An extra-happy Nurses Week to the three IU Health nurses who have been named winners of the “Lynda,” the Lynda A. Merriman Award for Compassionate Care. Thanks to the generosity of Chuck Merriman, this award honors the kind of dedicated IU Health team members who eased his wife Lynda’s seven-month battle with cancer at IU Health Simon Cancer Center and University Hospital. The Lynda is a cash award to recognize standout team members. Lynda winners are nominated by their peers at IU Health hospitals statewide.

The three winners are:

Jessica Snyder, RN is a wound ostomy continence nurse at IU Health North Hospital. She was nominated by Shelly Lancaster, RN and other colleagues at IU Health North.

“I routinely hear from her patients how they have appreciated her gentle and caring manner as much as her clinical expertise,” said Lancaster. “She regularly helps patients come to terms with their ‘new normal’ and helps them to master the self-care required to cope with a new ostomy.”

Lancaster shared one story that exemplifies Snyder’s outstanding care. Snyder had several times cared for a patient at IU Health North with complex wound care and ostomy needs. When that patient turned up in the emergency room at IU Health Saxony Hospital and was admitted there, the patient asked for Snyder. With her supervisor’s okay, Snyder packed up her supplies and traveled the half hour to IU Health Saxony. She continues to return there when this patient needs her.

Elaine Butler, RN improves the entire nursing team at IU Health Morgan Cancer Center, according to her nominator, Sonya Payne, RN.

“Most great oncology nurses demonstrate compassion—how could we not?” said Payne. But Payne says Butler is a standout because she improves the entire nursing team at the cancer center, with a special emphasis on continuing education for herself and her colleagues, and her willingness to guide new nurses. “Elaine is dedicated to her specialty,” said Payne. “She is a great role model and mentor.”

Payne pointed out two areas in particular in which Butler excels. One is having difficult conversations with patients, including discussions of death and dying. “No matter how busy she is as a charge nurse, Elaine will stop what she is doing and give the patient her full attention,” said Payne. “She truly listens—which is often what our patients need most.” The second is ensuring that the team has proper orders, education and support to practice safely, and care for every type of cancer patient.

Jean Kolp, NP at IU Health Arnett Primary Care goes well beyond medical care to deliver holistic experiences for her elderly people throughout the community, according to Brenda DeBlaso, practice manager.

“The senior population Jean works with daily can be very challenging, and she always has a smile and kinds words for her patients,” said DeBlaso. Kolp, who receives referrals from Arnett Primary Care Physicians, assists with overall wellness, psychosocial, financial and socialization issues for patients as well as their caregivers. She also holds an advisory position at Indiana Wesleyan University, in which she mentors nurse practitioner students.

In addition to completing Individualized Medicare Annual Wellness visits (she did over 900 in 2018), Kolp shares resources and opportunities with her colleagues at IU Health and throughout the seniors-serving community in Lafayette. She established the Indiana Geriatric Society of Greater Lafayette; volunteered to coordinate Healthfest 2019, which will provide education and resources to thousands of Lafayette geriatric residents and their families; and promotes socialization for seniors by volunteering for the local Senior Games and Wacky Wednesday movie days.

During the month of May, you can support outstanding nurses by donating to the Distinguished Nurse Excellence Fund, the only statewide fund benefiting nurses. Visit the IU Health Foundation to learn how contributions support people, progress and partnerships. Two additional “Lynda” winners, who are not nurses, will be announced later in May.

When Kathy Dowling needed a third kidney transplant she learned that more than 80 people volunteered as a donor. A teacher, coach and counselor, Dowling says she can’t begin to count how many students have touched her life. And she has no idea how many lives she has touched over the years.

The numbers – they are mind-boggling. One hundred seventy six surgeries and surgical procedures, four kidney transplants, one intestinal transplant, two comas, and three cardiopulmonary arrests.

Kathy Dowling is thankful to be alive.

