The Fatigue Project

We have the opportunity to be agents of transformation, fighting cancer-related fatigue and bringing to life one year of research of a fellow nurse. The project "Step Into Life" makes nurses and patients partners in combating a problem that afflicts more than 80 percent of all cancer patients and is the most-prevalent and least-treated symptom for stem cell and bone marrow transplant patients.

As a Stanford evidence-based fellow, Laila Craveiro developed a self-guided walking program for patients following the most current Cancer Network guidelines that list exercise as the number one non-pharmacologic intervention to address cancer-related fatigue.

We'll start in-services on the week of March 26 to teach the staff how to use the program. Binders with handouts for patients will be at the breezeway. Come to the various in-services, earn a T-shirt and become a buddy for a patient who might have you as a mentor in a journey of steps -- literally -- that can make a huge difference in the patient's long walk to recovery.

More from the bulletin board

Renewing Your Strength

How many times have you heard a nurse saying in confidence: "I love my job but I'm burned out.'' Here's your to chance to earn contact hours and spend a weekend at the UCLA retreat conference center at Lake Arrowhead, nestled in the San Bernardino Mountains.

UCLA is offering a Renewal Program for Healthcare Professionals called "Circle of Caring.'' The program is from April 13-15.

For more information contact the UCLA Healthcare Ethics Center at (310) 794-0185.

News from Home Pharmacy

Home Pharmacy wants us to know that we can control the time our patients go home. Really.

• Any medication orders faxed and received by noon at Home Pharmacy can be delivered to E1 that same day at 16:30.
• Orders faxed to Home Pharmacy between noon and 14:00 have to be followed up with a phone call so Home Pharmacy can determine if there is staff available to process the orders.
• Orders faxed between 14:00 and 16:00 will be delivered to E1 the next day at 11:30.
• Orders faxed after 16:00 will be delivered the next day at 16:30.

For Auto transplant patients: Get discharge orders on the day of transplant (day before discharge). Assess fluid intake since most patients will need 1L of IV fluids a day on top of their heparin drip. It's always a good idea to check with the caregivers to make them available for Home Pharmacy teaching.

For Allo patients: Notify Home Pharmacy as soon as discharge date is set. They more likely will be discharged with immunosuppressant IV drugs. The same rule applies about caregivers. Notify them to come for teaching about the ambulatory pump use.

Home Pharmacy is open M-F 9:00 to 17:00 with a pharmacist on call through the pager 17563.
The on-call pharmacy for the weekend can be reached at (650) 725-5087.

From the desk of Theresa Latchford

Ever have questions like: Do the social workers ever evaluate patients coping mechanisms? Why do some patients get GCSF from home pharmacy and others from Walgreen’s? Who is that guy in the jeans and brown hair that regularly comes onto the unit? Why don’t the insurance companies allow us to admit patients after mobilization? Who really runs the BMT program? Which patients do the nurse practitioners see? Where all the tranplant cells are kept? It is now the time to find out the answers to all your BMT program related questions…..Come joining us on brown bag lunch days (dates and themes posted in the nursing conference room). Eat your lunch, ask questions, and meet other BMT program department team members.

The next BMT Lunch and Learn Lecture is set for Wednesday, March 14, 1 p.m. with David Miklos, MD, talking about boosting alloimmunity through DLI.

Master’s Degree in Nursing

Going back to school doesn’t have to be difficult. San Francisco State University in collobaration with Stanford Hospital and Lucile Packard is offering an MSN program with courses located at SHC &LPCH. There will be four informational sessions during March at LPCH to discuss the program and recruit students for the third cohort program. Amy Nichols, Associate Director for the program, will be there to answer questions. Sessions are: March 13, 4-5 p.m. at LPCH boardroom, 1st floor. March 15, 4-5 pm, at LPCH boardroom, 1st floor. March 20, 4-5 pm, ground floor conference room LPCH March 27, 4-5 pm, ground floor conference room LPCH.

