When the Doctor Becomes the Patient
Cardiologist shares his personal experience as a bone marrow cancer patient
BY NAN BIALEK | PHOTOGRAPHY BY DAN BISHOP
The symptoms of his bone marrow cancer started around 2002, when Dr. Lee Biblo, cardiologist and chief medical officer at Froedtert & The Medical College of Wisconsin, moved to Milwaukee from Cleveland.
“When I got here, I was sort of tired and thought, well, I changed jobs, moved my family and was sort of depressed,” Biblo says. “After a year, I thought, ‘This doesn’t feel right.’ So I did what every doctor does, I ordered a blood test on myself.”
His diagnosis was myelofibrosis, a chronic, low-grade cancer, that in Biblo’s case was handled medically until 2011 when his doctors recommended a bone marrow transplant to treat his worsening condition.
Up to that point, Biblo and his wife, Dr. Ileen Gilbert, had not told their two daughters about his cancer. He says they wanted them to have a normal experience in high school and not be worried about his health. The prospect of a bone marrow transplant, however, convinced the couple to tell their kids.
“At that point, they were actually in college and law school and they took it pretty well,” Biblo recalls.
Biblo says the mortality risk is somewhere between 15 and 20 percent, so he had to get his life insurance in order and make sure his wife knew where everything was in case he didn’t survive.
“It became pretty daunting,” he says.
Nobody in his family was a good bone marrow donor match. The experts sorted through some 70 potential donors before finding a perfect match in a 24-year-old woman from Virginia.
The process started with five days of chemotherapy. Biblo says he came into the hospital “pretty naively thinking I could do some reading, finish some manuscripts. But the chemotherapy exhausts you. I could barely watch ‘Judge Judy.’”
Even though Biblo says the care he received was wonderful, patients are always being interrupted for various procedures and he was essentially sleep-deprived for a month. During that time, the patient’s immune system is particularly weak.
“I remember thinking, ‘If I slip and hit my head, it’s curtains.’ You feel very vulnerable, you’re just trying to do the best you can and the nurses are helping you. When you go through something like that, you start feeling bad for yourself,” Biblo says.
Another patient snapped him out of it. He met her at the microwave, where he was warming up one of the gifts of chicken soup he had received from colleagues. The other patient was from out of town, and had nobody to support her as she was experiencing the same feeling of vulnerability.
“My kids and wife were terribly supportive, and I wouldn’t have made it through any of this without their support and love,” Biblo says. As a physician, he says, he now makes sure to identify his patients’ advocates early on and pays particular attention to communicating with them.
Biblo says he also encouraged colleagues to look at the possibility of providing more outpatient vs. inpatient treatment for cancer patients. He envisioned patients using an oncology hospital during the day and going home at night to both improve outcomes and lower costs.
“Although bone marrow transplants are pretty complicated, I think even more of that could have been managed at home,” he says.
Since Biblo’s hospitalization, Froedtert provides more outpatient options for bone marrow transplant patients, says Froedtert spokeswoman Nalissa Wienke, “and hundreds of people have benefitted from this in just a few years.”
Biblo returned to work five months after his transplant, and has not missed a day of work since. He’s had some relatively minor issues, such as a problem with tear ducts, and there is a risk of secondary cancers from the chemotherapy, but, he says, “My prognosis really is wonderful.”
Preemie doctor knows firsthand about
BY NAN BIALEK | PHOTOGRAPHY BY DAN BISHOP
As a neonatologist, Dr. Carey Ehlert routinely cares for infants in the newborn intensive care unit at Children’s Hospital of Wisconsin. She is also an assistant professor of pediatrics at the Medical College of Wisconsin.
Yet her training and experience with premature babies wasn’t enough to prepare Ehlert for her own preterm labor experience.
Pregnant with her second child during a neonatology fellowship at Children’s Mercy Hospital in Kansas City in 2002, Ehlert was on the night rotation when her water broke. At 35 weeks, Ehlert knew there could be potential complications. A pregnancy is considered full term between 38 and 40 weeks.
Ehlert remained calm initially. She called the attending physician to cover the rest of her shift and even drove herself to the hospital while her husband found someone to look after their son, who was 3
at the time.
“I was still in my scrubs and finally had to tell the hospital staff I was there as a patient and not a doctor,” Ehlert recalls.
