Methodist emergency department staff get a refresher course in identifying and treating a deadly infection.

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

The patient wasn’t real, but the scenario playing out in IU Health Methodist Hospital’s emergency department last week was all too realistic.

A team of nurses and doctors gathered around a “patient” who was disoriented, feverish and in pain. With little patient history information to go on, they worked together to quickly recognize the signs of sepsis, “a silent killer,” and treat the patient with fluids and antibiotics.

Every year across the United States, more than a quarter-million people die in hospitals as a result of sepsis, defined as a medical emergency caused by the body’s overwhelming response to infection, which can lead to tissue damage, organ failure, amputations and death.

Last year, more than 3,500 Hoosiers died in hospitals from sepsis, according to Indiana Hospital Association data.

As part of Sepsis Awareness Month, teams of nurses and physicians came together in an escape room-type simulation at Methodist to treat a patient who displayed signs of sepsis.

Symptoms include fever, difficulty breathing, low blood pressure, fast heart rate and mental confusion. It can be hard to diagnose because it shares many symptoms with other conditions, but fast treatment often is the difference between life and death.

In this case, the patient was a mannequin brought over from the Sim Center in Fairbanks Hall. As Dane Rogers controlled the mannequin’s voice, Methodist emergency physician Dr. Steven Wipprecht relayed critical information to visiting med student Elizabeth Ogunsanya and nurses taking part in the drill.

In just over 6 minutes, the team had identified and begun treatment for the life-threatening infection. The risk of death from sepsis increases by as much as 8% for every hour that treatment is delayed.

Dr. Wipprecht, who organized the drill and conducted the training outside his regular shift in the emergency department, said his passion is for resident and med student education.

“This is a new cutting-edge way to educate our folks in the department while still getting to do so in a collaborative environment with nursing.”

Stressing the need for active, close-looped communication among doctors and nurses, he said most patient complaints and errors come from missed opportunities for communication. And often, he said, it is nurses who save the day.

Still, three out of 10 people diagnosed with sepsis die. That’s why it is critically important that staff always be alert to the signs of sepsis. Delaying diagnosis and treatment by even 15 minutes can affect mortality.

“Some of our patients are here for weeks, which is why it’s important we do this education on the floors, in the ICUs, because the earlier we get antibiotics in, the mortality rate decreases,” he said.

Because early recognition and timely care are key to improving survival, the Methodist ED “escape room” gave providers, registered nurses and patient care assistants an opportunity to develop a plan and deliver appropriate care in a lifelike circumstance where the clock was ticking.

Emergency medicine intern Becky Yuan said she found the simulation eye-opening.

“It was nice to have the practice in a sim setting before real patients,” she said. “It’s surprising how many patients sepsis affects and the mortality rate. It’s a lot higher than I thought.”

For Methodist RN Jennifer Burchett, the training was valuable, even if just a reminder of the critical work nurses do every day.

“We do really good work here,” she said. “Sepsis isn’t sexy, but it’s not all car accidents and shootings (in the ED). There’s a lot of great work we do that’s not on the highlight reel.”

Dr. Wipprecht ran 10 simulation cases with different teams from the emergency department in one morning. It was the first simulation of its kind for sepsis, but the plan is to go campus-wide with it, he said.

Participants weren’t graded on their performance, but they were encouraged to compete for the best time against other teams. The winning team received Starbucks gift cards.

And all walked out with stickers declaring them “sepsis heroes.”

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

She grew up in Indiana and moved to California with her husband. Now Kymberli DeWitt is back home again and a patient at IU Health Simon Cancer Center.

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

Four years ago when Kymberli DeWitt was diagnosed with Myelodysplastic syndromes (MDS) she was undergoing treatment for severe ulcerative colitis.

She was living in California at the time with her husband of 26 years, Scott. At a hospital close to home, she underwent a proctocolectomy with ileal pouch-anal anastomosis, or j-pouch surgery. The procedure surgically creates an internal reservoir from the small intestine.

It was during that procedure that her labs came back questionable and doctors diagnosed her with MDS. The conditions occur when blood-forming cells in the bone marrow become abnormal. She received a stem cell transplant in California. When the transplant began to fail she developed leukemia and received a “touch up transplant” again in California.

