What happens when a person becomes resistant to antibiotics?

Knowing the difference in needing and not needing an antibiotic.

When antibiotics are taken too often or for the wrong reasons, they kill off the sensitive bacteria that antibiotics can treat. When this happens, resistant bacteria can grow and multiply, causing drug resistance. Tanya Abi-Mansour, a pharmacist at IU Health Bloomington Hospital who specializes in antibiotics, gives her insight on the dangers of using antibiotics without a prescription and explains what happens when your body becomes too resistant.

“Antibiotics treat bacterial infections by either killing the bacteria or preventing the bacteria from growing,” says Abi-Mansour. When needed, they are an effective treatment. However, many individuals request antibiotics from their provider when their condition does not warrant antibiotic usage, which can lead to misuse and overuse, she says.

“It is sometimes hard for the patient and the provider to tell if an infection is viral or bacterial, since they both have a lot of similarities and are both spread by similar functions,” she adds. Both may cause acute, chronic and latent infections, depending on the severity of the illness.

So what happens when a person becomes resistant to antibiotic treatment? When an individual has an infection caused by bacterium that is antibiotic resistant, this can lead to a more serious infection. It could lead to an increase in hospital visits and a prescription for a more expensive and toxic antibiotic to treat that particular disease.

If individuals overuse antibiotics, they may experience minor symptoms such as diarrhea or their condition may deteriorate leading to life-threatening effects, such as inflammation of the colon. Abi-Mansour emphasizes the importance of elderly individuals, who are diagnosed with chronic illnesses, to be very careful with their antibiotic use since they would be the most vulnerable to this problem.

Another side effect from antibiotic misuse is the potential for superbugs. According to Abi-Mansour, “Since certain antibiotics can drive more resistance when taken too frequently, bacterium start to form that become resistant to multiple types of antibiotics and the bacterium become very difficult to treat.” This emphasizes the importance of only using antibiotics when truly necessary.

Even though these superbugs are not visible to the human eye, the impact they can have on an individual is substantial. Common infections, such as neisseria gonorrhea, are transmitted through skin-to-skin contact and cause side effects such as infertility and abdominal pain.

Antibiotics are also given to livestock in order to prevent disease from spreading. The increasing amount of superbugs can cause more harmful bacteria to come into our food supply and as a result, subject us to life-threatening diseases.

What to Know?

Since antibiotics have a huge impact on public health, individuals should take the time to educate themselves on the proper use of antibiotics, says Abi-Mansour, and individuals should know the importance of keeping up with your overall health. “Washing your hands frequently and keeping up with your vaccinations are some of the most important ways you can stay healthy and avoid antibiotic usage all together.”

History: The first true antibiotic was penicillin discovered by Alexander Fleming, who was the professor of Bacteriology at St. Mary’s Hospital in London. The United States played a major role in production, making the drug widely available for use.

Length of use: Most antibiotics are typically used for 7-14 days.

Common Side Effects: Bad reactions to antibiotics are responsible for 1 in 5 emergency room visits. These side effects may include digestive problems, such as nausea, vomiting, diarrhea and bloating. These symptoms will disappear once an individual stops taking antibiotics.

How they are Provided: Oral (tablets, capsules, liquid), topical (creams, lotions, sprays) and injections.

Common Illness that require antibiotic use: Bronchitis, runny nose, ear infection, influenza, sore throat and sinus infection.

IU Health featured expert is Tanya Abi-Mansour, Pharm.D., Clinical Pharmacist, Infectious Diseases, practicing at IU Health Bloomington Hospital.

Cousins live five miles apart; admitted to transplant unit same day

Two members of the same family received the same transplant under the care of Dr. Jonathan Fridell.

By IU Health Senior Journalist T.J. Banes tfender1@iuhealth.org

They grew up in the same Elkhart County community 165 miles north of Indianapolis. And by chance two cousins came to IU Health University Hospital for the same transplant – with the same surgeon.

Luetta Fay Miller received a pancreas and kidney transplant on Nov. 19, 2017 and Marty Wingard also received a pancreas and kidney transplant on Dec. 19. 2018. Both were diagnosed with diabetes. Both were recently readmitted to IU Health on the same day – their rooms separated by just a few steps.

The two cousins grew up in Middlebury, Ind., a community of about 4,000 residents where the slogan is “Grown from Tradition.” The area is known for its rich Amish heritage that ranges from farming the land to operating an RV plant. The residents talk about one of the largest restaurants in the state – Das Dutchman Essenhaus that serves up authentic Amish recipes, and the Pumpkinvine Nature Trail, a favorite for outdoor enthusiasts.

