Showing posts with label Medicine. Show all posts
Showing posts with label Medicine. Show all posts

Dignity therapy: Making the last words count

Guided conversations with the terminally ill are popular with patients, families and doctors who’ve experienced them. But are they truly beneficial? Researchers are looking beneath the anecdotal appeal.

By Lola Butcher - October 08, 2021

This article was originally published in Knowable Magazine

In the mid-1990s, psychiatrist Harvey Max Chochinov and his colleagues were researching depression and anxiety in patients approaching the end of their lives when they became curious about this question: Why do some dying people wish for death and contemplate suicide while others, burdened with similar symptoms, experience serenity and a will to live right up to their last days?

Over the next decade, Chochinov’s team at the University of Manitoba in Canada developed a therapy designed to reduce depression, desire for death and suicidal thoughts at the end of life. Dignity therapy, as it is called, involves a guided conversation with a trained therapist to allow dying people to speak about the things that matter most to them. “It is a conversation that we invite people into, to allow them to say the things they would want said before they are no longer in a position to be able to say it themselves,” Chochinov says.

Dignity therapy is little known to the general public but it has captivated end-of-life researchers around the world. Studies have yet to pin down exactly what benefits it confers, but research keeps confirming one thing: Patients, families and clinicians love it.

These end-of-life conversations are important, says Deborah Carr, a sociologist at Boston University who studies well-being in the last stages of life and explored the topic in the 2019 Annual Review of Sociology. A key need of people who know they are dying is tending to relationships with people who are important to them. This includes “being able to communicate their wishes to family and ensuring that their loved ones are able to say goodbye without regret,” she says.

And the closer we get to death, the more we need to understand what our lives have amounted to, says Kenneth J. Doka, senior vice president for grief programs for Hospice Foundation of America. “As people reach the end of life, they want to look back and say, ‘My life counted. My life mattered. My life had value, had some importance,’ in whatever way they define it,” Doka says. “I think dignity therapy speaks to that need to find meaning in life and does it in a very structured and very successful way.”

A dignified ending

Chochinov’s search to understand why some people feel despair at the end of life while others do not led him to countries like Belgium, the Netherlands and Luxembourg, where euthanasia and assisted suicide have long been legal. There he learned that the most common reason people gave for seeking assisted suicide was loss of dignity.

To learn more, Chochinov and his colleagues asked 213 terminal cancer patients to rate their sense of dignity on a seven-point scale. Nearly half reported a loss of dignity to some degree, and 7.5 percent identified loss of dignity as a significant concern. Patients in this latter group were much more likely to report pain, desire for death, anxiety and depression than those who reported little or no loss of dignity.

Dignity at the end of life means different things to different people, but in interviews with 50 terminally ill patients, Chochinov and his colleagues found that one of the most common answers related to a dying person’s perception of how they were seen by others. “Dignity is about being deserving of honor, respect or esteem,” Chochinov says. “Patients who felt a lost sense of dignity oftentimes perceived that others didn’t see them as somebody who had a continued sense of worth.”

Dignity therapy is tailored to enhance this sense of worth. In a session, a therapist — typically a clinician or social worker — carefully leads the patient through a series of nine questions (see graphic) that help a person express how their life has been worthwhile. “It’s not like a recipe, that you can just read out these nine questions and then call it dignity therapy,” Chochinov says. “We train therapists so that we can help them guide people through a very organic kind of conversation.”

The session typically lasts around an hour. About half is spent gathering biographical highlights, and the other half focuses on what Chochinov calls the “more wisdom-laden” thoughts that the patient wants to share. A few days later, the patient receives an edited draft for review. “There’s an ethos of immediacy — your words matter, you matter,” he says. “They can edit it and they can sign off on it to say, ‘That is what I want as part of my legacy.’”

Dignity therapy uses this standard set of nine questions as a starting point for discussion. The questions invite the dying person to evaluate their life and offer their wisdom to family and friends.

But does it work?