“I love that the IU Health teams see me as a challenge. They don’t see me as a problem,” said Dowling. “They’re my people. They never give up and even if they would make a mistake, I wouldn’t care because I know they’re doing their best with a difficult situation.”

Born and raised in Greenfield, IN. Dowling took to the water at a young age. She remembers riding her bike to the Riley Park Pool, swimming all day, going home for dinner and then heading back to the pool. She went on to swim throughout high school and was a lifeguard into her college years. She attended Indiana University and started teaching English at the age of 21. She lived in Merrillville, IN. for a short time and then returned to Greenfield where she continued teaching. She obtained her master degree from Purdue University and later her life science degree from Butler University. She spent more than 33 years at Greenfield Central High School in the role of dean of students and guidance counselor. She was also the swimming and diving coach. Locally, she advocated for water adjustment lessons starting before the age of seven. Her curriculum was adopted by the Red Cross and became a national trend.

She remembers a turning point in her career when a student committed suicide and included her name in a final message. She ended up consoling fellow students and found a natural calling to counseling.

“I have no idea how many lives I’ve touched but I know an awful lot of kids who have touched mine as a teacher, counselor, dean and coach,” said Dowling.

Her health issues began in 2004 with a ruptured intestine. She developed sepsis – a potentially life-threatening condition caused when the body responds to infection. She was in a drug-induced coma and her family set up long-term home care. She wasn’t expected to come out of that unconscious state. A year later she ended back in the hospital – this time at IU Health – where doctors began treating her for renal failure. She had her first kidney transplant in 2007 and a second one three years later – both kidney donors were friends – a Greenfield minister and a drama director at Greenfield Central High School. In 2014 she had a multivisceral transplant – another kidney and an intestine. When that kidney failed, she began dialysis and a fourth transplant followed. In December 2018, she was diagnosed with stomach cancer – another surgery followed to remove the tumor. Throughout her multiple hospitalizations she was in the care of IU Health nephrologist Tim E. Taber and transplant surgeons Dr. William C. Goggins and Dr. Richard Mangus.

“I’ve been an educator my whole life and IU Health is a teaching hospital so they work as a team and you see them learning from each situation, each challenge that comes their way. They’ve always made me feel so confident in their choices. They tell me they learn from my health challenges but they also say they’ve learned from my spirit,” said Dowling.

Now when she returns to IU Health once a month for lab work she is greeted with hugs and smiles. She sees lots of familiar faces – the person who cleaned her room, the receptionist at the front desk, the parking attendant, and lots of nurses. The list goes on. “I have met some wonderful people. They have all had a role in my healthcare,” said Dowling.

When she retired from Greenfield Central High School, she ran for school board and is serving her second term. She also volunteers in a first grade classroom two days a week and serves on the board of the Greenfield Parks and Recreation.

“I just care about kids and I think you learn better when you’re having fun in the classroom. There has to be one person who makes them feel special – I hope I’m that one person,” said Dowling “I think I have a lot of prayer warriors and God isn’t done with me yet. When anyone asks how I’m doing I say ‘every day is a victory.’ What I’ve been through has made life easy because you live each day like it’s your last.”

— By T.J. Banes, Journalist, IU Health.
Reach Banes via email tfender1@iuhealth.org.

The note, written in the neat handwriting of a mechanical engineer, simply said, “Rosemary and I will never be able to thank you enough for everything that you have done for us. We will never be able to pay you back for our ‘miracle’ transplant. Hopefully you can use this donation to advance your cause.” Enclosed was a $25,000 check.

In late 2013, Joe (who asked us not to use his last name) had swollen legs and trouble catching his breath. He and his wife Rosemary went to the hospital near their Fort Mitchell, KY. home, where Joe was diagnosed with two dozen blood clots in both lungs. He was admitted, stayed for seven days, and then sent home with 24-hour oxygen. Six weeks later, still with no clear diagnosis, Joe was referred to University of Cincinnati Medical Center, which diagnosed him with interstitial lung disease and prescribed medications to slow the disease’s progression. However, Joe’s health steadily declined for three more years.