Twenty-two years ago Marty Wingard married his wife Doretta. Her mother, Esther Miller is the sister to Miller’s mother Ruby Schrock. The mothers are two of five siblings who grew up in Middlebury and raised their families in the community dating back to the 1830s. Twenty–three years ago Luetta Miller – who has a twin sister Loretta Chupp, married her husband John Mark. They have a daughter, 21 and a son, 10.

The families are part of the older Amish church that includes 200 churches in the district. 30 families in the area attend their church -Crystal Valley -.

“We all grew up together and we all know each other,” said Wingard. He and his wife met at a gathering at a friend’s house. Miller said she met her husband when the girls were getting together and the boys showed up.

Wingard, who works at an RV production plant recently returned to IU Health for treatment of an interparietal hernia. In his spare time he enjoys working on old tractors.

Miller returned to with a spiked fever. She and her husband work with “egg innovation,” a farm with 20,000 chickens that provides organic eggs to various retail stores.

Wingard was recently walking the hallways, feeling stronger, and ready to be discharged. Miller said she was hopeful that she’d be leaving right behind him.

After 40 years of hospital social work, team member begins new chapter

She is one the first social workers on the transplant team and now Nancy Flamme is retiring.

By IU Health Senior Journalist T.J. Banes, tfender1@iuhealth.org

As she walks the halls of the fourth floor transplant unit at IU Health University Hospital Nancy Flamme says it still hasn’t hit her. She won’t be coming to work at the hospital every day. She won’t be working with the staff members and patients she’s come to love.

With four decades of hospital social work under her belt, Flamme is retiring. She started at IU Health in 2001 and began working in the transplant unit in 2003.

“Things started to explode in transplant as far as the number of transplants,” said Flamme. “We had two social workers – one for liver and one for kidney. Because of the increase we needed another social worker,” said Flamme, who was approached by Linda Munsch, now manager of transplant services. “I jumped at the opportunity and haven’t looked back since,” said Flamme.

“We were fortunate to have someone of Nancy’s caliber join our team at a time where we were experiencing significant growth in the liver transplant program. She worked tirelessly to ensure that our patients were connected with the needed resources and provided much needed emotional support to this complex patient population. Her work and dedication will be truly missed,” said Munsch.

Nurse Practitioner Tony Davey has worked with Flamme for the past 15 years and before that he worked with her in his role as liaison with IU Health Home Care.

“I love Nancy. Back then she rounded with the doctors and she used to update me on the patients. She is an incredibly hard worker,” said Davey. “She knows a lot and if something needs to be done, she just does it. With patients she’s always been supportive and direct and ready to troubleshoot to get things done in the most effective way.”

Flamme said she began thinking about a career in social work when she was a student at North Central High School and began volunteering with adults with disabilities. Later as a student at Hanover College she spent a semester working with the welfare system in urban Philadelphia. She went on to get her master’s degree from Washington University in St. Louis.

The most rewarding part of Flamme’s role at IU Health has been following the patients through their transplants.

“I start working with them from the time they begin their evaluations and continue through transplant. I can get a call from someone who had a transplant ten years ago. They came in so sick and now I get to see them after they have recovered. Some of them become active again – going back to work and are able to lead healthy lives.”

Over the years, Flamme has met countless patients and also their family members. Many she still hears from through holiday cards. She will miss that.

She says she will also miss her co-workers.

“I haven’t been here quite two years and Nancy has been awesome,” said transplant social worker Joshua Sumner. “She’s a wealth of knowledge and an authority on transplant and how social work interacts with the patients.”

So what’s next for Flamme?

She’s planning a trip to Hawaii and looks forward to spending more time with her sister and visiting her nephews who live in Colorado, California and Michigan. She also looks forward to continuing her volunteer work with her church Northminister Presbyterian and with other local organization that help those in need.

One of the youngest adult CAR-T patients ready to return home

Devon Tesler, 20 recently completed a groundbreaking new gene therapy at IU Health Simon Cancer Center.

By IU Health Senior Journalist T.J. Banes @tfender1@iuhealth.org

That pesky cough – it was still lingering. But Devon Tesler is feeling better. He’s hopeful.

The 2017 graduate of Hamilton Southeastern High School prepared to return home after completing a new gene therapy under the care of IU Health hematologist/oncologist Dr. Hillary Wu. It’s been a little over a year since Tesler was first diagnosed with Non-Hodgkin lymphoma. It all started with a cough.