Miguel Julião, a physician in Lisbon, Portugal, specializes in helping patients who have difficult symptoms, which is why he was asked one day a few years ago to see a patient suffering with unbearable pain. “The minute I got into his room, he told me ‘I would like you to help me die soon,’” Julião says. “I told him, ‘I don’t agree with euthanasia and I don’t do it, but I would like to know about you as a person and what you are most proud of in your life.’”

In the next few minutes, Julião learned about the man’s pride in raising “two good human beings” and stories of their life as a family. And he received an invitation to return for more conversations, which continued until the man died a month later.

The encounter prompted Julião, who was pursuing his doctorate at the time, to pivot his research and focus squarely on dignity therapy. He has had lots of company. Chochinov estimates that nearly 100 peer-reviewed research papers, and at least four in-depth analyses — “systematic reviews” of the accumulated science — have been published so far, and more studies are ongoing. The largest study yet, of 560 patients treated at six sites across the country, is now being conducted by Diana Wilkie, a nursing professor at the University of Florida, and colleagues.

Wilkie also helped conduct the first systematic review, published in 2015, which came up with a conundrum. When all studies were viewed together, the evidence that dignity therapy reduced desire for death was lacking. “The findings have been mixed,” she says. “In the smaller studies, you see benefit sometimes and sometimes not; in the larger studies, not.”

The most definitive study — Chochinov’s original clinical trial, completed by 326 adults in Canada, the United States and Australia who were expected to live six months or less — found that the therapy did not mitigate “outright distress such as depression, desire for death or suicidality,” although it provided other benefits, including an improved quality of life and a change in how the patients’ family regarded and appreciated them. A few years later, however, Julião conducted a much smaller trial in Portugal in which dignity therapy did reduce demoralization, desire for death, depression and anxiety.

Julião thinks that the different outcomes reflect differences in the patient groups: His study focused on people experiencing high levels of distress, while Chochinov’s did not. But Julião also notes that his study was small, with only 80 participants. “We still need more evidence,” he says. “But, on the other hand, you see a high interest among clinicians, because they see it work in daily practice.”

Positive and negative results also may depend upon how studies measure “success.” Scott Irwin, a psychiatrist at Cedars-Sinai Cancer in Los Angeles, worked at a San Diego hospice that introduced dignity therapy in 2009. “It was absolutely worthwhile — no question,” Irwin says. “Not only did the patients love it, but the nurses loved it and got to know their patients better. It was sort of a transformative experience for patients and the care team.”

Researchers reviewed the “legacy documents” — the tangible product of dignity therapy — of 27 patients at a hospice in San Diego to determine what they talked about with the therapist. These are the most common themes that emerged, shown with the percentage of patients who touched on that theme.

Indeed, Wilkie’s literature review reported “overwhelming acceptability, rare for any medical intervention.” Patients seem to get something out of it, even if that “something” isn’t captured by measures like reduced desire for death. In one study of 100 terminally ill patients who received dignity therapy, 91 percent reported feeling satisfied or highly satisfied; in another, 93 percent gave high ratings of satisfaction.

In Portugal, family members of dying individuals have prompted Julião to develop new uses for the therapy. He and Chochinov first adapted the interview to be appropriate for adolescents. More recently, two individuals told Julião they regretted that their loved ones had died without receiving dignity therapy, prompting the researchers to create a posthumous therapy for surviving friends and family members.

In a study of this interview protocol for survivors, “we have wonderful, wonderful comments from people saying, ‘It’s like I’m here with him or with her,’” Julião says. Doing dignity therapy posthumously could be useful in helping families deal with bereavement, he says — an idea he’d like to test.

Barriers to use

But for all its appeal, few patients actually receive dignity therapy. Though the tool is well-known among clinicians and social workers who specialize in caring for seriously ill patients, it is not routinely available in the US, Doka says.

A primary barrier is time. The therapy session is designed to last just one hour, but in Irwin’s experience at the hospice, patients were often too tired or pain-ridden to get through the entire interview in one session. On average, a therapist met with a patient four times. And the interview then had to be edited by someone trained to create a concise narrative that is true to the patient’s perspective and sensitive in dealing with any comments that might be painful for loved ones to read.

