Transcending Cure with Care

It is difficult to stand out, head and shoulders above the other nurses at an institution of MD Anderson’s magnitude, but Angela Krach does stand out—not only for her exceptional clinical skills, but also for her caring compassion and commitment to my husband and me.

On March 30, 2012, my then-fiancé James called mid-afternoon, slightly panicked, saying his doctor had just told him to go directly to an emergency room—all his blood counts were dangerously low, and it could not wait through the weekend. James had not been feeling well overall and got unusually winded on a walk the day before, prompting him to go see his doctor. We had no idea what that meant at the time, but six hours later, doctors hospitalized James and told us he likely had leukemia. We were in complete and utter shock, and our lives took a 180-degree turn. Just the night before I had been bugging James to decide if he wanted to wear tails or a tuxedo to our wedding that was planned for a few months later in August 2012; now we were planning to battle for his life.

James' leukemia diagnosis was one of the more dire subsets that required a bone marrow transplantation for a chance to live; however, his insurance company would only cover the requisite stem cell transplantation at a "center of excellence." So we transferred our lives to Houston and MD Anderson and ended up under the attentive care of Angela Krach. We met Angela when James was re-admitted to the hospital in November 2012 for complications following his August stem cell transplantation.

Expected complications, such as graft-versus-host disease, and some not-so-expected complications, such as viral encephalitis and a suspected fungal pneumonia, created a perfect storm of complications for James, who has been in the hospital for the past four and a half months, with the exception of 14 days just before Christmas. Angela admitted James that first night when he transferred from the Ambulatory Treatment Center to the inpatient stem cell transplant unit. She was welcoming and clinically efficient in those first 24 hours, but it was not until later that we discovered her truly exceptional professional and personal intuition.

As James' encephalitis began to resolve and he started eating again, he began experiencing a delayed cough. Angela was the first to note that the cough might be more than it seemed, suspecting that he was silently aspirating. She persistently approached the medical team to advocate for a chest X-ray and barium swallow test, which not only confirmed that he was silently aspirating but also that he had developed aspiration pneumonitis. Her insistence led to interventions for James that have kept him alive and in a rehabilitative state. It is her ability to go beyond the everyday responsibilities of nursing and to use a professional’s intuition to anticipate problems that make her such an exceptional clinician.

That was not an isolated occurrence. A few weeks later, James was extremely lethargic and fatigued, and Angela quickly assessed that his oxygen saturation was dangerously abnormal. She quickly intervened and, within moments, had an entire team of professionals at his bedside to transition James to the intensive care unit where his pulmonary function could be better monitored. He was later diagnosed with pneumonia that the doctors suspected was fungal.

Angela also goes above and beyond to make sure James is progressing physically. She is right there for him with a smile underneath her mask, unmatched energy and a can-do attitude. She doesn’t simply administer medications; she is willing to attend to his global care needs, including physical therapy work. Sadly, James is bedridden and must be prompted to do the various exercises he has to do each day to get better. Angela is the only nurse who consistently finds a way to engage him in a way he responds to: the results are tangible when she cares for him. I credit her with kick-starting James' recovery, pushing him to do more each day and recognizing when she should nudge him a bit more. She also takes time to make sure I understand everything going on with James medically. She eases my fears and even checks on us after her shifts when she isn’t our nurse to see how we are doing.

Though many nominations likely include stories of nurses going above and beyond to clinically support their patients, what sets Angela apart even further was her help in making our wedding day perfect and special—even in the hospital. James and I originally planned our wedding for August 2012; after he was diagnosed, we decided we would get married when we returned home after his transplantation. We have yet to return home, and it is still unclear when he might leave the hospital. But we had been through so much together this past year and no longer wanted to wait to say, "I do." We arranged to have our wedding and reception at MD Anderson, but Angela was instrumental in making our dream a reality. She orchestrated a dress rehearsal for James two days before the wedding, carefully camouflaging his catheter and Zassi tube on the wheelchair and ensuring that he was fully dressed in his tuxedo. She was off the day of our wedding but came to the hospital to dress him and made him feel and appear the perfect groom. She gave him some of his dignity back by ensuring he looked his best in front of family and friends and celebrated with us as a member of our now-extended MD Anderson family. It is impossible to convey the magnitude of what her kindness meant to James and me that day.

Angela's love for her job shows not only through her work, but also her compassion for patients and family members. She is truly exceptional. It is with great enthusiasm that I nominate her for recognition as one of this country’s best oncology nurses!