith.

He died peacefully at home surrounded by family and friends a few days later. Angela gave this young man the opportunity for a peaceful and comfortable death. She was also instrumental in avoiding an admission to the PICU at the expense of great moral distress among the clinical staff. Many other examples of Angela’s hard work with this population of patients exist. Her gentle demeanor and compassionate non-judgmental approach has allowed her to help many of these patients and their clinicians in very difficult circumstances. Angela’s work at St. Jude is essential and I urge you to consider her for this important award.