When efforts failed to stop her contractions, the medical team prepared Ehlert for delivery. A short time later, she gave birth to her daughter, Emily.
“I knew something was wrong when I didn’t hear her cry,” says Ehlert.
Before Ehlert had a chance to hold her newborn daughter, the NICU team, many of whom she knew, went into action. After starting her initial care in the room, the team moved Ehlert’s daughter to the
Still recovering from the delivery, Ehlert sent her husband to be with their daughter. Once alone in her hospital room, Ehlert broke down.
“I had no idea what was happening,” she says. “I wasn’t used to not being in control.”
When she was finally cleared to see her daughter, Ehlert found it difficult at first to put aside her doctor knowledge and just be a mom.
“I paid attention to every beep and blip on the monitors,” she says. “I realize now that I was disassociating myself from the situation.”
But Ehlert’s experience has a happy ending. Her daughter spent 12 hours with a breathing tube as a result of excess fluid in her lungs. And two days after her birth, Emily was discharged from the NICU.
“I realize I’m luckier than most,” says Ehlert of the outcome of her daughter’s premature birth. Still, the experience has had a lasting impact on Ehlert’s practice.
“I have a much better understanding of the emotional state of the parents now.”
Whenever possible, Ehlert makes sure that the parents can hold or at least touch their newborn before he or she is taken to the NICU.
“It doesn’t always make me popular with the nurses,” says Ehlert. But the memory of not being able to hold her own daughter after she was born remains strong.
“I’ve realized the importance of skin-to-skin contact between the parent and baby,” says Ehlert. “That physical touch is just as important for the parent as it is for the child.”
Bridging the Gap
Guiding residents through the next phase of training
BY MARK CONCANNON | PHOTOGRAPHY BY DAN BISHOP
Countless hours of ingesting detailed medical information is just part of an aspiring doctor’s education. Physicians must also learn how to apply that knowledge in practical terms in day-to-day, face-to-face interactions with patients.
Dr. Heather Toth, the program director of the internal medicine pediatrics residency program at the Medical College of Wisconsin, teaches new residents who have just graduated from medical school that next and critical phase of their training.
“I’m able to help at multiple levels,” says Toth. She grew up in the Milwaukee area and graduated from the University of Wisconsin Medical School. She did her residency and became chief resident at MCW before becoming an associate professor and assuming her current role.
“I think one of the biggest steps is going from the classroom to hands-on patient care,” Toth says. “The Medical College does a great job of arranging earlier and earlier patient contact during medical school.”
The MCW internal medicine pediatrics residency is a four-year program, which trains six residents per year. During the residency, a student can decide on a future career direction, whether in primary care or a medical specialty.
Toth’s residents have one thing in common — a strong bedside manner.
“By virtue of choosing this residency, all of them come into our program with good communication skills,” Toth says. “During the application process, we’ll look for that too. When we interview applicants, we’ll be able to tell who are going to be those good bedside patient care residents.”
TV medical procedurals such as “E.R.” have portrayed medical residents as frequently berated, sleep-deprived wretches who barely see the light of day.
“That’s close to reality sometimes,” Toth says. “Other times, not at all. We do challenge our residents.”
“Some days are tougher than others,” says third-year resident Brittany Bettendorf. “You know you’re not going to get as much sleep and be dealing with really sick patients, but those days are the most rewarding. You get to spend time with patient’s families and you feel like you’re part of the family because you’re in the hospital so much.”
Residents can work as long as 28 hours straight and can average 80 hours of hospital time per week.
“There are some long nights where you hardly ever sleep,” says chief resident Rachel Johnson. “There is a real adrenalin rush because you realize there is a huge responsibility taking care of these patients. It is stressful, but there’s not the yelling you see on the TV shows. The attending physicians have great respect for the residents here.”
But at the end of such a rigorous routine comes great professional reward.
“I think it’s integral to becoming a constant stand-alone physician,” Bettendorf says.
“I can already tell that I’ve grown from being a first-year resident to where I am now. I feel much more capable of making decisions, some of which are medical decisions and others are how to handle difficult situations.”
“I can remember my first day of internship,” Johnson recalls. “I was totally scared and not sure I could do this and then after graduation after my fourth year I felt so ready to do it on my own.”