A native of Anderson, Ind. DeWitt graduated from the former Highland High School and was a member of the Marching Scots. When her husband took a job transfer, they decided to move back to Indiana – closer to her family and also close to IU Health. The couple has three children Danielle Fowler, 31, Nicolas Eicks, 30, Victoria DeWitt, 25.

“Truthfully, we needed a job near a transplant facility. Facilities like IU Health aren’t everywhere,” said DeWitt. Since March she has been coming to IU Health for transfusions to help control complications of aplasia, a bone marrow disorder characterized by a decline of red blood cells. The condition manifests in severe bruising. She is under the care of IU Health oncologist/hematologist Dr. Jennifer Schwartz. “It’s such a difference here – so much more one-on-one time with the nurses and it’s really a personal approach,” she said.

DeWitt smiles as she talks about her condition and the road back to Indiana. Long sleeves and pants hide the bruises. She is upbeat and tells about her hobbies – gardening, reading, and exploring new places with her husband.

“I’ve always worn makeup and a smile because I want to put my best foot forward, even on the worst days,” said DeWitt. “A good friend often sends me a text that says, ‘you’ve got this,’ and really I believe I do. I believe in the power of being positive.”

In honor of her birthday one kidney donor recently celebrated the gift of life that resulted in a chain of eight IU Health patients.

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

The way Bill Eiler remembers it he was watching an episode of the popular ABC-TV series Grey’s Anatomy when he had an “a-ha moment.” The episode was about living donors.

“I like doing nice things to help people,” said Eiler, a resident of St. Paul, Ind. So he decided to donate a kidney – not to anyone in particular. Eiler is known as an “altruistic donor,” someone who donates to a transplant waiting list. Some people also call him a “Good Samaritan.”

Donate Life reports there are 100,000 people in the United States awaiting a kidney transplant. The average wait time is three to five years. Kidneys from living donors offer an alternative to dialysis for patients living with renal failure. On average a living kidney can function for 12 to 20 years – sometimes longer. In August, IU Health surgeons performed 18 adult kidney transplants and one pediatric transplant. The kidney transplant program performs more than 200 kidney transplants a year making it one of the top programs in the country.

When Eiler reached out to donate his kidney he said he wasn’t sure he would be a viable donor. Throughout his life he had been treated for polio, hepatitis, and melanoma. It turns out his kidneys remained healthy and he became the first in a group of eight people – one of IU Health’s first organ transplant chains.

Eiler’s kidney went to a woman. That woman’s son became donor number two. His kidney went to a second recipient. That recipient’s husband became donor number three. His kidney went to another man. That man’s niece, Jessica Journey became donor number four. Her kidney went to a young man.

Recently, to commemorate her birthday, Journey hosted a 10-year celebration of the chain of life. Eiler was there to celebrate with her – the bookends of the chain.

Journey said she felt called to help her uncle but she knew she wasn’t a good match.

“I always had a feeling that there was something more. It just all made sense, when I was told about the possibility of a chain during a phone call with my coordinator at the hospital,” said Journey, who recently joined IU Health Foundation as the manager of donor relations.

Known as Kidney Paired Donation (KPD), the chain occurs when a recipient has a willing living donor who is incompatible (a poor match). Most recipients and donor pairs are entered into a KPD program because of blood type or Human Leukocyte Antigen (HLA) incompatibility or both. Other pairs may enter if they are seeking a donor better matched in age, size or some medically suggested reason.

So on Sept. 22, 2009 Eiler became the first donor in the chain.

Retired from the US Postal Service Eiler spends his time volunteering with CASA, the Kiwanis Club, and teaching archery and fishing to youth attending Flat Rock YMCA Camp. He’s also seen on stage with the Shelby County Players.

“I was the only one in the chain who didn’t have anyone I was related to,” said Eiler, whose transplant coordinator was Kelly Coffey. “I know some people probably thought I was crazy, but it was really no big deal. If I had another kidney, I’d do it all again.” His eyes water when he tells about his recipient’s response to his gift of life.

“She said ‘thank you for giving me my life back.’” That was all it took to know I’d made the right decision,” said Eiler.