He’d been coughing since March and made a couple trips to the doctor. First he was put on antibiotics, then allergy medication. When his physician suggested a chest x-ray, he learned he has lymphoma. He was referred to IU Health where he went through six rounds of chemotherapy followed by several rounds of radiology. He was preparing for a stem cell transplant when his family learned about CAR-T therapy.

The innovative gene therapy uses custom-made cells to attack a patient’s own specific cancer. CAR-T cell therapy allows doctors to isolate T-lymphocyte cells – the body’s cells that fight infections and are active in immune response. The T cells are then engineered to express a chimeric antigen receptor (CAR) that targets a protein on a patient’s cancer cells, attaches to them and eventually kills them. IU Health is one of the first sites in Indiana to administer the treatment. Tesler is one of the youngest adult patients to receive the therapy.

As he prepared to go home Tesler talked about the side effects of the treatment. His appetite has been spotty but he still has a taste for his favorite candy Tootsie Rolls and Twizzlers. He’s slowly building back up from his 10-pound weight loss.

“I haven’t noticed too many side effects other than swelling in my elbows, ankles, and wrists. I also get fevers and headaches,” said Tesler. That pesky cough is one of the few lingering symptoms that he had before treatment. It was one of the first signs that he was ill.

“He did the radiation so the cough started to subside and then it came back after chemo,” said his mom, Michelle Byrd. “Because CAR-T is so new there are no typical symptoms that we should expect. Every patient is different.”

There’s been another surprise too – he hasn’t lost the brown hair on his head, and he has more facial hair than usual.

Aside from his favorite sweets, Tesler has also had a taste for lots of veggies and waffles. He’d also like to visit one of his favorite restaurants Panda Express.

But first things first.

“He can eat what he wants, but no outside food unless it’s prepackaged or frozen,” said his mom. We’ll be staying close to home and keeping an eye on his levels. It’s great to have this kind of care so close to home. Some people come from far away and have to spend the months after CAR-T in a hotel.”

Mom of five looks forward to going home

After her last chemotherapy treatment, Jennifer Goecke rang the bell and looked forward to returning home to her favorite role in life – being a mom.

By IU Health Senior Journalist T.J. Banes tfender1@iuhealth.org

She says her life is simple – nothing too unusual or edgy. Jennifer Goecke is a mom. She’s a mom to five children and at times has been a mom to nine – part of an extended family.

It was during her last pregnancy when she began feeling pain in her left leg. Initial doctor visits left her feeling like the pain was related to her pregnancy. She made it to 36 weeks in the pregnancy and more complications occurred. A placental abruption resulted in an emergency delivery.

“It was a scary time. She almost died,” said her mother Georgia Hall. And even after Goecke and her newborn were released from the hospital the pain in her leg continued. When it got so bad she couldn’t put pressure on it, Goecke visited an orthopedic doctor. She was set for surgery when tests revealed a sarcoma – a malignant tumor.

“I didn’t know what to think. I was in shock. I’d just had a baby. My hands were full,” said Goecke, 37, of Connersville. Her three boys and two girls range in age from five months to 18 years.

She came to IU Health Simon Cancer Center in July where she spent five days inpatient for chemotherapy treatments, then home for 16 days and then back again. She recently completed her last cycle and rang the bell on 3 East – signaling the end of her chemotherapy. Nurses, her mom, her cousin and aunt cheered her on, knowing that this was a time to celebrate.

“The tumor seems to be shrinking so the chemotherapy must be working,” said Goecke. Sarcoma, an uncommon type of bone cancer results in fewer than 200,000 patients a year. Now, they wait. An MRI scheduled in October will determine if surgery is needed.

For now, Goecke is anxious to reunite with her children.

“She’s a good mom and she’s always been a good kid. She really never had any illness other than chicken pox,” said her mom. “As a kid she was a tomboy. She loved to climb trees and be outside in the country.” For a time Goecke played both basketball and football. Later in life, she played sports with her kids and enjoyed anything outdoors – camping, attending their games.

“Besides the pain, the hardest thing has been being away from kids,” said Goecke. “I’m ready to go home.”

The fog of addiction lifts for recovery coach

He should have died so many times, especially when he was pushed out of a car after an overdose. But Jay Berry climbed back from a life of pain to one of promise and purpose: “Fifty percent or more of my job is planting a seed of hope.”