Julião says he transcribes each patient’s interview himself and also edits it into the legacy document. The entire process typically takes about eight days; he suspects this is why he is one of only two people who provide dignity therapy in Portugal. He says he has enthusiastic responses from clinicians and social workers attending the lectures and workshops he has conducted since 2011. “But they don’t do it clinically because it’s hard for clinicians to dedicate so much time to this.”

Dignity therapy is most widely available in Winnipeg, its birthplace, where all clinicians at Cancer Care Manitoba, the organization that provides cancer services in the province, have been trained in the protocol. If a patient expresses interest, or a clinician thinks a patient might be interested, a referral is made to one of the therapists, among them Chochinov.

“And then I see them, either in their hospital bed or more typically at their home,” he says.

A few months ago, he spent about an hour with a dying woman. She told him about her proudest accomplishments and shared some guidance for her loved ones. 

A few days after he delivered a transcript of the conversation, the woman thanked him by email for their discussion and for the document that “will give my family something to treasure.”

“Dignity therapy is part of the bridge from here to there, from living my life fully to what remains at the end,” she wrote. “Thank you for helping me to tell this story.”

Q&A — Microbiologist Steven C. Ricke — Salmonella: Why it’s a Chicken and Egg Thing

Eliminating this food-poisoning bacterium from poultry is tricky — not least because rapid, precise tests are still unavailable. Researchers are looking at vaccines, probiotics, prebiotics and even essential oils as ways to reduce contamination on the farm.

Poultry contamination with Salmonella bacteria is a leading cause of food poisoning.
Image via pxhere (CC0 Public Domain)
By Maureen O'Hagan - September 17, 2021
This article was originally published in Knowable Magazine
Every year, food tainted with Salmonella bacteria causes nearly 3 million illnesses in the US, according to the Centers for Disease Control and Prevention. Among those sickened by Salmonella, 26,500 will be hospitalized and 420 will die, accruing an estimated $365 million in direct medical costs. Though Campylobacter is less likely to lead to hospitalization or death, it’s still no fun, causing diarrhea, vomiting, nausea and, in some cases, long-term health problems. Preschoolers and the elderly are most at risk.

These pathogens can lurk in many different kinds of foods, but chicken and eggs are major sources. Researchers regularly find Salmonella or Campylobacter on chicken sold at grocery stores, with anywhere from 8 percent to 24 percent of packages testing positive. The law doesn’t ban the sale of raw chicken that’s contaminated like this — instead, it requires manufacturers to test a certain percentage of chicken coming off the production line, and as long as positive tests remain beneath a threshold, production can continue unchanged.

Part of the thinking is that raw chicken — unlike, say, lettuce — gets cooked, killing the microbes. But advocates for change find holes in that reasoning: If it’s so simple, they wonder, why do so many people get sick?

To learn more about the persistence of Salmonella and Campylobacter  on poultry, Knowable Magazine spoke with Steven C. Ricke, a microbiologist at the University of Wisconsin–Madison and the author of a 2021 article about poultry safety in the Annual Review of Animal Biosciences. This conversation has been edited for length and clarity.

What are some of the challenges to eliminating these pathogens on the farm or in the processing facilities?

Campylobacter has an optimal growth temperature of about 42 degrees Celsius, which happens to be the body temperature of chickens. It’s pretty well adapted to poultry. And wild birds are carriers for Salmonella. So are house cats and cockroaches. It can get on the poultry feed when it’s stored. Mice and rats, they love grain. Salmonella can be airborne.

It’s a great survivor — so you can imagine the challenges.

And you can’t look at chickens going through a processing line and say, “There’s Salmonella there.” But sampling itself is a challenge. Ideally, for every product that goes out the door you’d like to be able to immediately run it through some kind of test. Is there any Salmonella there? Campylobacter? If yes, then you take other measures to decontaminate it. Right now, we don’t have tests that are fast enough or precise enough. There’s a lot of research being done, but we’re not there yet.

If we had faster, better and more precise diagnostic tools, other stuff would get easier. For example, in testing control measures, you don’t know how effective the measure was until you have really good diagnostic tools and can ask: How much did we lower the numbers when we applied this treatment?