Journey’s transplant recipient was 15 at the time and is now 25. “We keep in touch. We appreciate each other,” said Journey. “It’s different than any other connection because it’s our shared kidney story that connects us.

As he recently prepared for his second kidney transplant, Alan Wilson began mapping out a plan to help advocate for other patients with kidney disease.

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

Resting in a hospital bed, his wife at his side, Alan Wilson talks openly about his kidney match – not once but twice.

On Jan. 27, 2009 his mother, Lori Miller donated a kidney to Wilson. When his body began rejecting the kidney his wife Danielle was tested and was a match.

Wilson explains his health with a blanket term – FSGS, focal segmental glomerulosclerosis. The condition causes nephrotic syndrome and kidney failure. A single disease does not cause it; it can have many different causes including infection, medication or an illness.

Raised in Kosciusko County, Ind. Wilson worked for a time in auto parts and then at Maple Leaf Farms – a poultry company. He and Danielle met through mutual friends and were married June 7, 2008.

Since before his first transplant Rick and Danielle have made it their mission to help educate others about all aspects of kidney disease and transplant. He received his second transplant from his wife earlier this month.

“When I went through this the first time it was 11 months from diagnosis to transplant to back to work,” said Wilson. “I tell people, ‘yes, it’s a big part of my life but it doesn’t define me.’”

He relates how his candid approach to his disease has bridged relationships.

The couple was recently checking out at a local grocery store when Rick engaged in a conversation with the cashier. Within minutes they found common ground – the woman related how she had lost a daughter to kidney disease a few years ago. She walked out from behind her register and gave the Wilsons hugs when they shared their story.

“We have gone from being guarded about our story to being completely open and it has opened doors for others,” said Wilson. Back home in Warsaw, Ind. they started a support group where people with end stage renal failure, family members, and caretakers talk about various topics. The conversations include insurance coverage, finding a living donor, and coping with guilt.

“When my wife found out she was a compatible donor, she was over the moon but I felt guilty,” said Rick Wilson. “How do you ever begin to thank someone for such a tremendous gift – from someone so close to you like your mom and your wife?”

This week is Nephrology Nurses Week. Darby Sturtevant talks about how her work includes not only patient care, but also family care.

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

Darby Sturtevant describes the nephrology world as a small world.

“Patients see the same techs and nurses,” said Sturtevant. She started at IU Health seven years ago working with the transplant program. Five years ago she became a nurse practitioner working with dialysis patients in the outpatient setting.

“When you see the same patients weekly you get to know them and know their families. You hear about grandbabies being born, you see pictures, and you share in their life,” said Sturtevant. Nephrology nurses are trained both in dialysis but also in educating family members and caregivers.

“We work with patients who have a chronic condition and it impacts so much of their life. They spend 12-16 hours a week in the clinic and that doesn’t include how worn out and tired they are when they go home. They are only able to live normal lives a few days a week and then there are so many restrictions with diet and exercise,” said Sturtevant, who grew up in Fishers. She is married to Sam Hunter. They have one daughter, Coralyn Hunter, 2, and are expecting a second child in January.

“Nephrology sort of chose me. I loved working with transplant patients and seeing an immediate result –patients switching from being sick to becoming healthy,” said Sturtevant. She hadn’t seen the other side of kidney disease until she shadowed another nurse. She estimates she has 120 patients that she sees weekly.

The American Nephrology Nurses Association (ANNA) designates the second full week in September at “Nephrology Nurses Week.” It’s a time to recognize nurses who are dedicated to caring for patients with kidney disease. Nephrology nursing is a specialty, and can be taught on the job.

“The nephrology nurses are the backbone of nephrology care for our patients,” said IU Health Dr. Brent W. Miller, clinical chief of nephrology. “They manage the care of very difficult conditions. The quality of the physician I am is directly related to the quality of our nephrology nurses.”

“I’ve taken my donor everywhere. She’s given me life; the least I can do is to show her the world.”

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

Alexis Pavlopoulos had just gotten off the elliptical machine to get a drink of water when she blacked out.

She remembers waking up on the gym floor to the sight of EMTs standing over her.