By Maureen Gilmer, IU Health senior journalist, mgilmer1@iuhealth.org

When Jay Berry looks in the mirror, he sometimes sees the 11-year-old boy who stole prescription pills from his grandma’s medicine cabinet. Or the teenage wrestler who self-medicated to cut weight. Or the young adult who couldn’t drag himself off his parents’ couch.

But then he sees the 29-year-old man who has finally found his footing.

Berry is a peer recovery coach for IU Health. He works the overnight shift in the virtual care program of System Clinical Services, helping others who struggle with addiction.

It’s appropriate that Berry started his job with IU Health a year ago this month. Every September, the Substance Abuse and Mental Health Services Administration sponsors Recovery Month to boost awareness of mental and substance use disorders and celebrate recovery.

As a coach, Berry offers help and hope to those who are spiraling down, caught up in a dependence on alcohol, illegal drugs or prescription meds.

He’s seen it all. He’s done it all.

He comes from a place of understanding. One of the requirements of the job is lived experience.

So when he looks in the eyes of a patient who comes into the emergency department, he can relate to their pain, their confusion, their sense of hopelessness.

“Jay is a passionate fighter for those in the throes of addiction,” said Ian McDaniel, executive director of virtual care for IU Health.


As a boy, Berry used to watch the medical drama “House,” about a pill-popping doctor. He was intrigued.

“I was always a little too smart for my own good. I knew in my grandma’s medicine cabinet she had the same stuff that was making him act so silly, and I wanted to know what that felt like.”

He was 11.

Not long after his 12th birthday, he tried marijuana and alcohol. He says he did it to fit in with the older kids he hung out with. Not regularly, but often enough.

“It made me feel like an equal,” he said.

At the time, Berry lived in Anderson with his family. A move to Fishers before high school meant he had to find new friends.

He struggled, coming from an inner-city environment to a wealthier suburban school.

“I was out of my element. I became shy and closed off. I felt like I didn’t fit in.”

He did, however, have a talent for finding drugs. So that’s how he fit in.

Weed, alcohol, pills – those were the go-to substances. When he was introduced to heroin, he tried to act cool. He snorted it.

When he made the wrestling team, he had less time and opportunity to mess with drugs.

But when he needed to drop weight quickly to wrestle in a lower weight class as a sophomore, he started mixing appetite suppressants with more opioids. That’s when his habit truly started, he said.

And it continued into college at Ivy Tech Bloomington. He gave up wrestling, deciding the drugs were more important.

“I began to really break bad,” he said. In 2011, as a college sophomore, he started selling pills, in addition to taking heavy doses of Oxycontin, more than his 5-foot-7-inch, 140-pound frame could absorb.

He overdosed several times, he said. He was arrested a couple of times, he entered treatment programs. Eventually, he moved back in with his parents and enrolled in an outpatient treatment program, which he stuck with for a couple months before the heroin pulled him back.


When he was arrested again, he started taking recovery more seriously.

He had an apartment with his fiancé and life was pretty good for a few months, he said. Then came another relapse and another overdose.

“I’ve overdosed several times before, but this time was different,” he said. “I was in a car when I OD’d on heroin and was just pushed out of the car. I was taken to the hospital and revived, but I suffered severe trauma to my brain.”

Berry was in a medically induced coma for 13 days to let his brain heal, but when he woke up, he couldn’t walk or talk and he was nearly blind.

It was the summer of 2012. He was placed in a rehab hospital in Indianapolis and started on a long road to recovery, learning to walk and talk again, dealing with partial blindness.

When he left the hospital, he returned to his parents’ home in Fishers. He lost his girlfriend; he couldn’t work.

“I really did not do anything,” he said. “I laid around feeling sorry for myself.”

And he got high on pain meds.

He lived like that for several years, until eventually even he got tired of his situation.

“I took a hard look at my life and came to the conclusion that it wasn’t my disability holding me back, it was my drug use.”

He entered a 12-step program, determined to do it “100 percent their way,” he said. He has been clean since February 2017.


Once he had a grip on his own sobriety, he learned to extend a hand to others, and that is what led him to IU Health.

“I wanted to be independent, I wanted to live a purposeful life again.”

His job is to provide non-clinical support to IU Health patients coming into emergency departments with a substance issue, whether that’s an overdose or another health problem related to drug use. A nurse will contact Berry or one of the other peer coaches, who work out of a building on Senate Avenue in Indianapolis.

The coach will speak with the patient through a secure communications portal, do an assessment, then discuss the patient’s goals.

Often, he said, patients suffering from addiction don’t know how to get help. When he can share his story, it gives hope.

