Love, loss and becoming a Pirate nurse

Love, loss and becoming a Pirate nurse

When she mentioned to her primary care physician assistant that she was looking into PA school herself, the response she got was unexpected, and trajectory changing - she wished she had gone directly into nursing instead of chasing a host of degrees necessary to even apply to a PA program. A nursing degree, Giambalvo was told, would put her directly in contact with patients.

Giambalvo applied and was accepted to ECU. She toured other campuses, but ECU was "where I'm supposed to be."

Life was great. Being a Pirate was great. One day in her freshman year she went with friends to a house on the Grid where a cute guy lived, Giambalvo said. The visits continued for weeks, but one day the cute guy's roommate was recovering from a tonsillectomy and was reeling from 'all kinds of drugs,' which exacerbated a severe lack of game.

The roommate - his name was Justin Bossian, Giambalvo would learn - was "so bad at it. Like, oh my God it was terrible. The flirting was awful and that made it 1,000 times more charming," Giambalvo said through a roll of laughter.

And then on one of those rare wintery days in Greenville, Bossian visited her dorm room and walked home at 2 a.m. in a snowstorm because they had gotten lost in the swirl of learning about one another. A few weeks later he stayed until the sun nearly rose before making the first move.

"He finally kissed me, and I was like, 'Geez, it's about time,'" Giambalvo remembered.

From that point they were inseparable.

A young man with a mission

Bossian was originally from Saunderstown, R.I., but moved with his family to Holly Springs in time for high school in 2009.

Kim Bossian, Justin's mom, said he struggled with weight until he decided in his early teens to model his life after Tom Brady, training each day to become the healthiest he could be.

"Fitness and nutrition became a lifestyle for Justin. We outfitted our garage with all the Rogue fitness equipment he needed to continue building his body into a sculpture," Kim said.

Justin often worked out with his friends, and brother Jayden, who serves in the Marine Corps as a first lieutenant. In 2023 he competed in his first National Physique Committee body building competitions. Kim said she was so inspired by Justin that when she turned 50 she followed in his footsteps and competed herself.

"Justin designed my nutrition and fitness plan for the competition. He wasn't able to attend, as it was his first full in-hospital chemo week, yet was incredibly proud of his accomplishment and mine," Kim said.

Bossian was a year ahead of Giambalvo in the kinesiology program in the College of Health and Human Performance. He was a physical force, Giambalvo said, and was a hardcore fan of ECU's football program, serving as an intern with the team and all the while lifting incredible amounts of weight himself.

"The kid was a beast. He could throw weight like you wouldn't believe. He deadlifted almost 600 pounds," Giambalvo said, and was so excited at the accomplishment that the bar hit his leg on the way down, but not without leaving a mark.

Justin had been training to compete in the body building competition with his mother, the one he would eventually miss due to a nagging pain in his thigh. He mentioned it to the football team's medical staff. They thought it might be scar tissue and told him to keep an eye on it.

David Kemble, a professor of kinesiology and coordinator of the undergraduate health fitness specialist program, had Bossian in several of his classes and said he was a solid student, but intangibles distinguished him from peers.

"He was an outgoing young man who never met a stranger. He had a contagious personality," Kemble said. "I didn't know where he was going to end up, but I knew he was going to be OK."

Dr. Rhonda Kenny, a now-retired professor in the health fitness specialist program, invited Eddie Palmer, a 2008 alum of the kinesiology program and owner of a well-established health and life consulting company in California, to speak to a kinesiology survey class. Bossian was in that class and after the presentation ended, Bossian reached out to Palmer for mentorship.

Palmer told Bossian he would need to branch out past his personal focus on powerlifting to help anyone who came through the door seeking his help.

"Justin always liked who he was, and I told him that in this profession that's a great step. Most people aren't coming in with health issues. They're coming with lack of appreciation and confidence about who they are. You being a person who likes who you are - not insecure or overly confident - you are going to help people find themselves, discover themselves," Palmer said.

The diagnosis

Bossian graduated in May 2024 and started working in a gym as a personal trainer. In August, a doctor ordered an MRI on that lingering bump, which revealed a concern, warranting a referral to an oncologist. By September imaging of his lungs was ordered and the following day he was given news that would upend their worlds: a very rare and incredibly aggressive soft tissue cancer had spread from a lesion in his leg to both lungs.

"I was on the call that day. He was devastated, but hopeful," his mother said.

Bossian texted Giambalvo a screenshot of the scan and then called her right after she finished a test for one of her nursing classes.

It's in my lungs, he told her. I'm going to die.

"I called my mom, and I told her," Giambalvo said. "I couldn't stop crying. I was a mess."

More scans and tests confirmed the diagnosis. A nurse of nearly three decades, Kim pushed for a second round of tests just to be certain. His best hope was chemotherapy, which started immediately.

There were odd side effects, including intractable hiccups and hair loss, but the chemicals didn't wipe him out as happens with so many battling cancer. He never stopped going to the gym and never stopped being an unlimited well of positivity.

Just before he was to ring the bell that signaled the end of inpatient treatment - to allow Justin an opportunity to continue his treatment at home - doctors hit them with the news that the cancer had become resistant, which didn't come as a surprise. Giambalvo had kept a journal of the symptoms that were cropping up that Bossian was reluctant to tell his caregivers. Headaches. Blurred vision. Feeling just … weird.