Her heart was beating wildly – 216 beats per minutes – as medics struggled to slow it down. A normal resting heart rate for adults ranges from 60 to 100 beats per minute.

It was Jan. 13, 2014. Pavlopoulos was 24 years old. She’d always been active, a four-season athlete throughout high school.

She thought maybe she was just out of shape, but after being rushed to IU Health Bloomington Hospital one mile away, she learned she was suffering heart failure caused by viral cardiomyopathy – an infection had weakened her heart muscle.

The next days, weeks and months would be filled with challenges. Like when she had an ICD (implantable cardioverter-defibrillator) implanted to detect abnormal heart rhythms.

She had the flu and was home sleeping on the couch not long after that surgery. She remembers springing up and screaming once, then again and again. Her ICD had shocked her three times when her heart rate climbed close to 300.

After repeat episodes, it got to the point where she was afraid to go to sleep.

When she was sent to IU Health Methodist Hospital for evaluation in May of 2014, doctors discussed the possibility of a transplant but thought she wouldn’t need one for another 10 years. Less than two years later, they determined her heart was failing rapidly.

“THEY HAVE A HEART”

Pavlopoulos was put on the transplant list June 15, 2016. Fifteen days later, the phone rang at her parents’ home in Bloomington.

“I got the call at 9:24 in the morning June 30. I was lying in bed, getting ready to take a shower.”

A heart was available.

She struggled to process the news as fear welled up inside her. From her bedroom, she called down to her mom on the first floor: “Mom, it’s the hospital, they have a heart.”

Pavlopoulos and her family were caught off guard. They expected to wait months for this call, but now they were scrambling to get ready to make the hour-long drive to Methodist.

Before she was going anywhere, however, Pavlopoulos was going to take a shower and shave her legs.

“In that moment, that was the most important thing to me – that I had a shower and shaved my legs. They told me I’d be in the hospital for about 14 days post-transplant and I didn’t know when was the next time I’d be able to shower.”

They arrived at the Indianapolis hospital at about 11 a.m., and soon they would be joined by a host of nervous family and friends. Someone brought in bags of peanut butter sandwiches and M&Ms to keep people occupied.

Pavlopoulos did her best to keep the mood light. When the surgery was pushed back to 7:30 that evening, the medical team asked her if she needed a Xanax to calm her anxiety.

“I said, ‘No, but can you divide it up and give it to all these people?’ ” She still laughs at the memory.

A NEW LIFE

That night – June 30, 2016 – into the next day is when Alexis Pavlopoulos started her new life. The day a new heart began beating in her chest. She was 26 years old.

Less than a year earlier, when her future was uncertain, she had married her longtime sweetheart, George.

“I told him to run. He said he was in it for the long haul.”

Three-plus years have passed since her transplant, and Pavlopoulos, 30, is living a life that honors her multi-organ donor.

“I’ve taken my donor everywhere. She’s given me life; the least I can do is to show her the world.”

Chicago, Virginia Beach, Asheville (N.C.), Cabo San Lucas and last year – Greece, where Pavlopoulos met her husband’s family.

This summer, Pavlopoulos sat down to write the hardest letter she’s ever written – to her donor’s family. Following is an excerpt:

“I hope to live a life worthy of the precious gift I have been given. You and your loved one are never far from my thoughts. Thank you for your generosity and selflessness to choose to give another life. Thank you for making such a sacrifice in the deepest time of your family’s grief and saving my life. Please know that her spirit lives on. I hold her in my heart. And she is with me, literally, with every breath I take. I promise to take good care of her. I promise to honor her with everything I do.”

BEATING HEART IN A BEAR

The letter, accompanied by a bear with a recording of the donor’s heartbeat, was first sent to Pavlopoulos’ IU Health transplant coordinator, Alejandra Darroca, who then forwarded it to the Indiana Donor Network. That organization is responsible for sending it to the family, provided they are interested in hearing from their loved one’s organ recipient.

Darroca believes the bear (and letter) will be meaningful to the family because it is a gift from Pavlopoulos.

For privacy reasons associated with organ donation, organ recipients can’t divulge much personal information in their letters, said Darroca, who continues to coordinate all of Pavlopoulos’ medical care post-transplant, maintaining a vital link between her and her evolving healthcare team.