That is his purpose.

“People can and do recover. I am living proof.”

In those meetings, however, he gets as much as he gives.

“I get a continual reminder of where I was, where I can still end up. I get a constant feeling of gratitude and appreciation for where I am now and for all of the hardships. I am grateful for the good and the bad. It’s because of those bad moments that I am employed today with IU Health.”

It’s an incredibly rewarding experience, he said, even when you get a patient who doesn’t want to talk or who gets angry.

“There’s still a chance that I can plant a seed. Fifty percent or more of my job is planting a seed of hope.”

Photo by Mike Dickbernd, IU Health visual journalist, mdickbernd@iuhealth.org

Artists inspire others by sharing thoughts, observations

It’s been called a different kind of healing. Art has its own way of inspiring others through story telling. These works are part of the Second Annual CompleteLife Art Show at IU Health Simon Cancer Center.

By IU Health Senior Journalist T.J. Banes tfender1@iuhealth.org

German-born artist Anni Albers once said, “Art is something that makes you breathe with different happiness.” That breath is evident in the artist contributions of the Second Annual CompleteLife Art Show at IU Health Simon Cancer Center.

Patients and caregivers submitted a variety of artworks ranging from a boat peacefully sailing at sea to a fossilized femur. Each piece has meaning that is absorbed through personal journeys – a patient treated for breast cancer, a husband who cared for his terminally ill wife, and a cosmetologist who fits patients for wigs.

“The purpose of the show is to highlight and share the power of art, healing and health and to educate others about arts in healthcare and art therapy – how they are the same and how they are different, and to create a healing and inspiring environment at the hospital,” said Lindsay Syswerda, manager of the CompleteLife Program.

The CompleteLife Program at IU Health is a comprehensive therapy program that attends to the body, mind and spirit of the whole person. CompleteLife services are available for patients and families at IU Health Simon Cancer Center and IU Health University Hospital. Complimentary programs include appearance consultations such as a wig bank fittings and makeup workshops, massage, music, yoga, and art therapy.

The majority of the works in the CompleteLife art show were created independently. Certified Art Therapist Lisa Rainey describes her work with patients at IU Health like this: “Art therapy is a largely non-verbal form of psychotherapy and counseling; however patients are always invited to share their hopes, desires, and life stories.”

Here are a few of those stories in this year’s show “Imagine. Inspire. Reflect.”

  • “The Gift,” oil on canvas by Teresa Altemeyer, a patient with chronic lymphoma. Altemeyer is not only a patient but also a patient advocate working closely with the Indiana Chapter of the Leukemia & Lymphoma Society (LLS) to help educate others diagnosed with LLS. She facilitates a first Monday Cancer Support Group at IU Health University Hospital and is a professional artist. A bouquet of flowers she received while hospitalized inspired her painting. “It is easy to forget what the beauty of the “outside world’” looks like when you are in a room full of equipment and instrumentation for days on end,” said Altemeyer. “The beauty of the flowers reminded and inspired me to focus on the world waiting for me beyond the four walls of my room and to reflect on the people I needed to get well for who are important in my life.”
  • “Hope,” a colored pencil drawing by Wilma Cross, CompleteLife cosmetologist and a chronic lymphoma patient. Her artwork represents those people in her life touched by cancer including her husband, patients, and friends.
  • “Inspired to Survive,” an acrylic pouring paint by ovarian cancer patient JoNell Stevenson. She has had four bouts with cancer and says other survivors – including attendees at an Ovarian Cancer Retreat she attended in Montana, have inspired her to survive.
  • “Dawn of a New Day,” an acrylic painting on canvas custom framed with recycled wood, by Jay Hanner. A caregiver for his wife of many years, Hanner’s work was inspired by their trips to Gulf Shores. He says, “Each new dawn is a blessing.”
  • “Splashes of Inspiration,” by Carmon Weaver Hicks. Created with splash paint balls, nail polish and markers, Hicks’ artwork represents her splashes of inspiration during her diagnosis of metastatic breast cancer. She is a 13-year survivor.
  • Breast Cancer Awareness Paracord Bracelets by Ron Andrei in honor of Karen Andrei. When Karen Andrei was diagnosed with breast cancer her husband began creating the paracord bracelets as a way to reduce stress. He hopes the bracelets will raise awareness of the disease.

The CompleteLife Art Show continues at IU Health Simon Cancer Center through September 29. It will again be displayed at the Harrison Center for the Arts on Friday, Oct. 4. The show is sponsored by Roche Diagnostics.