In September 2017, when the need for a transplant became evident, Joe’s doctors referred him to IU Health and David Roe, MD, medical director of Lung Transplant and ECMO at IU Health Methodist Hospital. Dr. Roe wanted to admit Joe immediately due to the seriousness of his disease, but allowed him to return home as long as he logged his functions and oxygen levels and emailed them to Dr. Roe.

In November, Joe failed the six-minute walk test, an indicator of pulmonary health. He was declining and the transplant team decided to list him for a lung transplant. Two days later, they called again and said to come for the transplant. “I was at rehab, and I got this call saying to be there by 5 pm,” said Joe. While Rosemary packed the car for the two-and-a-half-hour drive, Joe—always the engineer—changed the furnace filters.

The surgery took nearly 12 hours, and Joe spent 28 days in the hospital, with kidney complications that required a brief time on dialysis. He was then expected to spend 30 days in the Center of Life for Thoracic Transplant (COLTT), but completed his therapy there in just two weeks.

During Joe’s time at Methodist, Rosemary was especially grateful for the support of the nursing staff. “We’ve been through every nurse,” she said. “The thing is: they really treat you with respect.” She documented the entire process in a journal.

They noted that Katie Bussard, RN, BSN, ACNP, helped motivate Joe. “Katie gave Joe a challenge every day,” said Rosemary. “Joe made sure to do a little more every day.”

Bussard said, “We are kind of pushy, because we know that constant participation is what makes patients better. I call our floor boot camp, because we want to know that patients can do what the COLTT requires.”

Bussard, whose mother’s work as a nurse inspired her, began her career at IU Health in Adult Critical Care, then earned her master’s degree to become a nurse practitioner. “I had worked in the ICU as a bedside nurse for my whole career and loved the complexity and intensity of the patients. I particularly became interested in the pulmonary aspect of critical care, and that is one of the reasons I wanted to work with the lung transplant team,” she said. “Our role is a complex one. We are nurses who have advanced training and education allowing us to work alongside physicians and other healthcare providers to care for critically ill patients.”

She especially enjoys bumping into former patients who return for follow-up appointments or just stop in to visit. “It is so great to see them once they have fully recovered from their transplant and are back to normal everyday life,” she said.

Joe added, “This whole IU Health facility is unbelievable—the best I’ve ever seen, from the housekeeping staff to the surgeons. After 12 days on a liquid diet, my first real meal since surgery was noodles and beef—the best food ever.”

Even before Joe was discharged, the couple had discussed how to show their gratitude. “We’re so blessed,” Joe said. Their $25,000 gift to the IU Health Foundation carried the stipulation that Roe determine how the money was spent. He has suggested using the gift to fund the home spirometry program, so patients can report their lung capacity via their cell phones without having to leave home.

Now things are pretty much back to normal, and Joe is back in the office. He said, “The guys at work say, When are you going to retire? Retire? I just started over!”

During Nurses Week, May 6 through 12, you can support outstanding nurses by donating to the Distinguished Nurse Excellence Fund. Or explore other giving options through the IU Health Foundation.

A former elite swimmer opens up about the physical and mental toll her gastrointestinal condition took on her well-being – and how psychotherapy saved her.

When Renice Dobbs paces the pool deck, cheering on the west-side swim team she coaches, she’d love to be able to jump in, maybe even race her young crew. Dobbs was once a championship swimmer. She took to the water at the age of 12 and competed with USA Swimming as a member of Indy Dolphins. She even had dreams of making it to the Olympics or at least to the Olympic Trials.

Now the closest she can get to the water is the pool deck. A central line in her chest gives her body nourishment as she struggles with the physical and mental effects of gastroparesis – a disease in which the stomach cannot empty itself of food in a normal fashion.