“Alexis is a very sweet girl, and the bear is a very small part of saying thank you. It’s not enough to say thank you, but I tell her the best thing you can do to thank your donor is to take care of yourself, be a good steward of your heart and help your community.”

Pavlopoulos, “the perfect patient,” is doing just that. She is eating right, working out and staying away from people during flu season as best she can. That can be hard for the self-described social butterfly.

She now is back to working full time in payroll for Indiana University, and she and her husband have bought a house. She uses her Facebook and Instagram pages to reach out to others going through similar health challenges, talking to people around the world.

Now that she knows her letter and bear have been delivered, she hopes someday to hear from the family, but it’s enough that she has been able to share a little of what is in her heart.

“A lot of people have survivor’s guilt,” she said. “I don’t. In my support group, somebody said it best: This person chose to save a life in the tragedy of losing theirs. So you honor your donor. You live a life worthy of receiving that gift.”

To learn more about organ donation, contact Indiana Donor Network.

During the 30 years she has been a transplant nurse Debra Beal has helped hundreds of patients toward recovery – including one she calls “her husband.”

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

It was September and pediatric transplant patients were wheeled around the halls of IU Health University Hospital – not Riley Hospital – in little red wagons. That was back when Debra Beal first started working at IU Health as a transplant nurse.

“When I first came on board, there were more kidney and liver transplants. Now pancreas transplants have increased. The patient stays aren’t as long and we don’t see pediatric patients anymore. They’re all at Riley,” said Debra Beal, a charge nurse and three-time Daisy nominee.

Over the past 30 years she’s seen the IU Health transplant program grow by leaps and bounds. She’s also seen the faces of countless patients turn from despair to hope.

One of those patients is her husband Mike. Not only does September mark 30 years of her service with IU Health, it’s also her birthday month and the date of her 21^st wedding anniversary.

Beal grew up and graduated from the former Soldiers and Sailors Children’s Home, in Knightstown, Ind. The home was founded in 1865 with the original intent of providing care and education for orphaned children of Civil War veterans. Over the years the state-run facility – listed on the National Register of Historic Places – expanded to meet the needs of a diverse student population. The campus provided both a Core 40 curriculum and vocational training in such areas as culinary arts, veterinary science, and building trades up until it closed in 2009.

“I came from a family of five and after my mom passed from leukemia my father couldn’t handle raising the five of us,” said Beal. She was in the first grade and the fourth of the five children – all who graduated from the home. Two of her siblings remain in Indiana and two others live in Texas.

“Because I grew up at the home I always knew I wanted to have a profession and be self-sufficient,” said Beal. First she thought about becoming a teacher but when a family member suggested nursing, the idea took hold and she pursued her degree at Indiana University.

She had been working at IU Health for 10 years when she met her husband through a computer dating service sponsored by a local radio station. Mike Beal says a friend talked him into subscribing to the dating service. He grew up in Wannamaker, Ind. and attended Franklin Central High School.

Their first date was to a little restaurant along US 40 – close enough that Debra could get to work on time. She’s worked weekends almost since the time she started at IU Health.

Not long after their first date, Mike Beal says he was on vacation in Utah and knew he was in trouble.

“I called her and she missed my phone call and boy was she mad. I knew it was the real deal then,” said Mike. After the couple married he often brought his wife dinner at the hospital during her weekend shift.

There are so many things Debra likes about working weekends but she especially likes her patients. “I think the big thing is seeing the impact on patient’s lives,” said Beal.

On Feb. 1, 2006, that impact became very personal.

Mike Beal received a liver transplant after being diagnosed with nonalcoholic stealtohepatitis (NASH). The liver inflammation is caused by a buildup of fat in the liver. Debra Beal wasn’t her husband’s transplant nurse during his hospitalization but she never left his side and admits she couldn’t resist taking his vitals and keeping tabs on his progress.

“They called me for the transplant at 5 a.m. and I didn’t get the transplant until 14 hours later. Afterward I looked up at her and said ‘I didn’t think I’d come out of it. I thought I was going to die,’” said Mike Beal. “She just stood there smiling. She’d seen it before and she knew I was going to be OK.” At the time, Beal remembers IU Health Transplant surgeon Dr. Richard Mangus was a fellow who worked on her husband’s case.