How Does Cellulite Reduction Help

If you are from Oklahoma City and are keen on identifying ways and means to reduce cellulite levels in your body, you are perhaps in the right place. There are scores of people in the city and surrounding areas who suffer from this condition. This is a condition that leads to dimpling of the skin and it also becomes lumpy in appearance. It mostly impacts the thighs and buttocks but could also happen in other parts of the body. Cellulite is a condition when excess fat deposits try and push through the various connective tissues located beneath the skin. It impacts women more than men and it is believed that around 80 to 90 percent of women will most probably experience this condition.

While there could be many types of treatments, we have to choose the right one taking into account specific cases. Switching over to a diet that is low in fat, staying away from smoking, moderating alcohol intake and supporting all these by an active lifestyle could help bring down the incidences and levels of cellulite. Women are more prone to cellulite because their fat distribution is different and so is the case with connective tissues and muscle. Liposuction is considered to be effective in removing those ugly looking cellulite formations but it is not very sure whether it has a long term impact.

How To Treat & Manage Cellulite

Several therapies are available for removing cellulite in OKC. Acoustic wave therapy is a commonly used method that might be effective. A hand-held device is used to transmit the sound waves. It can help in reducing cellulite but it might take several sessions. Laser treatment is another method that could help in improving the appearance of cellulite that is more than a year old. A laser probe is inserted under the skin. The laser is then activated and it breaks up the tissue. This could lead to the thickening of the skin and increase collagen production. The thickening of the skin could help reduce the appearance of the cellulite located below.

There is also one more method known as carboxytherapy. This method involves the insertion of carbon dioxide gas under the skin. While this may provide a noticeable impact and reduce cellulite formation, one should be aware of the side effects. The side effect could include discomfort and bruising of the area once the procedure is complete. But if the end-users can bear the discomfort, the results could be quite impressive.

Choosing The Right Professionals Is Important

While there are many approaches to reducing the problems associated with cellulite, it is important to hire the right professionals. You must look for a good liposuction professional in Oklahoma City who can handle such complex procedures. The cost, side effects, and other such factors should also be taken into account.

The Final Word

To sum up, there is no denying the fact that in a world where appearances matter a lot for women, cellulite is certainly a problem. But proper diagnosis and then treatment is the way forward. It should be done with patience and after the right research. Some natural treatments and methods are also available and the same could also be tried out.

Contact US:

Sawan Surgical Aesthetics

Address:209 Lilac Dr #200, Oklahoma City, OK
Phone: (405) 285-7660

Daughter, 13: These holding hands honor her mother

On what was one of the most difficult days of Skeeter “Dee” Durnil’s life, a team of caregivers embraced her family and honored her final wishes.

By T.J. Banes, IU Health senior journalist, tfender1@iuhealth.org

It’s been said that a mother holds her child’s hands for a while, but her heart forever. For Kaylee Durnil, 13, that image of her mother holding her hand lives on – even after her mother’s passing.

It was the end of August and Skeeter “Dee” Durnil was closing in on 50 days spent at IU Heath University Hospital. She was not recovering from a diagnosis of nonalcoholic steatohepatitis (NASH). She was being cared for in ICU for severe liver damage.

“She got very close to all the staff – the nurses and even the food service folks,” said her son Chris Durnil. So it was no surprise that when Dee made a final wish to go outside, her caregivers leaped into action.

“I took care of her every night for a month. When she said she wanted to go outside, I thought it might lift her spirits. I had seen her angry; I’d seen her scared and when she went outside, for one of the first times I saw her content. She was holding her daughter’s hand and smiling,” said Lisa Dunnivant, an ICU nurse. During Dee’s stay at University Hospital, Dunnivant watched Hallmark movies with her and listened while Dee talked about her family including sons Chris Durnil, 35, Jacob Durnil, 22, and daughters Caitlin Durnil, 26, and the youngest, Kaylee Durnil, 13.

Dunnivant had clocked out for the day when she got the call that Dee wanted to go outside. She returned to the unit and joined the family as they gathered around her hospital bed in a little outdoor enclosure.

“I love them so much. They’re like family to me,” said Dunnivant. “I’d do it all again in a heartbeat.”

That wasn’t the only thing that happened on that final day. As Dee held her youngest daughter’s hand for what would be one of the last times, IU Health Art Therapist Lisa Rainey offered to make a mold of the two hands.