We also need tools for rapid identification of Salmonella’s different serovars — the traditional typing system for this pathogen that is based on immunological assays. Identifying the serovar is important because not all Salmonella are equalSalmonella serovars Typhimurium and Enteritidis — these are pathogens of major concern and have been the source of a lot of outbreaks. Other serovars, you would not assign much risk to them. Ideally, you’d have a sensor that would instantly tell you which Salmonella serovar was there and in what kind of amounts.

Anything you can do to stack the deck against pathogens and support your good bacteria, that’s a win.

In your paper, you mention that to fight these pathogens the poultry industry uses probiotics (bacteria thought to be beneficial) and prebiotics (nutrients that promote growth of probiotics). You also mention essential oils. What’s the idea behind these things?

There’s been a growing concern about antibiotic resistance, so the poultry industry has been working to curtail routine antibiotic supplementation. The thing is, antibiotics had a benefit, so now there’s a lot of interest in trying to recoup some of that benefit with these other compounds. Essential oils, probiotics and prebiotics can be added to the feed or water, but they each have a different aim.

Essential oils have antimicrobial properties. They have the potential to kill foodborne pathogens — depending, of course, on the particular compound, the pathogen and the concentration.

Probiotics and prebiotics work, in different ways, to prevent pathogens from establishing in the gut in the first place.

Some people think of these products as more like snake oil.

There’s actually a lot of science behind it. We have worked with essential oils from the citrus industry and they can be very inhibitory towards pathogen growth and survival. In one study, orange oil reduced Salmonella by a detectable number, by a log or two, which in the industry would be important. I wouldn’t say we’ve achieved complete kills of the pathogens, but antibiotics haven’t done that either. Of course, some essential oils are inhibitory and some are not. In a best-case scenario, we want to reduce the pathogens below detection limits.

Probiotics used in the poultry industry include Bacillus,  Bifidobacteria and Lactobacillus. It’s pretty much what’s in yogurt, but maybe different strains. The aim here is to help establish a healthy gut microbial population.

Prebiotics are non-digestible carbohydrates such as fructo-oligosaccharides, galacto-oligosaccharides and mannan-oligosaccharides. They’re essentially food for the good bacteria. There’s no evidence that I’m aware of that pathogens can use the prebiotics — that’s the beauty. It’s almost like you’re starving out the pathogens and you’re feeding the good bacteria at the same time.

In a young bird’s first 24 to 48 hours, they’re pretty susceptible because their gut microbes are not well-developed. With probiotics and prebiotics, you can accelerate the development of the young bird’s gut microbes. When you establish a healthy gut microbial population, it serves as a barrier to prevent pathogens from establishing. It’s called competitive exclusion, which is sort of like saying, the neighborhood is already occupied and there’s no way for pathogens to buy a house.

Anything you can do to stack the deck against pathogens and support your good bacteria, that’s a win.

There are groups trying to get the USDA to declare Salmonella an “adulterant” in chicken, meaning contaminated chicken couldn’t be sold. After E. coli O157:H7 was declared an adulterant in beef, illnesses declined substantially. Would that be a good step?

I understand the desire to have it declared an adulterant, but it’s a complex issue. For one thing, you’re dealing with chickens versus cows, two different animal species. Also, Salmonella has quite a bit of range and adaptability. It’s so ubiquitous, I used to say, I could go out and isolate Salmonella from just about anywhere.

On top of that, there are over 2,500 serovars of Salmonella and not all of them make you sick. I think that gets lost in the discussion. In addition, the existence of Salmonella on a carcass is a real imprecise measurement. The question is, how much? If you have one Salmonella on a carcass, the risk of getting sick is essentially nil. But if there were a million Salmonella on the carcass, the risk is much higher. The problem is that we don’t have quantitative tests for Salmonella.

We need more science to do more investigations and to field-test this stuff on real farms and then have good detection and quantitation tools.

We don’t have tests to determine how much Salmonella is in our food?

Well, there are ways to do it, but they’re slow. You want instantaneous results, like the old science-fiction movies where you have the sensor that instantly gives you answers. We don’t have that yet. It takes us potentially at least three or four days to get an answer.