“I never imagined that situation would come into my life. My husband needed a transplant,” said Debra Beal. “It definitely put a different spin on my job. I often wondered how families handled it and did it so well. And now I know first-hand what it’s like to take care of a patient who is your family member.”

Mike Beal said not only was his wife his best “transplant support group,” but she was also his encourager – reminding him daily that there is light at the end of the tunnel. They now celebrate that transplant anniversary with trips to Hawaii.

“Transplant is different for every patient and probably the hardest thing I’ve been through in my life,” said Mike Beal. “She reminds me when to take my meds even when I’ve taken them. She cares and she’s organized and I’m the most compliant patient there is because I have no choice with her as my wife.”

Two days after Steve Hill started coughing up blood, doctors diagnosed him with an inoperable lung tumor. He went down the road of treatment options, but with little success. Then he heard about IU Health Ball Memorial Hospital’s precision genomics team. “They found the one branch of my DNA that had a defect in it,” Hill said. “Going from a baseball sized tumor to cancer free was just something I didn’t think was possible when we first started this journey.”

People who meet Dave Jackson for the first time quickly learn two things – he wants to finish the race, and he wants to inspire others.

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

First he was diagnosed with pancreatic cancer. Then Dave Jackson decided to volunteer for IU Health Simon Cancer Center and the Cancer Resource Center.

Volunteers are trained by five agency partners – including the American Cancer Society, Cancer Support Community, Leukemia & Lymphoma Society, Little Red Door, and Susan G. Komen of Central Indiana to connect patients and families with information about their diagnosis and treatment as well as community programs and support services. Jackson brings an extra punch to the service. He is a cancer patient at IU Health Simon Cancer Center and is in the care of Dr. Paul Helft.

He was diagnosed with pancreatic cancer in December of 2016 and began volunteering two years later.

“I wanted to focus on others,” said Jackson, a retired chemist with Eli Lilly who is married to Leanne Jackson. They have two daughters Katie Cannon and Emily Jackson. “I thought, ‘I’m being treated here. They’re keeping me alive, so why not volunteer here,’” said Jackson, 66. He comes to the hospital twice a month and is generally seen pushing a cart offering books, puzzles, and other complimentary materials to patients and families.

“I don’t often share my personal story but when I have I have seen it make an impact,” said Jackson. He relates how one day he was volunteering in the infusion center where a woman was sitting with her adult daughter. The mother was struggling and when Jackson told her that he is also a cancer survivor the woman’s demeanor changed

“I could see her visibly relax and I knew that was the whole reason I was there that day,” said Jackson.

It’s the kind of response he hopes for when he talks to others about cancer.

“Cancer affects every aspect of my life but doesn’t control me. I want people to know that a cancer diagnosis doesn’t necessarily mean your life stops. As long as I can do the things I love to do, I will do them,” said Jackson.

One of his favorite pastimes is bicycling – not just around the block – but serious distances. For the second year, he recently completed the Empire State Ride to End Cancer, a 500-mile ride that starts in Staten Island and ends in Niagara Falls. He and his wife are originally from New York State so the ride interested them geographically but also for the purpose – to raise funds for cancer research. Jackson averaged 40 miles a day for a total of 295 miles during the seven-day ride. He was one of 180 riders who raised in excess of $1 million for the cause – a 40 percent increase over last year’s ride.

A member of the Central Indiana Bike Association, Jackson has also participated in local rides including the Hilly Hundred, Spokes of Hope, and 24 Foundation, a ride that benefits IU Health Simon Cancer Center.

In addition to biking, Jackson practices yoga, he and his wife walk 5Ks, he plays golf and in recent years took up the violin and plays with the orchestra at St. Luke’s United Methodist Church.

“I was listening to Joshua Bell play Mendelssohn’s Violin Concerto and I was in tears it was so beautiful. I thought, ‘it’s nice to listen to but it would be even more fun to play it,’” said Jackson.

“I think people who know me know I’m 66 on the outside but I’m 11 on the inside. I’m not going to let cancer slow me down.”