Recipe Corner

From Lynn Ellison’s Weight Watcher Kitchen Southern-style oven fried chicken Point value 5 Preparation time - 15 min Cooking time - 20 min 1/2 cup all-purpose flour 1/4 tsp table salt 1/8 tsp cayenne pepper or black pepper 3 oz buttermilk 3/4 cup cornflake crumbs 1 pound uncooked boneless, skinless chicken breast, (cut into 4 oz pieces if on weight watchers) 1. Preheat oven to 365 degrees. Lightly coat an 8x8x2 inch baking dish with nonstick cooking spray; set aside. 2. Combine flour, salt and cayenne (or black) pepper together in a medium bowl. Place buttermilk and corn flakes crumbs in to 2 SEPARATE bowls. 3. Roll chicken breast halves in flour mixture and evenly coat each side. Next dip chicken into buttermilk and then corn flake crumbs. 4. place coated chicken breasts in prepared baking dish. Bake until chicken is tender and no longer pink, about 20 minutes (there is no need to flip the chicken during baking). If you are not watching your weight, you can substitute 2 eggs beaten for the buttermilk.

Bulletin board

Study Group

If you are planning to take the next OCN certification exam, you might want to check out this informal group review class facilitated by Debra Thaler Demers. The group meets March 25, from 8 am to 5 pm at CC2103. To RSVP, email Albert at amedina@stanfordmed.org

Staff Support Group

Wednesday, March 7, from 2-3 pm in the E1 conference room, we have a chance to discuss loss and grieving in a support group designed for the nursing staff. Judy Passaglia, palliative care project manager, will lead the discussion.

Dinner and discussion

Robert Lowsky, MD, will provide update on ASH and ASBMT at a dinner at on Wednesday, March 14, at Parkside Grill in Portola Valley. For reservations, call 650-725-3004 by March 8.

Read and Learn

Dr. Kate Tierney keeps offering wisdom, chocolates for right clinical answers and good articles to read around E1. She advertises the last selection in the binder with selected literature that she prepares.

An article from Newsweek: "Fixing America's Hospitals” and "Hematopoietic Stem Cell Transplantation: Implications for Critical Care Nurses" from the last edition of the Clinical Journal of Oncology Nursing, 2007. “Nice review of the numerous complications of transplant,” she says. Check it out.

Book Club

The Unit’s book club meets again at 7 p.m., Thursday, March 15, to discuss “Love in the Time of Cholera’’ by Gabriel Garcia Marquez. It’s an ingenious, enchanting and improbable love story that takes place in a fictitious Caribbean setting. It is from a Nobel Prize winning writer who knows how to translate, without sappy or obvious tricks, that inner island of magic in the sea of human hopes. Bring a dish and your thoughts on the book to Laila Craveiro’s house, 3229 Maddux Drive, Palo Alto.

Kids play group

Have kids younger than 6? Join the unit’s monthly play group. Meeting times and locations vary. If you are interested, look for the next email about the group’s goings-on.

Get to Know … Janet Metcalfe (March 2007)

There are people who keep track of their lives in moons or sunrises – like in the old days. Janet Metcalfe counts her time in the years she has survived breast cancer -- 10 -- and the years she has been a nurse -- 37. Or, for that matter, by the number of years until she retires form this major role in her life. “July 20, 2012,” she announces, “that is the date. I will be done then.”

So she says.

And so it is anticipated on her new vanity license plate: JOCAR5. It stands for “Janet, obsessive- compulsive, awaits for retirement in five years.” Although Janet whispers with a funny, smart-like drop in her eyebrow, that the “AR” can also be the self-deprecating initials of traits that “cannot be published…” she makes clear.

All who know Janet well fear that self-imposed time-frame for E1, the unit that has benefited from her professional expertise for a little more than 20 of her 35 years as a Stanford employee. “Our medical supplies will go to space the day after she steps out of here,” says Donna Clem, a good friend and fellow night-nurse champion.

“Mission Organization -- that should be her motto,” says Heidi Flores, another close friend within the Blood and Marrow Program. Janet’s intensity is obvious to all who get and give shift report to her. She is engaged right now in yet another major clean-up project after the staff refrigerator was put in order. The target of the day is the staff lounge. Be aware of the dates and rules. Janet is like a mother with a goal in mind: your room. Shoes, cupboards, lockers…nothing will be overlooked.

She is always planning ahead. Getting prepared for what is in store. Looking for her place in the future.