Just after returning from spring break, doctors uttered inconceivable words: rapid disease progression. He was transported back to Duke. His breathing was labored. His body wasn't strong enough to withstand more chemo.

The cancer had taken over and taken off. Within days he was gone.

"Justin chose his dignity and limited time left with family and friends by his side at home. Liv and his family made certain of one promise they kept to him; he would be home that very day, surrounded by his friends and family," Kim said.

Bossian's cancer, CIC-DUX4 Rearranged Sarcoma, is very rare, making up less than 1% of sarcomas, translating to about 200 cases worldwide. The average time from diagnosis to death is 22 months.

"He didn't even get 12. He fought so hard for eight months and the courage he showed … ," Giambalvo said.

Kim Bossian said Justin is their hero, a beacon of light.

"He has always been that guy, thinking of others first. Even during his last moments he waited for the right moment of calm before taking his last breath, reminding us that the gift we gave to him was unconditional love and support," she said.

Carrying care into her future

Giambalvo credits the ECU College of Nursing's faculty with not only keeping her motivated to complete her schooling, but for the understanding and flexibility she needed to support Bossian in his fight.

"I spent two weeks of last semester sleeping in the hospital, and the faculty and staff of the College of Nursing were so amazing. The Wi-Fi in the hospital was spotty so turning in my assignments was hard. They told me to focus on him and do what I needed to do," Giambalvo remembered.

Susan Lally, a clinical associate professor of nursing and one of Giambalvo's instructors, lamented that Giambalvo had to take on responsibilities well beyond someone of her age, but did so with grace and tenacity.

"She was making a lot of the decisions, helping him navigate what decisions to make for his care," Lally said. "And now that exam just doesn't seem important anymore or getting that reflective journal turned in."

Lally said helping Giambalvo through the caregiving process was part of her job.

"I think it was important for faculty to say, 'OK, you can have another two days to turn in that assignment.' It's so important for us to look at things human-to-human and reassure her it was OK to not make an 'A' or it's OK to turn a paper in two days late because she was at the hospital until 3 a.m.," Lally said.

If Giambalvo, and her fellow nursing students, can learn how to accept grace and extend it to one another, that will make them better at their jobs caring for other people after graduation, Lally said.

When she spiraled with grief over the chasm that opened in the wake of his diagnosis, her professors steadied her, especially Dr. Andrea Sessoms, a clinical professor of nursing. Sessoms vowed to fight to keep her in the program if she slipped behind the rigorous grade requirements.

"She said, 'I will not allow them to kick you out because you're going through something unimaginable,'" Giambalvo said.

Bossian likewise was adamant that she would graduate.

"When he was in hospice and dying, he told me, 'I will not allow you to stop. You're going to finish and you're going to be a nurse.' So, I'm pushing through this semester," Giambalvo said.

Hard lessons to learn

What Giambalvo said she'll take from her time with Bossian is his belief that everyone has the chance to be better.

"He cared so deeply for others. He would tell you what you needed to hear - not always what you wanted to hear - because he cared so much," Giambalvo said. "The world is a poorer place without him."

After she graduates in December, Giambalvo said her goal is to help patients - and the family and friends who are just as much a part of the healing process - feel empowered. So many times, she and Bossian had to guess at what the next steps would be and what their options were.

"I think this experience is going to help me better support families. I had a patient who was newly diagnosed with cancer this past semester and I had to step out of the room while the doctor was talking with them because I had to cry. After I stepped back in, I apologized to them and I said, 'I'm so sorry, I know what you're going through. If you ever just need to talk, I'm here,'" Giambalvo said.

It was a comment from Dr. Jeanne Martin, the chair of the baccalaureate nursing program, on the first day of class that has helped to temper the bouts of imposter syndrome that have flared during clinical rotations: You will make someone's worst day better.

"That stuck with me. One of the greatest honors in life that you could ever have is being there for a patient," she said.

Lally said the biggest lesson she hopes Giambalvo can take from this experience is how to balance leveraging her hard-earned, lived experience to connect with, and provide compassionate care for, her patients without getting lost in empathy that could stifle her clinical judgment.

"In nursing there's a line - people don't need to know about your experience, but because you've had it, they can feel it. At some point it might be helpful to say, 'Yeah, I've lost somebody to cancer, too,' but you really need be able to make it about them," Lally said.

If she can get that balance right, Lally said, "that will be her guide and her motivation."

Giambalvo said her long-term goal is to help establish a sarcoma clinic in Greenville, to reduce the demands on patients who sometimes drive hours to reach ECU Health Medical Center, and then hours more to reach specialty clinics like the one where Bossian was treated. She ultimately sees herself working in pediatric oncology, but said she needs time away from cancer care because it "has not been kind to me."

Caregivers in pediatrics are usually there because of a passion for kids, but Giambalvo learned firsthand that families and loved ones need care, too.

"Your patient is also the parents - they are living through their worst nightmare. We need to be there for them because while everybody's busy focusing on taking care of the child, nobody is taking care of mom and dad," Giambalvo said. "My experience with Justin has made me see that everyone in cancer treatment is afraid and they need to be cared for and I'm ready to be part of that."

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