The patient was at 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’d already had a prolonged and complex treatment process for his rare blood disorder; bone marrow transplant patients typically spend weeks in the hospital while their wiped-out immune systems return to functioning with new white blood cells. And now he was back in the hospital.
But for this patient, a little bit of good luck and family bonds among his care team helped ease the next steps of his treatment.
Allogeneic Bone Marrow and Stem Cell Transplant Program Coordinator Jackie Smith, MSN, CRNP, who works with all post-transplant patients, had admitted him.
Smith knew that he was being worked up for a clinical trial for GVHD treatment—which happened to be overseen by her younger sister, clinical research nurse Kim Hummel, BSN, RN.
Heading into the weekend, Jackie told the inpatient nurse who was caring for the patient that the team was hoping to consent him for the trial. That nurse was her daughter, Rachel Smith, BSN, RN.
Penn Medicine’s bone marrow transplant program already considers itself a family, with patients in its care for long periods of time. Having a literal family of three nurses in its ranks, often treating the same patients at various phases of care, makes the camaraderie that much stronger, they say.
Jackie, Kim, and Rachel bring their signature sarcasm and lightheartedness to what can be a long and stressful journey. When Jackie has a patient who may be eligible for one of Kim’s trials, she’ll tell them, “I’ll have one of my researchers come and talk to you. She’s my sister.” Then Kim appears, resembling Jackie, but with dark hair instead of blonde, and the patient will often laugh and inevitably ask which sister is older. The women make the patient guess.
“It makes a very stressful, life-changing event that’s occurring for these patients a little lighter,” Jackie said. “There’s a little bit of fun to it.”
Or in the hospital, Rachel might playfully warn a patient at discharge, “You’re going to see Jackie Smith and she’s my mom … you better eat before you get there, because my mom is awesome, but she gives some tough love!”
And when Jackie sees one of Rachel’s former patients in the outpatient clinic at the Abramson Cancer Center (ACC), with the patient’s permission she will take a picture to send her daughter, which gives Rachel a good feeling to know her former patient, so sick in her care, is now doing well.
“My mom will say, ‘Oh, I had this patient come in and they wanted to thank you for everything you did for them, they really appreciated it,’” Rachel said. “Seeing how healthy and how much better they look… It makes me feel like what we’re doing each day is actually making a difference for them. It’s super nice building that bridge between inpatient and outpatient.”
Working together to help a patient get treatment
For the patient with GVHD that weekend—David DeSantis, of Lititz, Pa., who had received a transplant with healthy donor stem cells a few months prior—the nurses’ close ties helped hasten the path into a clinical treatment trial. The timing was critical. DeSantis, 67, had begun systemic steroids, the approved treatment for GVHD, and once that happened, there was a short window in which to start the study treatment. The hospital needed the patient’s consent by Monday if they were going to start treatment in time, and the patient’s wife, Tammy—whom he wanted to hear about the study before he signed the forms—would only be there Sunday.
No problem. Rachel told the couple that her aunt was running the trial, and while she wasn’t working that day, she was just a call away. Rachel grabbed her personal phone and put her aunt on speaker. Kim answered their questions, and DeSantis readily gave his consent.
“Each member of the family—Jackie, Rachel, and Kim—touched an important part of this patient’s care journey; each of them were so important at different stages of care, are so good at what they do, and their ability to work so quickly and well together made a such a difference in his care,” said David Porter, MD, Penn Medicine’s director of Cell Therapy and Transplant.
Three nurses, three stories
Jackie started as a staff nurse at the Hospital of the University of Pennsylvania’s oncology unit back in 1995, just as Penn’s allogeneic transplant program was starting up. While working as a nurse on the unit, Jackie earned her nurse practitioner degree, and then switched to taking care of post-transplant patients in the outpatient clinic. She has seen just about every transplant patient since the program started, meeting with them multiple times a month for a year after the procedure.
Kim came into the fold as an administrative assistant for Porter back when Jackie was an inpatient nurse. At the time, Kim was a young mom working in the corporate payroll office of a national auto parts chain. She knew she’d need further education to advance in any field and had eyed Penn’s tuition reimbursement benefit. Early one Saturday morning, Kim’s phone rang. It was Jackie, from the hospital: Porter’s assistant had resigned; was Kim interested in taking over?
Over time, Kim advanced from assistant to research coordinator for hematologist Edward A. Stadtmauer, MD, and later, with a nursing degree in hand, Porter’s research nurse. She’s now a project manager with the ACC-Clinical Research Unit’s Cell Therapy & Transplant group.
Then there’s Jackie’s daughter Rachel. She just joined the inpatient team in October, fresh out of nursing school—but she has practically a lifetime of experience on the unit, spending years coming to work with her mom.
“She always had a great relationship with her patients,” Rachel said of Jackie. “I was so inspired by that, and I knew I wanted to be a nurse.”
Rachel wasn’t sure if she wanted to work in oncology, but after she interviewed on the bone marrow transplant floor and met the nurses and nursing assistants, many of whom knew her mom, there was nowhere else she’d rather be.
“It was a nice, comforting feeling knowing where I’m starting is where my mom also started as well,” Rachel said.
Porter said it’s not surprising that Rachel would want to work on the transplant unit.
“The unit engenders incredible loyalty among the staff,” he said. “The nurses are incredibly sophisticated, well-trained, hardworking, and compassionate.”
On a recent visit to Penn, DeSantis said that when he first met Jackie, the nurse practitioner, he didn’t know about her sister Kim, the research nurse, or her daughter Rachel, the inpatient nurse. But knowing there’s that connection makes Penn feel “a little more homey” during what can be a very hard process.
Before he and Tammy left that day, they gave the three nurses a fitting goodbye.
“I know I’ll see you,” Tammy told Kim, anticipating her husband’s ongoing participation in her clinical trial. “I hope to see you,” she said to Jackie, who would see DeSantis for follow-up care. And to inpatient nurse Rachel, laughing, she said, “I don’t want to see you.”