“I work with many patients and families who are faced with a terminal illness and I want to be able to help those patients cope through the dying process. Often times I’ve worked with the patient for months before their disease progresses to a point where comfort measures and maximizing quality of life replace those treatments that were once curative. I pride myself on the individual relationships that are built with each patient,” said Rainey, who works with IU Health Simon Cancer Center’s CompleteLife Program. “Art therapy is a largely non-verbal form of psychotherapy and counseling; however patients are always invited to share their hopes, desires, and life stories. I’m honored to get to know each and every one of my patients. I make sure they know that I am never in a rush, am 100% present, and truly interested in learning their life story,” said Rainey.

On this day, the timing was critical.

A social worker contacted Rainey and CompleteLife Program & Cancer Resource Center Coordinator Lindsay Syswerda in the morning with the news that Dee was transitioning to comfort care. If there would be a hand mold made it needed to be immediately.

“When we arrived to do the hand mold, Dee was sitting up, smiling, and talking with her family members. I had not seen her that awake, alert and engaged in quite some time,” said Rainey. Close by was Dee’s youngest daughter, holding back tears knowing that her mother’s life was coming to an end.

“Mother and daughter locked hands and then placed them in the casting alginate. They held hands for about five minutes while the alginate cured, and created the impression that I would pour plaster into to create the final piece of artwork,” said Rainey, who lost her mother when she was ten.

“I wish that I had a cast of her hand to touch and hold when I think of her or want to communicate with her. I’m so happy to be able to provide this creative intervention to those terminal patients who have young children,” said Rainey.

Dee passed that evening and the mold was displayed at her funeral as a reminder of her love for her children. The reminder lives on for her youngest daughter, Kaylee Durmil.

The teen, a student at St. Thomas Aquinas School, likes social studies, language arts and robotics. She hopes to one day become a criminal psychologist for a Behavioral Analysis Unit of the FBI. Her mom was a big influence on that decision – they spent hours watching crime shows together and trying to predict the plots.

Now the hand she once held for more than a decade is a forever memory – a symbol of her mother’s love that will remain in her heart forever.

“It sits on my desk in my room,” said Kaylee. “Seeing it every day reminds me of the Sally Hanson red nail polish my mom wore on that day.”

School nurse – A one-person clinic that cares for kids

On any given day, Tiffany Lindsay never knows who will walk through her door – an eight-year-old with asthma, or a seven-year-old who lost a tooth. It keeps her on her toes.

By T.J. Banes, IU Health Senior Journalist, tjbanes@iuhealth.org.

She’s a mom, she studied child development in college, and she later became a nurse working in adult trauma care.

Those qualifiers alone could put Tiffany Linsday at the head of the class as a school nurse. But she’s learned over time there are no two patients alike – especially in a school that represents 17 different countries, 12 different languages, and a large population of students who receive free and reduced lunches.

On any given day she can see as many as 150 students. Their needs include diabetic blood checks, asthma treatments, and first aid for scrapes and cuts.

Lindsay began working for IU Health in 2006 as a unit secretary. After high school she attended Purdue University studying child development but eventually felt it wasn’t her calling. At IU Health her co-workers encouraged her to go back to school for her nursing degree. She completed her degree in 2017 and began working at IU Health Methodist Hospital with adult trauma critical care patients.

A back injury lead to on-the-job restrictions and when she could no longer lift patients, she began searching for alternate paths to pursue a career she loves. Married to Nathan Lindsay for 20 years, the couple has three children attending Washington Township Schools – Adeline, a junior and Gavin a freshman at North Central High School and Garrett a first-grader at Allisonville Elementary.

IU Health provides 12 nurses throughout Washington Township Schools – including eight elementary schools, a developmental preschool and three middle schools.

Lindsay works at Fox Hill Elementary in an office that displays a poster of a hand-drawn roll of Lifesavers and several colorful candies. The sign reads: “Mrs. Lindsay, thank you for taking such good care of us. You’re a lifesaver.” The rest of her office is decorated in bright colors – encouraging students to eat a rainbow of colors. She changes the theme throughout the year to drive home other messages: Heart health, appropriate sleep and summer safety.

On any given day, her office is a flurry of activity. She answers the phone “Good Morning, Fox Hill clinic,” and proceeds to answer parent questions. One student comes in with a tooth that has just fallen out. Lindsay helps her wash up and then places the tooth in a necklace, puts the necklace around the little girl’s neck and sends her on her way. There are other students who come in regularly for blood sugar checks and asthma treatments. A teacher comes in to have a burn bandaged.

To keep track of the youngsters in her care, Lindsay keeps a notebook and also records activity electronically. At the end of last year, the notebook was so full she couldn’t close it.