There’s a lot of research being done. We’ve got more rapid tests and we’re getting more and more precise on our quantitation. I think it’s on the horizon.

What’s the most important development you’ve seen in fighting these pathogens?

Whole-genome sequencing has been a game-changer, mostly because it allows you to more accurately pinpoint the source of an outbreak. It’s really revolutionized the science of identification. It’s like the forensic science stuff on these crime shows. The DNA from the person suffering from salmonellosis — can you find that strain in any of the food they ate? Then you go back to the farm and see: Is that same Salmonella there? Or did it get introduced somewhere else in the food supply chain? It allows you to more precisely trace the cause.

Whole-genome sequencing also helps us to understand these pathogens better. For example, because we know the entire genetic code, we can identify which genes make the bacteria virulent. Foodborne Salmonella and Campylobacter typically do not make adult chicken sick. So one of the fundamental questions is, what makes them pathogens in people?

Salmonella contamination has been significantly reduced in some other countries, especially in eggs. Are the challenges somehow more insurmountable in the US? Too expensive? Too inconvenient?

All the above. The places where those pathogens have been effectively eliminated are much smaller countries, with smaller-scale production. For example, they do complete sanitation of trucks bringing feed into the farm. That’s an expensive, extensive process that just wouldn’t be practical here from an economic standpoint.

But there are interventions that would work here. For example, Great Britain went into a very extensive poultry-vaccination process that worked pretty well in eradicating Salmonella in eggs. Vaccines have been employed here, too, but part of the problem is vaccines are somewhat specific. Let’s say you create a vaccine that works on Salmonella Enteritidis. Salmonella Typhimurium can come in and fill that niche, and so now you’re going to have to create a second vaccine. So it’s sort of a moving target. Vaccination programs are very active now and more are being developed as we understand more about Salmonella.

What else would help?

You want what we call multiple hurdles — several interventions that are very different from each other mechanistically, so they attack the problem differently. We’ve done things like combining mild heat with organic acids, and it’s very effective.

What we really need is more investment, trying to figure out things like which probiotics work best, which combinations work best, so you can get that one-two punch: the probiotic to prevent the establishment of Salmonella and your essential oil to knock out any Salmonella already there. We need more science to do more investigations and to field-test this stuff on real farms and then have good detection and quantitation tools.

Where is the research headed?

Coming up with what I would call mechanistically better-defined interventions to where we know what they’re doing and how they work. Traditionally, producers have relied more on anecdotal reports; we’ve moved beyond that now, and the farmers and companies producing these products know we need peer-reviewed research. We’re in an era that’s exciting for me because I do that kind of mechanism-based research. Now there’s both governmental support and industry support.

What are you working on right now?

We’re doing microbiome mapping of poultry-processing facilities — mapping all the microbes that are found there — trying to identify what we call indicator organisms. These organisms are non-pathogenic, but they behave similarly to the way Salmonella behaves. The idea is they’re usually found in high numbers, and they’re very quantifiable, which makes them easier to detect and measure than Salmonella.

By monitoring these indicator organisms, you can determine whether your interventions are working. If the indicator organism went from, say, 2,000 down to 2, we know that if Salmonella were in there, the measure would work the same way against it.

‘We Are Not That Great’: Gain-of-Function Research Highlights our Hubris

Photo by HFCM Communicatie, CC BY-SA 4.0, via Wikimedia Commons
By Iris KulbatskiHealthy Debate - September 13, 2021

The SARS-CoV-2 pandemic has made believers out of us. The statements “I believe in science” and “follow the science” express our collective assurance that scientific innovation will continue to serve humanity and sustain us through our pandemic weariness.

Historically, our scientific pursuits have catalyzed both extraordinary accomplishments and unimaginable atrocities. The line between the two is thin and the guardrails that protect against crossing this line are easily corroded. As a by-product of human ingenuity, science, like any other human endeavour, is flawed and at times unpredictable – beset by human error, inaccuracies, biases, conflicts of interest, ethical challenges and political influence.

There are limits to our advances, and the more reckless we are with our scientific pursuits, the closer we come to the edge of these limitations. And when we do cross that line, science can no more save us from ourselves than an alchemist can turn lead into gold.