Toth says directing the program and teaching young doctors practical skill, enabling them to gain the confidence that goes along with it, has been a great fit. “I love it. It’s a little bit of everything, teaching and patient care.”
“Dr. Toth is amazing to work with,” Bettendorf says. “She’s an incredible clinician. She shows us how to communicate well with patients and their families. When she walks into a room I think there’s this sense of ‘things are gonna be OK.’”
“It’s a blessing to be involved in this,” Toth says. “To be able to take advantage of all the resources we have right here in Milwaukee.”
Health coaches team up with doctors on patient care
BY MARK CONCANNON | PHOTOGRAPHY BY DAN BISHOP
While nearly every NFL team employs about 20 coaches to handle 53 players, a single, primary care physician has traditionally been asked to individually diagnose, treat and monitor the status of dozens of patients. But since last May, doctors at Pro Healthcare have been getting valuable assistance from their own staff of assistants, seven health coaches who help patients with many aspects of their treatment.
Dr. Chris Yiannias says the program has improved the outlook for the 16 to 20 patients who have participated.
“Some patients are pretty complex,” Yiannias says. “They require more resources and more supervision for overall care.”
The health coaches are registered nurses who assist patients who have three or more chronic conditions, helping them with everything from taking their medications and grocery shopping to getting transportation to and from doctor’s appointments.
“The coaches help people overcome obstacles,” Yiannias explains. “They identify impediments and access to community resources to get from Point A to Point B. That takes more time than what a doctor can provide in a short visit.”
The program, which is offered free of charge, also supports patient caregivers. Linda Wollschlager says the health coaches give her peace of mind as she cares for her 86-year-old mother Lorraine Simon.
“I know the health coach is my backup,” Wollschlager says. “If I have concerns or questions, I can go to her.”
Lorraine Simon, who had been hospitalized and visited the emergency room many times earlier this year, has made no trips to the hospital since working with her health coach.
“She’s my angel in disguise,” Simon says. “If I have a problem, she can solve it.”
The coaches make home visits and talk to family members, sharing all pertinent information with family caregivers and primary care physicians via an electronic records database.
“The coaches are out in the field or on the phone constantly,” Yiannias says. “We’re all part of a team, getting better overall information about our patients. It leads to better care and better outcomes.”
Infections in neonates drop due to team’s diligence
BY AMY SIEWERT | PHOTOGRAPHY BY DAN BISHOP
Dr. Jeffery Garland is passionate about fighting infections. He has spent the past 20 years researching and developing procedures to reduce the rate of infections on some of the most vulnerable patients — premature infants living in the Newborn Intensive Care Units at hospitals.
Garland practices at the NICU at Wheaton Francisican-St. Joseph Campus where he is a pediatric specialist in neonatal-perinatal medicine. He is also the Wisconsin representative on the CDC’s National Guidelines Committee — a think tank of experts developing ways to decrease the spread of infections.
Until the early 2000s, preemies in NICUs had a 20 percent chance of getting an infection that put them at risk for lower developmental scores. “Their cognitive function is less and they have a high rate of cerebral palsy,” Garland says.
Garland and St. Joseph nurse Janice Ancona were the state leads on a nationwide initiative conducted on the infection problem. It was discovered that most central line infections were coming through the hub where the staff administers medicine into the IV line. Garland discovered a way to curb the problem right in his own backyard. He studied a technique that was being done on chemotherapy patients at Children’s Hospital of Wisconsin and he adopted it for neonates.
For 20 minutes twice a day Garland and his research nurse Colleen Alex had NICU nurses put a Vancomycin solution (antibacterial solution) into the hub of the baby’s IV line and let it sit there. The solution was then removed before administering food and medicine. A substantial decrease in infection rates occurred, dropping from 18 to 7 percent.
At that point the “scrub the hub” motto became standard procedure nationwide, which includes daily care of the IV line, cleaning the HUB area with alcohol and taking IV lines out of patients early.
Garland’s determination in finding a way to reduce infection for some of the most vulnerable patients put Wisconsin on the top of the list for the lowest infection rates across the nation in the study.
The state went from October 2012 to July 2013 without one IV infection in 13 NICUs across the state.
In general, the infection rates from central venous catheters in neonates dropped from 18 to 3 percent, greatly reducing the risk of permanent disabilities for children already fighting for their lives.