Within the hospital, it means full engagement with the committee working with Epic, the still-to-come better and improved electronic documentation program. On a personal level, the future holds the dream of quarterly visits to her recently-married son and daughter-in-law in San Diego. More time in Florida, with her youngest sister, a new golf aficionado who recently made her first hole-in-one with a pink golf ball, a fundraiser item for breast cancer research, a gift from Janet. “That was pretty special, I would say…Do you now how rare that is? And at the 10^th anniversary of my recovery?”

The baby-sister, who has a twin brother, has been responsible for Janet’s frequent flyer miles lately. “I only like to travel to be with family. I had never made a move to go to Europe or Hawaii,” she said. Janet and her sister are very close. “It was very hard when she moved from Pleasanton to Fort Lauderdale,” Janet explains. “We are the kind of people who had had the same Christmas breakfast together since grammar school.” But they talk on the phone regularly, at set times, so as not to interrupt some of Janet’s favorite TV shows: Survivor, Lost and 24.

Janet is the eldest of four children. She had a quiet and fun-filled childhood in Palo Alto, “biking everywhere,” she says. She was born in Wisconsin, but came to California as a toddler and the Bay Area instantly became home.

Janet’s mother was a nurse at Stanford and her father worked at the Red Barn close to the Hospital. At that time, the Barn was the high-tech site for artificial insemination of Holstein cows. Janet can recall running to tumble on hay where today Nordstrom’s department store is located.

She also recalls being the charge nurse one day and having her mother floating to her floor. “That was weird…But she did well…” Janet says of her late Mom, a woman whom she admired and took care of during a battle against cancer. Janet holds dear memories of her mother and her presence in a middle name: Ann.

With her mother’s gift of a stuffed hippopotamus when she was 12, Janet started a lifetime collection of figurines of the animal. Janet also has an impressive number of Hallmark Christmas ornaments: “About 600,” she estimates.

Two years ago Janet had to have almost half of her stomach removed due to a massive ulcer. A great outcome, she states. The physicians initially thought it was another malignancy. She tells of the event with a sense of humor: “I finally lost the 40 pounds I needed to let go since my pregnancy over 30 years ago.” She only pities herself for not being able to eat popcorn at the movies anymore, “I do not digest it well. I have to watch what I eat.” So she adjusted a few new recipes to accommodate her “weaker stomach,” such as the precise mix of ¼ of regular coffee to one cup of decaffeinated coffee to take her through a night shift of work. Her only culinary claim to fame though, she makes clear, is her expected contribution to unit parties: a warm artichoke dip. “All the rest I microwave. I would starve without a microwave,” she says.

She has an intact stomach for action movies though. “Kill Bill”, from Quentin Tarantino is one of her favorite movies. She likes action flicks. Really. The ones with more blood than what we transfuse at work. That is true also for books. Steven King is a winner on her list. “I would never read those books from the unit’s book club,” she comments feeling sorry for the taste of the group’s selection.

Janet is amazing in her honesty. She can be blunt. But she will say things in front of you, never behind your back. To make people “better, their best,” she says while trying to acknowledge her own intensity. She can be funny too. If you had never seen her tap-dancing with EKG leads on the soles of her shoes to the tune of her Lasix song, make sure to place a performance request. She also has jokes that will be told for generations of Stanford nurses as a Janet classic. Like the one she cracked in a Statue-of-Liberty-like pose with a dinner roll stuck on a fork. She asked, very seriously: “What is that?” to confused, wide eyes all around. She loses her patience and opens a victorious smile over the slow response: “an elevated BUN, people, an elevated BUN.” That is Janet -- in all her glory.

Get to Know ... Fu-Ying (May 2006)

Fu-Ying Lee-Lam. The name makes an impression. Short sounds laced together by hyphens, by layers of life. The first part means “flower after the rain”, a traditional Cantonese name given to a petite, rose-cheeked girl, the eighth and last child of the Lee family. Lam came with marriage, 13 years ago. She met her soul mate as a fellow traveler for part of her three-month incursion through eight Asian countries in the early 90s.

