Patricia Carney: Dr. "Get-Up-and-Go"
By Laura Stephenson Carter
"Cancer" and "fun" are not often words that occur in tandem. But cancer researcher Patricia Carney, Ph.D., finds fun in whatever she doeswhether it's conducting research, writing grants, teaching medical students, or romping with Zealr, her 10-month-old Alaskan malamute. She's even had fun naming her dogs, all as energetic as she is. "Zealr" is an anagram of "Lazer," Carney's first dog, a Samoyed who died of lymphoma at the age of three. "He was like a beam of light, so I named him Lazer," Carney says. Her second dog, a wolf-hybrid, was named "Razel." Zealr came next.
Carney, who started her career as a nurse at Mary Hitchcock Memorial Hospital in 1980, is now a researcher who specializes in cancer. An associate professor of community and family medicine, she is the director of the cancer control program at Dartmouth's Norris Cotton Cancer Center; the assistant dean for medical education research at DMS; and the director of the New Hampshire Mammography Network. "She's one of the most distinguished researchers in mammography," says Allen Dietrich, M.D., a man whom Carney considers a friend and her mentor.
For as long as she can remember, Carney had her heart set on being a nurse. "I wanted to be a nurse since I was about six years old," she says. "I never wanted to be anything else." She went from playing in the early 1960s with a Nancy Nurse dollincluding accessories like a thermometer and pretend pillsto becoming a Candy Striper at age 12 at Exeter, N.H., Hospital. By the time she was 16, she had "logged more volunteer hours than any other Candy Striper in the history of the program," says Carneyover 1,600 hours.
She enrolled in the nursing program at Saint Anselm College in Manchester, N.H., and the summer after her first year saved someone's life. She was the waterfront director at a resort in Maine, when she rescued a drowning man. That "made me feel more confident in my ability to react to things," says Carney. "I was amazed at how you didn't even think . . . you just snap into action."
She did her clinical rotations at a nursing home run by Carmelite nuns and says that "a lot of my success I attribute to all the blessings I got when I was working there." She laughs. Then she grows serious as she recalls those days. "I loved taking care of older people," she says. "I absolutely loved it. Old people are so wise, they love to tell you their stories. They just appreciate any little thing you can do for them." One very sick patienta woman with pancreatic cancermade a lasting impression on Carney. "I liked her so much," she says.
Then one day the woman's bed was empty. "I remember feeling how special working with her had been," Carney recalls. "It made me want to work with people who were like that. So I picked oncology."
After completing her B.S.N. in 1980, "I took a job at Mary Hitchcock as a staff nurse on the oncology unit." There, she dealt with "very sick people, very intense therapies," she says. "And I loved that as well." Within a year, she was an assistant head nurse. "She was one of those exceptional new grads," recalls Marilyn Bedell, a head nurse at the time. "From the moment you met her, you knew she was special. She engaged with patients immediately. She was always upbeat, happy to be at work, and happy to be a nurse." But she "wasn't afraid to confront [problems], in a positive way, when things needed to be confronted," adds Bedell, now the nursing director of oncology.
During Carney's second year at DHMC, she met Audrey Prouty, a patient who had had ovarian cancer for about nine years. "She was incredible," says Carney. "She had more courage and more ability to re- flect on her life and look around her at a very stressful time." One day, Prouty's husband was bringing her home from a chemotherapy treatment when her hair began falling out. "Hair for a woman is like the crowning beauty," Carney says, but Prouty didn't let this development bother her. Carney eagerly continues with the story: "They had this bush . . . where they used to put cotton and things for birds to make nests out of. So she and her husband stood next to that bush and pulled her hair out and put it on the bush. Then in the spring, all the nests around their house were made with this fine, fine hair. It was so sweet. But that's what she was like."
Prouty died on July 7Carney's birthdayin 1982. That summer, Carney and three other nurses held a 100-mile bike ride honoring Prouty's courage. Ever since, the Audrey Prouty Memorial Century Ride and Fitness Walk has been an annual event benefiting cancer research at Dartmouth. In 1982, the four nurses raised $5,000. "The next year there were about 35 of us, and we raised about $12,000," says Carney. "And it just escalated year after year after year. This past year we had 650-something participants, and it brought in $185,000."
Everybody, I think, knows an Audrey Prouty," says Carney, "and that's where this event has been successful: you go to the event, and you tell your stories, and you talk to people who are riding with pictures of their mothers, of their children. It's an honor," she adds, "to honor the courage that people who go through this have." The Prouty Ride "proves the power of one," notes Bedell. "Patty's gut and determination kept [it] going."