Still, just being near the water is progress for the 28-year-old Brownsburg resident, who felt her life slipping away as she endured debilitating symptoms, multiple hospitalizations and emergency department visits while doctors tried to find the cause of her nausea, vomiting and weight loss.

It was shortly after her 25^th birthday in 2015 when Dobbs started to feel ill. She doesn’t tie it to a specific event, saying it started randomly.

“I thought it was the flu, and it wasn’t the flu,” she said. “Then I thought I was pregnant, and I wasn’t pregnant. It spiraled out of control from there.”

She underwent test after test, she tried medications, and she had her gall bladder removed. Each time, she hoped to find relief. When her symptoms persisted over a year’s time, she and her husband, Michael, opted to go to the Mayo Clinic in Jacksonville, Fla., where the diagnosis of gastroparesis was eventually made after several visits.

By then, she had lost nearly 40 pounds off her 5-foot, 5-inch frame. Her weight dipped to 107 pounds before doctors put in a feeding tube. Doctors in Florida transferred her to IU Health gastroenterologist Andrea Shin.

For the next year, Dobbs was in and out of the hospital, dealing with dehydration, anemia and problems with her feeding tube. She spent Thanksgiving 2017 in the hospital. That was hard enough. Then she was let go from her job as an administrative assistant.

“Things were crumbling around me,” she said.

IN SICKNESS AND IN HEALTH

One bright spot in her ordeal was her husband, who supported her in every way he knew how.

“We’ve been married for six years, and half of it has been me being sick,” she said. “He’s been doing a great job with the ‘in sickness and in health’ part.”

What Dobbs didn’t know during this time was that her symptoms were being aggravated by anxiety and stress. It took several visits with a psychologist for that to sink in with her.

When Dr. Shin suggested she make an appointment with Dr. Anne Mary Montero, a clinical psychologist with the GI division (technically Digestive and Liver Disorders) at IU Health, she was resistant, to put it mildly.

“I’m doing fine,” she told everyone. “Why can’t everybody see that I’m doing fine?”

But in reality, she said, “I was not doing fine at all. I needed Dr. Montero, and I couldn’t see that, and no one could point that out to me without it being offensive to me.”

IT’S NOT ALL IN YOUR HEAD

None of that surprises Dr. Montero, who explains that she is prohibited ethically from discussing any patient’s case but is free to speak in general about treating individuals who suffer a combination of physical and psychological reactions to chronic and/or serious illness.

The physical condition is real, she tells patients, just as the stress is real. But the stigma surrounding mental health can get in the way of proper treatment.

“It’s so unfortunate that the very symptom patients are coming in to get support for can be misinterpreted or internalized as something that patients commonly may feel – that their doctor either doesn’t believe them, thinks they’re ‘crazy’ or thinks it’s all in their head,” she said.

There’s no such thing as “all in your head,” she tells them. Half of all physical symptoms cannot be fully explained by identified medical conditions.

“Physicians who are looking at the constellation of a patient’s symptoms, with all of their experience, intellect and testing resources, may be able to identify a number of significant contributors but remarkably, up to 50 percent can’t be fully medically explained.”

Dr. Montero, who has offices at IU Health North Hospital and IU Health Springmill Medical Clinic, appreciates when the medical care team incorporates mental health providers into a patient’s care when warranted. Psychological factors can constitute at least one layer contributing to a patient’s symptoms. But that doesn’t mitigate other layers that might also contribute, she said.

With 20 years’ experience in the field, she has studied in depth what she calls the brain-gut axis, which describes how the two areas of the body communicate with each other.

Essentially, what’s going on in your gut can affect your brain and vice versa. It can become a vicious cycle.

“It’s how our bodies are wired,” Dr. Montero said. “Digestive organs are like a central processing unit in the body that collectively regulates a lot of our body’s functions. Among those are some emotional responses. It’s a two-way arrow, a reverberating process where one end of the domain affects the other.”