Restricted to laboratories with high-level clearance and rigorous safety protocols, gain-of-function research treads an almost imperceptible line between catastrophic risk and potential benefit.

Life finds a way

In his bestselling literary works, science fiction author Michael Crichton explores themes of science, technology, medicine and the ways in which human failure can lead to catastrophe. In a case of life imitating art, the current SARS-CoV-2 pandemic reads like a storyline from a Crichton novel.

SARS-CoV-2 continues to spread across the globe almost two years after it was first discovered. As the world mulls the theory that a lab leak ignited the SARS-CoV-2 pandemic, the real and present danger of gain-of-function research has been brought to light.

Gain-of-function research involves the genetic modification of hazardous pathogens in ways that can increase human infectivity. The goal of such research is to understand the mechanisms of human infection and develop strategies to mitigate a pandemic, should an outbreak occur. Restricted to laboratories with high-level clearance and rigorous safety protocols, gain-of-function research treads an almost imperceptible line between catastrophic risk and potential benefit.

Despite the safety guardrails that exist for such labs, there are numerous examples of gain-of-function research that clearly crossed this line – deadly pathogens that escaped from labs, scientists who were accidentally exposed or infectedsafety and security breaches, unethical activitypoor work environments and political intrigueTemporary moratoriums and outsourcing of research to other countries does little to ensure long-term global safety. Whatever illusion of certainty we manufactured for ourselves should long ago have vanished like a desert mirage.

History will sort out the origins of SARS-CoV-2. In the meantime, our struggle to contain the crisis suggests that we are in over our heads, despite our best efforts, years of gain-of-function research and our so-called pandemic preparedness.

The current global crisis is a valuable case study of our finite ability to control nature once it’s pushed to the edge of an unstable guardrail. Even the theoretical possibility that SARS-CoV-2 escaped from a lab should cause us to take pause, because gain-of-function research using some of the deadliest pathogens known to humankind continues to thrive as the current pandemic rages on. Amid unprecedented morbidity, mortality, economic and personal hardship, political and social unrest, scientific and medical upheaval and desperate attempts to vaccinate the world, we are consistently steps behind rapidly emerging variants and subsequent waves of disease.

If ever there was a lens through which to view the potential catastrophic impact of gain-of-function research, it is the SARS-CoV-2 pandemic, regardless of whether the virus gained functionality in a lab or through natural selection. To quote Crichton, either way: “… the history of evolution is that life escapes all barriers. Life breaks free. Life expands to new territories. Painfully, perhaps even dangerously. But life finds a way.”

We live in a golden cage where the illusion that we can control life shackles us to a false sense of security. It is precisely this hubris that drives us toward existential danger.

The litmus test of science

In 1963, Joseph A. Davis Jr. curated an exhibit at the Bronx Zoo titled The Most Dangerous Animal in the World. The exhibit appeared in the Great Apes House, situated between cages containing orangutans and gorillas. Visitors to the exhibit were stunned to see a reflection of their own face looking back at them from behind a cage. The illusion, created by an artfully placed mirror, delivered an elegant, powerful message, further articulated by a sign that read: “You are looking at the most dangerous animal in the world. It alone of all the animals that ever lived can exterminate (and has) entire species of animals. Now it has the power to wipe out all life on earth.”

The ability for self-reflection has made us arguably the most sentient, intelligent and dangerous species on the planet. It takes little consideration to realize our sophistication and ingenuity, to pat ourselves on the collective back for the brilliant ways in which we’ve managed to tinker with our natural world for the benefit of humankind. Yet, science, technology and medicine also serve as a mirror through which to reflect on our misconceptions. Despite the sophistication of our innovations, the assumption that we can outsmart nature is a dangerous delusion. It is also the height of arrogance.

We live in a golden cage where the illusion that we can control life shackles us to a false sense of security. It is precisely this hubris that drives us toward existential danger. If we are to learn anything from this pandemic, it is the value of humility. Science is a human construct and is inherently fallible because we are fallible. The real litmus test of science is to hold a mirror up to humanity and reflect our true nature – both our virtues and our vices, our limitlessness and our limitations.