That gut and determination propelled her move from nursing into research, too. "I decided I wanted to develop more of a focus in prevention- early detection," she says. "It was so hard to see people struggle with this disease . . . I wanted to do the kind of work that would either detect it earlier or prevent it."
She applied for a job as a research assistant to Allen Dietrich, on studies that involved giving free Pap tests to women in New Hampshire. She coordinated that project and then another. At the same time, she started work on her master's degree at the University of New Hampshire.
"Her 'get-up-and-go' was apparent to me pretty quick," says Dietrich, a professor of community and family medicine, of pediatrics, and of medicine. "Her personal initiative, drive, and charisma are things I recognized in her early on."
After Carney earned her master's in nursing in 1989, Dietrich encouraged her to pursue a more advanced degree. "He said, 'Patty you are'I'll never forget this, he said'you're too good just to do this, you need to get a terminal degree.' And I said 'What's that?'" She laughs and adds that Dietrich explained, "You should go get your Ph.D. or go to medical school or something." Within a year, she'd been accepted at the University of Washington. "I don't think I would have gone without his support. He really believed in me."
When she's not at work, energetic cancer researcher Patty Carney is apt
to be doing something in the outdoors with her Alaskan malamute, Zealr.
Carney drove out to Seattle with her Siamese-mix cat, Kedi. "It means cat in Dutch," Carney explains. "I dedicated my dissertation to her because she sat there on my computer and just watched me . . . every day, whether it was papers or my dissertation."
Her dissertation was on using unannounced standardized patients to train physicians and nurse practitioners how to interact with patients. "It was absolutely fascinating," says Carney. "The actors wore these voice-activated hidden microphones." She was amused at some of her findings, including the fact that physicians used vaguer terms than nurses in talking with patients. For example, she says, "Physicians don't like to use the word 'rubber.' They like to call it 'protection.' 'Do you use protection?' The nurses were much more explicit."
Carney returned to DHMC as a research assistant professor in 1994, after earning her Ph.D. in nursing, public health, and community medicine. She split her time between her breast cancer research and a DMS program that uses standardized patients to evaluate students' clinical skills. "She pioneered using actors as standardized patients," says Dietrich. Carney didn't invent the technique, but was "one of the first to apply it in a clinical setting for research."
Carney has seen medical education change during her years at DMS. "We're a lot more focused on helping students learn how to become lifelong learners than we were before," she says. "The focus has certainly shifted from multiple-choice tests to looking at how students put it all together." There are also regular evaluations of students, the curriculum, and faculty. "It's a much more comprehensive approach than it used to be," she explains.
Carney's research has become pretty comprehensive, too. She is the principal investigator for a three-year American Cancer Society- funded study to evaluate factors that affect women's return for mammography and a five-year NCI-funded study to examine the influence of hormone replacement therapy on the incidence of breast cancer; she has also been involved in several other studies related to breast cancer and a number of studies about medical education. She has published nearly 100 journal articles and abstracts, has been invited to make presentations all over the country, has served on national committees, and has been a reviewer for major journals, including the Journal of the American Medical Association.
She is also the director and principal investigator of the New Hampshire Mammography Network, a mammography registry that has logged more than 690,000 encounters. "When women in New Hampshire come in to get a mammogram, they're invited to enroll in our project," Carney explains. "We collect some risk factor information, some demographic information, . . . information on their symptoms, . . . information on the interpretation of the film." The database provides a foundation for all kinds of analyses. One study showed that heavier women are less likely to return for mammograms if they've felt pain or discomfort during an exam. "Mammography centers may not be training the techs to work with larger women," Carney says. "We need to do a better job of training the techs."
Carney loves writing grants, too. "Oh, my gosh, what fun it is," she says. "I like the whole aspect of grant-writing, where you're trying to put together all the pieces of a complicated puzzle. You're trying to make it as clear as possible, as compelling as possible."
In fact, Carney's favorite expression"This is going to be so much fun"has helped to inspire others. "She always said how much fun things were going to be," says Bedell. "She's such an engaging, upbeat, and positive person."
Carney plays as hard as she works and loves bicycling, kayaking, skydiving, mountain-climbing, parasailing, cross-country skiing, building snow caves and sleeping in them, and something called adventuresledding. "We take our headlamps, and we climb up outrageous hills with those plastic sleds and just bomb down, like the Dartmouth Skiway," she laughs. "It allows you to feel like a kid again."
Laura Carter is the associate editor of Dartmouth Medicine magazine.