By the time patients meet with her, they often are discouraged after months or years of tests and treatments. They may have had to stop working, their relationships may be in peril, and their quality of life has suffered greatly. It’s no surprise they are skeptical of the focus on their mental health when it’s their physical health that is the problem.

“All kinds of emotions build up before they have the chance to get to my office. Emotional distress feels nebulous and it’s hard to imagine how that can be treated,” she said.

Patients often feel someone is going to blame them for having this distress, she said. “I say the opposite – this is a normal part of the brain-gut interaction; people just aren’t aware of it.”

One of the first things she tells patients is that their symptoms are real, their condition is real. Her job is to help them identify stressors and triggers that aggravate their physical condition, then come up with exercises to manage those stressors.

“I FELT HEARD FOR THE FIRST TIME”

For Dobbs that meant coming up with techniques to deal with nausea and vomiting, the latter often happening three times a day. She practices breathing and visualization exercises to keep the vomiting at bay, though the nausea is always with her, she said. She has gone two months now without a vomiting spell.

After two years of multiple in-patient hospital stays and trips to the emergency department, Dobbs recently celebrated a year without a hospital stay or ED visit. She attributes that to Dr. Montero.

“I felt heard for the first time,” she said.

She admits she didn’t want to talk to a psychologist at first. She knew her symptoms weren’t all in her head, and she was relieved when Dr. Montero assured her she was right.

“I think I even cried,” Dobbs said, after her second visit to the therapist. “I really opened up. I needed somebody to talk to and she was right there.”

In the back of her mind, Dobbs said, she always knew there had to be a connection between her emotional state and her physical health.

“It was something I needed to come to terms with. I’ll always have this baseline condition, but if I’m not handling these other stressors that are triggers, this isn’t going to get better, it’s going to get worse. That was a reality check for me,” she said. “You have this physical condition and when you add stress and anxiety on top of that, it starts to spin out of control. It gets so big no amount of medication or treatment is going to get you back.”

She acknowledges she doesn’t have it all under control, but her monthly appointments with Dr. Montero help guide her through the worst of it.

Two or three years ago, when she was suffering the worst of her symptoms, she said she would wake up every morning feeling physically terrible and mentally exhausted. Hopeless even.

“Even though I still wake up physically exhausted, I feel more ready to take on the world,” she said. “It’s hard to believe that 10 years ago I was a very competitive athlete on the national level.”

Life has changed, but now Dobbs pours her energy into the young swimmers she coaches as part of the USA Swimming club Giant Aquatics.

“It’s my outlet,” she said. It helps her forget about everything else.

The other distraction she and her husband live for is Disney World. They are Disney Vacation Club members, visiting the parks and resorts a few times a year. “It’s a chance to get away from the real world. It’s a magical place.”

They even named their Miniature Australian Shepherd pup Oswald (Ozzie) for Walt Disney’s Oswald the Lucky Rabbit cartoon character, which dates back to the 1920s.

REDUCING THE STIGMA

Dobbs agreed to share her deeply personal story because she hopes to encourage others in similar situations to reach out for help.

“Not every mental health professional is trying to pin you with a ‘crazy’ label. They’re really trying to help you. You can put your faith in them. Dr. Montero deserves to know that’s how I feel about this. She’s been that amazing to me and my journey.”

For her part, Dr. Montero said she is honored when people allow her to come into their lives at such a vulnerable moment. For psychotherapy to be successful, patients have to lean in and engage during treatment, she said.

“As much as I wish I could wave a magic wand and help people feel better, it’s more like dancing. You have to lean in toward one another and teach them steps so they can learn how to do the healing increasingly independently.”

When patients arrive already discouraged, it takes a lot more effort to move forward, she said. “But if they’re open and can lean in with me, I never cease to be amazed at the resilience of the human spirit and the human body.”

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