Fu, as every body calls her now, was born in Hong-Kong and moved with her hole family, at age three, to “the ghetto”, as she describes the lower east side Manhattan. “We have the classic immigrant history,” she says while describing the journey to America for better opportunities in life. Her father was a fireman and her mother used to sell vegetables in the market. She recalls her mother, currently the director of a Chinese opera school, telling how an uncle decided to sponsor them and how his wife “changed her mind about it when was too late.” The thought still makes Fu’s skin to crawl, but she sees meaning in telling the story as an example of the struggle they all lived to build a new beginning. “It was ruff,” she sighs in her New York accent, listing tells of robberies, butcher knifes used as self defense and life or death fights for nothing more than pocket change and pieces of gum. “I will never forget the day when we heard a thump in the front door and it was my Dad knocking in despair with the back of his feet. He had his mouth muffled and was being attacked. He escaped by luck.”

Her family entrepreneur abilities moved them out of that situation. They all worked on the garment industry, “sweat shops, really,” she says. Until they bought a home in Queens. When Fu entered third grade, her family acquired their own production line to work for either bigger factories or small business such as restaurants. “The first three children had no choice but to work. Yet five of us went to college.”

Fu grew up liking volleyball and French language. “Although I am fluent in Cantonese, I do write in French much better,” she says in a shy voice as if her multiple talents require an apology. She had the chance to visit France and to know Paris well. But her biggest traveler impression was in mainland China : “all that history, all that people and the Terracotta sculptures in Xian.”

She never though of a career choice until she worked in a neighborhood pharmacy store during high school. “I found a drug instruction book and, out of the blue, I quizzed the pharmacist. The fact that she knew all the medicines made an impression on me,” Fu explains. “I guess I wanted to be that knowledgeable about something too.”

And so she is. On medications and life. Fu is one of E1 pharmacists.

She bridged her way through two cultures, two American coasts, and millions of pharmacologic choices for stem cell recipients. She has three girls, two are twins, and a fun life with her husband that fully recovered from a “Christopher Rives-like horse back riding accident” six-month after their marriage. “It was more than a month in a hospital. It was very scary.” Yet she keeps insisting that her life is “not that interesting…what do I have to tell?” Our guess is that the secret is in the layers. On all those hyphens. Fu-Ying Lee-Lam. She makes even a bigger impression than her name does.

Get to know ... Jenny Llacer (Feb. 2006)

We’re all used to seeing Jenny Llacer sailing smoothly across the BMT unit from one acutely ill patient to another. We just never knew she could also sail between Fiji and Tonga.

Jenny’s done just that, not to mention the Mediterranean and the Panama Canal, in her family’s glamour-free boat. She navigated along with her step-father and other two or three crew.

Along the way, she rejoiced in four-hour sentinel watches on the most wide-open brilliant seas – no call light rings, no beeping IV pumps, no cardiac monitor alarms.

Jenny has always been a coastal girl. She grew up chasing crabs in the West Coast beaches of Southern California and had her share of ocean views when her father’s physics research moved the family to Long Island. There were frequent childhood visits to her father’s native Spain and her mother’s homeland in The Philippines. Back on this coast, Jenny studied biology at UC-Santa Cruz – “a radical surf town, a little empty-headed and a little politically engaged. I felt comfortable there.’’

But she felt a little isolated in her first career, cloning orchids for a commercial grower. Her favorite was a three-pedaled, fluorescent orchid from the mountains of South American called Masdevallia. The job required Jenny to spend hours cultivating orchid seeds, as tiny as dust particles, in sterile dishes. Lots of labor, little pay, but very peaceful. Her work among the orchids allowed Jenny many hours of meditation and sailing through the green. “I walked through a fantasy,’’ she recalled, “but the plants didn’t talk back. They were slow growing and I wanted to run.’’

So Jenny headed east again, earning her second bachelor’s, this time in nursing in New Jersey. With a goal to work with elderly patients, to soak up their wisdom, she accepted a job in oncology at the University of Pennsylvania. Then her husband-to-be Paul’s desire to head back to the West Coast got the new couple as far as Chicago for another stop – and a wedding in which Jenny donned a $39 white summer dress she found on sale just before the ceremony.

The couple and their daughter Isabel moved to California in 1999. Jenny’s been working at Stanford since then. Now that her daughter is 7 years old, Jenny is nurturing dreams to sail again, this time with husband and daughter in tow – “if Trisha lets me go,’’ she says with a witty smile, for a taste of adventure this summer to explore French Polynesia.