The fulcrum of science rests on our ability to erect the necessary guardrails to protect against exceeding the limits of our ingenuity. And as conservationist Baba Dioum illustrates: “In the end we will conserve only what we love, we will love only what we understand, and we will understand only what we are taught.”

It is time we turn toward the natural world and our own shortcomings with appropriate reverence and learn this fundamental lesson: We are not that great.

This article is republished from Healthy Debate under a Creative Commons license.
Read the original article.
Healthy Debate publishes journalism about health care in Canada by the people whose lives it touches the most, from physicians, patients and caregivers to health journalists, academics, and advocates.

COVID-19, a Nurse, her Mother, and Monoclonal Antibody Treatments

In an Oklahoma Watch feature “A Mile In Another’s Shoes,” an initiative to give voice to the voiceless or call attention to the plight of those affected by public policy, Davis, talks about treating COVID-19 patients and the personal tragedy that motivates her.

Registered nurse Jennifer Davis runs Norman Regional Hospital's COVID-19 Infusion Unit for patients on Sept. 3, 2021. Davis has been treating nearly 100 patients a week since June with monoclonal antibody infusions.
Whitney Bryen/Oklahoma Watch (CC BY-ND 4.0)
By Whitney BryenOklahoma Watch
September 6, 2021

Less than a month after losing her mother to COVID-19, registered nurse Jennifer Davis provided the first monoclonal antibody treatment to a patient at Norman Regional Hospital’s COVID Infusion Unit. Davis couldn’t save her own mother, but she is on a mission to save others from the virus, even if it means putting herself at risk. 

I’ve been in health care all of my career, ever since I was 15. I worked in nursing homes as a nurse aid and worked my way up from nurse aid, to home health aide to licensed practical nurse to registered nurse. Truly, medical is all I’ve ever wanted to do. When I was young, my grandma worked in a hospital and I thought “I want to work in a hospital and be a nurse too.” And then as I got a little older, my mom had cancer. Dad would come home from the hospital and say how wonderful the nurses were. And that really geared me into, “I wanted to be an oncology nurse” because I wanted to return that favor. So, oncology was where I went. 

I’ve been with Norman Regional for more than seven years. I worked with the oncology group so we did chemotherapy treatments, and I worked in outpatient infusion. It’s a plethora of anything that we can infuse you with and then send you home. I stayed with the infusion as oncology opened their own little area. I helped them get that started and then I stayed where I was at with the infusion center. But that was all prior to COVID. 

I was a supervisor and didn’t have to do patient care day in and day out. But since November, I’ve gone into full-time patient care again. The monoclonal antibodies were emergently approved by the FDA for treatment of outpatient COVID for high risk, mild to moderate patients that would risk being put into the hospital for severe COVID-related symptoms. The first infusion we gave was Nov. 23. In November, December, January and February we were pretty much nonstop. And then as the numbers declined and things kind of leveled off and we started getting the vaccines, we didn’t see as much COVID. We went from probably 80 or 90 patients a week to maybe two and three. And then COVID resurged with the variants and since mid-June, we’ve been nonstop. We’re doing over a hundred infusions a week. 

"if I can save one person’s life, I’ve done it in honor of my mom."

If you just can imagine a piece of pie and there’s one slice missing that piece of pie is the cells in your body. And COVID attaches and fills in that one piece that’s missing. Your cells then continue to multiply so every day you’re multiplying COVID cells. In essence, that first 10 days is when you’re building the most cells and when the people that get the sickest typically go to the hospital. If we treat those patients within the first 10 days, that monoclonal antibody goes in there and attaches to that same spot on that piece of pie that COVID wants to attach to. So now it’s fighting with an antibody that’s like, “I’m bigger than better than you.” Then COVID can’t multiply anymore. And now your body is multiplying and making antibody cells. It neutralizes the growth of the COVID and kick starts your body into making more antibodies to fight it. Therefore it reduces the length of the symptoms, the amount of symptoms. And hopefully you don’t get symptomatic enough to have to go to the hospital. 

