Stem Cell Transplant Nurse’s Expert Care Extends 'Beyond the Disease'

Lisandra Ayala
Photo by Andrew Campbell

Lisandra Ayala, RN, BSN, OCN, takes care of extremely vulnerable patients as a nurse in the Stem Cell Transplant Unit at the Medical Center.

This story originally appeared on the University of Chicago Medical Center's Discovery & Impact website.

By David Rumbach

Oncology nurse Lisandra Ayala’s patients in the Stem Cell Transplant Unit at the University of Chicago Medical Center are among the most hopeful, anxious and vulnerable in the hospital.

Infusions of hematopoietic (blood-producing) stem cells have the potential to cure leukemia, lymphoma, myeloma or other blood disorders. However, to prepare for the treatment, patients must receive chemotherapy that wipes out their own stem cells and leaves them with weakened defenses against life-threatening infections. For a month or more, they remain in the hospital waiting for the infused cells to travel to their bone marrow, begin producing cells and, eventually, provide them with a new and disease-free immune system.

As the first line of defense during this vulnerable period, Ayala, RN, BSN, OCN, and her colleagues monitor patients closely for dangerous drops in blood counts and subtle signs of adverse reactions or possible infections.

They often are the first to provide critical medical interventions. In addition, they enforce precautionary bans on visits from sneezing or coughing relatives and even intercept deliveries of fresh flowers, which may harbor bacteria.

Just as importantly, nurses in the Stem Cell Transplant Unit get to know their patients “beyond their disease” in order to provide emotional support during their extended hospital stays, said Ayala, winner of the 2010 Patricia H. Morgan Award for Excellence in Oncology Nursing.

“I read somewhere: ‘No one cares how much you know until they know that you care,’” Ayala said. “I think it’s true. I always try to connect with patients beyond their disease. They have family. They have friends. So we have to see the human being.”

The Morgan award honors nurses who continually develop their specialized skills and share their knowledge by mentoring their colleagues. Colleagues have described Ayala as a “resource person,” a “role model and mentor” and one of the first nurses on the floor (6NW) to learn how to infuse patients with stem cells. Ayala then taught other floor nurses the one- to three-hour procedure, during which the nurse stays at the patient’s side.

“If you were to watch, it looks like a blood transfusion, just a bag of blood,” Ayala said. “But these are stem cells, and it’s amazing when you think about it. These small cells go through the body and know just where to go and what to do.”

For most patients, recovery is the hardest part of the course of treatment, Ayala said. It’s where emotional support of nurses, working in concert with social workers, chaplains and others, becomes critical. Nurses become close enough to patients to keep track of birthdays and anniversaries, Ayala said.

Several years ago, she recalls, nurses arranged a family gathering in the waiting area near the unit for a woman who was too sick to attend her daughter’s wedding, even helping the woman dress and put on her makeup. And when the mother of a young patient who died of leukemia sent a letter of gratitude, the nurses responded with a personal memento.

“We decided to send the parents a photo album of us and some thoughts of support in this difficult time of their lives,” Ayala recalled.

Patricia H. Morgan was an oncology nurse who became a cancer patient at the Medical Center at the end of her life, according to her husband, Howard Morgan. The Morgan family established the award to recognize the role of nurses in medical care, especially in cancer care. Morgan said his wife’s work in cancer care and, later, the care she received as a patient, has given the family an acute appreciation of the disease and its effect on patients and clinicians alike. He also lost a daughter to cancer.

“So we’re familiar with how difficult this disease is for the family, and also how difficult it is for the professionals,” Morgan said at the award ceremony recognizing Ayala. “Our joy is to be able, as a family, to celebrate this.”

Ayala, who grew up in Puerto Rico, credits the hard work and encouragement of her parents, Ana and Angel Ayala, for making it possible for her, a brother and sister to earn college degrees.

“My dad worked for an oil company, and my mom worked in a family restaurant,’’ she says. “I remember them getting up early in the morning every day to go to work to get the things we needed to go to college. And I remember my mom, ever since I was little, she would get with me and do math or science on a little board. It was like having school after school.’’

Ayala worked as an oncology nurse at Norwegian-American Hospital in Chicago from 1990 to 1999 before returning to Puerto Rico to work at a U.S. Department of Veterans Affairs hospital. In 2002, she and her husband, Rafael, decided to return to Chicago, and she accepted a recruitment offer from the Medical Center that included classes she needed to become a certified oncology nurse.

“I thought a teaching hospital would be a great place to learn,’’ she recalled. “Now I’ve been here eight years. It’s a blessing to do what we do as nurses. It’s more than a job; it’s a calling, a vocation. I’m very proud to be part of a talented group of people.”