The patient had been admitted to the Hospital of the University of Pennsylvania (HUP) with severe graft-versus-host disease (GVHD), a common and serious complication that can occur after certain bone marrow transplants. He had already been through a long and complicated course of treatment for a rare blood disorder. Bone marrow transplant patients typically stay hospitalized for several weeks while their decimated immune systems are restored with new white blood cells. Now he was hospitalized again.
But for this patient, a little bit of luck and a family bond among their care team helped ease the next step in their treatment.
He was admitted by Jackie Smith, MSN, CRNP, coordinator of the allogeneic bone marrow and stem cell transplant program, who looks after all post-transplant patients.
Smith knew he was excited. Clinical Trials For her GVHD treatment, her sister, Kim Hummel, BSN, RN, a clinical research nurse, oversaw her care.
Towards the end of the week, Jackie informed the inpatient nurse who was caring for her patient, her daughter, Rachel Smith, BSN, RN, that the team wanted her to consent to the clinical trial.
The bone marrow transplant program at the University of Pennsylvania School of Medicine already functions like a family, caring for patients over the long term. The three nurses literally work together like a family, often treating the same patients at different stages of care, which they say creates an even stronger sense of camaraderie.
Jackie, Kim and Rachel bring their trademark sarcasm and levity to the long, stressful journey. When a patient is a potential candidate for Kim's clinical trial, Jackie tells them, “One of my researchers will come and talk to you. She's my sister.” Then Kim appears, looking like Jackie but with dark hair instead of blonde, and the patient bursts into laughter and inevitably asks which sister is older. The women let the patient guess.
“It makes what can be a very stressful, life-changing event for patients a little less stressful,” Jackie says, “and a little bit of fun.”
Or, in the hospital, Rachel might jokingly warn a patient as she discharges him: “You're going to meet Jackie Smith. She's my mother. You'd better eat before you get there. My mother is a wonderful woman, but she's tough on love.”
When Jackie meets one of Rachel's former patients at the ACC outpatient clinic, she takes a photo with the patient's permission and sends it to her daughter, and Rachel is comforted to know that her former patient, who became ill as a result of her treatment, is now healthy.
“My mom says, 'Oh, I had this patient come in and she wanted to thank me for everything you've done. She really appreciated it,'” Rachel says. “Seeing how much healthier they are and how much better they are… it makes me feel like what we do every day is actually helping them. It's so wonderful to build a bridge between inpatient and outpatient care.”
Working together to help treat patients
The patient who developed GVHD that weekend, David DeSantis of Lititz, Pennsylvania, had received a stem-cell transplant from a healthy donor a few months earlier, but the nurses' close work helped speed his path to a clinical trial. Timing was key: DeSantis, 67, had started systemic steroids, an approved treatment for GVHD, and there was only a short window in which to start the study treatment. The hospital needed to get the patient's consent by Monday to get the treatment in time, and Sunday was the only day the patient's wife, Tammy, who wanted to hear about the study before signing any paperwork, could come to the hospital.
No problem. Rachel told the couple that her aunt was running the court and was off work that day but was just a phone call away. Rachel pulled out her cell phone and put her aunt's phone on speaker. Kim answered the questions, and DeSantis quickly agreed.
“The entire family, Jackie, Rachel and Kim, were involved in key parts of this patient's journey. Each of them was incredibly important at different stages of treatment, were so good at what they do, and their quick and successful collaboration made a huge difference in this patient's care,” said David Porter, MD, director of Cellular Therapy and Transplantation at the University of Pennsylvania School of Medicine.
Three nurses, three stories
Jackie began working as a staff nurse in the oncology department at the Hospital of the University of Pennsylvania in 1995, just as Penn's allogeneic transplant program was beginning. While working as a nurse in the oncology department, Jackie earned her nursing license and then moved to care for post-transplant patients in the outpatient clinic. She has seen nearly every transplant patient since the program began, seeing patients multiple times a month for the first year after surgery.
Kim joined Porter as his administrative assistant when Jackie was an inpatient nurse. At the time, Kim was a young mother working in the corporate payroll department for a national auto parts chain. She knew that to advance in any field, she would need further education and had her eye on a tuition reimbursement benefit from the University of Pennsylvania. Early one Saturday morning, Kim's phone rang. It was Jackie at the hospital. Porter's assistant had resigned and she asked if Kim would like to take over.
Over time, Kim was promoted from hematologist assistant to research coordinator. Edward A. Stadtmauer, MD, later earned his nursing degree and became Dr. Porter's research nurse. He now serves as project manager for the Cell Therapy and Transplantation Group in the ACC Clinical Research Unit.
And then there's Jackie's daughter Rachel, who has just graduated from nursing school and only joined the inpatient team in October, but has worked alongside her mother for years and has practically a lifetime of experience on hospital wards.
“She always had such great relationships with her patients,” Rachel said of Jackie. “I was so impressed with that, I wanted to be a nurse.”
Rachel wasn't sure if she wanted to work in oncology, but after interviewing on the bone marrow transplant floor and meeting the nurses and nursing assistants — many of whom knew Rachel's mother — she didn't know there was anywhere else she wanted to work.
“It was a comforting thing to know that where I started was where my mom started,” Rachel said.
Mr Porter said it was no surprise that Rachel wanted to work in the transplant unit.
“This unit generates incredible loyalty among the staff,” he said. “The nurses are incredibly polished, well trained, hard-working and caring.”
During a recent visit to Penn, DeSantis said he didn't know her sister Kim, a research nurse, or her daughter Rachel, an inpatient nurse, when he first met her. But knowing those connections made Penn feel “a little bit more comfortable” during an incredibly difficult process.
Before he and Tammy departed that day, they said a fitting farewell to the three nurses.
“I expect we'll see each other,” Tammy told Kim, as she expected her husband would continue participating in clinical trials. “I hope we'll see each other,” she told Jackie, who was receiving follow-up care from DeSantis. And she laughed at Rachel, an inpatient nurse, saying, “I miss you.”