I have a lot of patients actually that are so thankful that we’re there. They’re concerned with us nurses who are seeing them face to face every day. They want to know “why are you putting your life on the line for us?” And I can’t answer for anyone else, but mine becomes personal because I lost my mom to COVID before this drug was out. And I just feel like, if I can save one person’s life, I’ve done it in honor of my mom.

Last October, my mom and I both became COVID positive. My daughter had surgery the last week of September and mom and I were at the hospital with her. We became symptomatic together. On Saturday, Oct. 3, she couldn’t go and get her nails done because she was tired and didn’t feel good. And on Sunday the fourth, I remember my preacher asking me, “how are you doing?” And I go, “I don’t feel good today. I’m just tired.”

I woke up on the fifth with night sweats and body aches, and I thought it  was just related to the stress. I have an autoimmune disorder and I thought it was just a flare up from the stress of my little one having a bad surgery and complications to her surgery the week before. And mom was still not feeling good either. I lost my taste on the eighth of October and that’s when I knew. 

I was in denial and didn’t get tested until I had to be tested before I had surgery on my thumb. And when it came back positive, I cried and I told mom, we had COVID. And the next day mom was just getting weaker and weaker. I had asked her mom, when was the last time you had your inhaler? She said, “Oh, I haven’t had it in a week or so. It’s at the pharmacy.” So I drove to the pharmacy and we went through the drive-through and got her inhaler. She took two puffs and in 30 minutes she had chest pain and couldn’t catch her breath. I called 911 and sent her to the hospital by ambulance.

From Oct. 14 until the 30th, I studied COVID, because I was going to tell these doctors how they were going to fix my mom. It doesn’t work that way, but I tried. I studied COVID and talked to mom as much as I could. On the 16th, on the way back to her bed from the bathroom she accidentally knocked her oxygen off and her oxygen levels went down. They couldn’t get them back up and she was struggling so they sent her to the ICU.

And I don’t think that I’ve had one person die from COVID related symptoms after these infusions. That’s what I call a miracle drug.

We weren’t allowed to visit her so it was really hard to have good communication. She couldn’t keep the oxygen on with her glasses to be able to read text messages. We were very dependent on the nurses to be able to do FaceTime. And then on Oct. 30, which is my birthday, the ice storm happened that week so we were all at her house because she had tons of tree damage. I had a hard time getting a hold of the nurse that day for an update. And finally around 4 p.m. I was able to get a hold of the nurse and he said, “well, she’s not doing well.” I told them I wanted to talk to her and she gets on the phone and she says, “I can’t do this anymore. I’m tired.”

I told my family it was time and we needed to go to the hospital. It was my son, my brother and my aunt and they would only let two of us in to see her. My brother and my aunt were on FaceTime with one of the hospital computers. My son and I geared up and when we walked in the door, I knew she was done. But I was able to hold her hand and brush her hair, change her clothes and talk to her about planning her funeral for the last four hours of her life. And she didn’t die on my birthday. She held on until the next day.

The hardest thing I’ve had to do is lose my best friend. But God knows what he’s doing. If I hadn’t gone through that, I wouldn’t be where I’m at now with my COVID patients that I’ve taken care of. I wouldn’t have the passion. I wouldn’t have the ability. I wouldn’t have the knowledge of knowing why COVID does what it does or the understanding. It put me where I need to be to be able to reach out and touch these people and help them heal. And to be that sense of comfort for the ones that are terrified dropping their moms off for a COVID infusion. It’s full circle. 

This work is tiring, but it’s so fulfilling. If I stay an extra 15 minutes, we can see one more patient. If someone will go get my daughter, I can see three more patients. It becomes an obsession because you want to help as many people as possible. And then if I can help all of these people stay out of the hospital, I’m also helping my colleagues that are seeing the ones that are dying. And I feel like if I can get these people in the first 10 days, they’re not going to end up at the hospital and they’re going to die. 

I have given probably 1,800 to 2,000 doses of monoclonals since November. And I don’t think that I’ve had one person die from COVID related symptoms after these infusions. That’s what I call a miracle drug. 

This article first appeared on Oklahoma Watch and is republished here under a Creative Commons license.

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