“It’s just like nursing at a hospital – you triage with ABC – airway, breathing and circulation,” said Lindsay, who also spends a lot of time talking with parents and helping educate them when a child has a chronic condition such as asthma or diabetes. With 100 fewer students in the school this year, she’s not as busy as the previous year but there is limited downtime.

“We want the kids to be successful. When you get medicine from the drugstore they don’t give it to you in Burmese or Swahili. We have a very diverse student population here so I spend a lot of time working with parents and helping them understand their child’s ongoing cough is not just a cough, it’s symptoms of asthma,” said Lindsay. All the school nurses work closely with IU Health’s Rebecca West, the district manager to help connect families with additional resources. “If I have ten kids I’m worried about, she knows all ten kids,” said Lindsay. If the family needs to see a specialist such a pulmonologist, the nurses help connect them and refer them to IU Health physicians.

The nurses meet twice yearly to talk about primary concerns such as allergies. Many students have never been exposed to certain foods and parents aren’t familiar with allergies. The nurses often become the first line of contact.

“I’ve had parents bring younger siblings in. We joke that it’s like urgent care. Parents have me look at something on them because they have nowhere else to go. As a nurse you get asked a lot of questions,” said Lindsay. She takes it all in stride and manages her day with a cadence filled with smiles and words of encouragement.

Fox Hill Elementary serves children in Kindergarten through Fifth Grade. Lindsay’s goal is to help the older students – with chronic conditions – learn to manage their treatments. Last year she had 60 scheduled medicines and treatments a day – every one of them organized in a secure file cabinet. The same cabinet houses a red medic bag that she grabs every time there is a fire drill or emergency. She is ready for whatever comes her way.

Each Friday she gives out prizes to the students who have ongoing medications. They are rewarded for their compliance at a time in their lives that they’d rather be playing with friends and ignoring treatments.

“It’s not always fun being called out of class for meds. I have students with diabetes who have to miss gym if their sugar levels are too high and I have students with asthma who can’t go outside if the temperature is above 80 or below 40. That’s a lot of time they spend in my office,” said Lindsay. To help them pass the time she provides books and drawing materials and sometimes employs their help making ice packs. Her prize box is filled with stuffed animals, pencils, books and bracelets.

When a little girl fell and broke her arm last year, it was one of those stuffed animals that helped soothe her until her parent arrived at school.

Lindsay has also used the prizes to motivate students with difficult health issues. Last year she helped nurse a young student who was born prematurely and was underweight. He just wasn’t eating and his mom often called or sent text messages to Lindsay seeking advice.

“My goal was to encourage him to eat and by the end of the year he was eating chicken nuggets and pizza. He’d gained eight pounds,” said Lindsay. She works closely with teachers and the school social worker in situations where student conditions are more than just a scrape from a playground fall. She even keeps a box of clothes for when a child needs a quick change.

“That mom instinct comes out a lot. When I have a student coming in frequently with an upset stomach, I start asking questions about a break up with a boyfriend or what’s going on at home,” said Lindsay. When a student complains of heartburn she asks what he ate on his way to school. All students receive free breakfasts at Fox Hill but there are always backpack snacks that they grab from home.

“A big one is those hot Cheetos and corn chips. When they eat those we might Google heartburn and then have a full conversation about healthy snack choices,” said Lindsay. “We look at the lunch menu together and I help guide them to make the best choices.”

In addition to the daily care of the students, Lindsay arranges vision screenings with the Lions Club for third- and fifth-graders and any other student recommended by staff members. She also coordinates a visit by a mobile dentist, Big Smiles.

“We have so many who need these services. Last year we had them once, this year my goal is every six months,” said Lindsay. The dental care includes cleanings and she is working to also get fillings for the students. “Last year we had kids referred for root canals. Can you imagine sitting in class and trying to learn and being in so much pain and then trying to eat a healthy lunch of carrot sticks and still feeling the pain,” said Lindsay.

She sees her role as not only a caregiver, but also a nurturer. Like the teachers in her building, Lindsay doesn’t clock out when the buses leave for the day.

“I absolutely love this job and connecting to the kids. I am here to help them learn by managing their physical health – that impacts so many areas of their lives,” said Lindsay. “Last year we had 800 students and I could call 700 of them by their name. Either I had seen them in the clinic or I knew their face. They all mean the world to me.”

Photos by Mike Dickbernd, IU Health visual journalist, mdickbernd@iuhealth.org