Sitting in the Cross Cancer Institute’s sun room on a recent weekend afternoon in Edmonton, Laurena Beirnes is reflecting on how drastically the process of bone marrow transplants (BMTs) has changed since she first got hired there, as a nurse, nearly 25 years ago. For the past two decades, Beirnes has served a large population as one of two BMT co-ordinators for all of northern Alberta – a position from which she retired in May.
Bone marrow transplant co-ordinator Laurena Beirnes
Photo by Laughing Dog Photography
“What we used to do,” Beirnes says, “is take the patients down to the operating room, they’d have a general anaesthetic, and there’d be two doctors doing a bone marrow harvest.” She points to her lower back – specifically, the large ilium bone in the pelvis. “We’d take out about a litre of bone marrow from there.”
There are two different kinds of BMTs: allogeneic, where one person’s bone marrow is donated to someone else, and autologous, where a patient’s marrow is removed, stored – usually to protect the marrow while the patient receives intense chemotherapy – and then later re-injected into the same patient.
For Albertans, an autologous transplant can be done in Calgary or Edmonton, while an allogeneic transplant can only be done in Calgary. This means anyone across the province set to receive bone marrow from another person must travel to Calgary for the procedure and then they typically need to stay there for three months after the transplant. “Our office in Edmonton will help prep the allogeneic recipients and we will do the followup when the patients return to Edmonton three months after their transplant,” Beirnes says. “We follow these patients for years and years.”
Over the past 30 years, Calgary’s Tom Baker Cancer Centre, in collaboration with Foothills Hospital, has become one of the country’s largest BMT programs, treating more than 160 adult patients in Calgary each year.
Beirnes has extensive experience with both BMT methods, but has focused on autologous transplants.
Today, the process for an autologous BMT is almost unrecognizable from the old methods. Instead of anaesthetics, large surgical needles and multiple physicians, now patients are taught how to inject themselves at home with a special drug called filgrastim, once per day, leading up to the procedure. Filgrastim, Beirnes says, “shakes up the marrow, and pushes those stem cells – that we used to have to do the bone marrow harvest for – out into the blood.” At the Cross Cancer Institute, a specially trained nurse from Canadian Blood Services draws the stem cells straight from the patient’s bloodstream.
While the position of transplant co-ordinator comes with a flashier title than what she held in her nursing days, Beirnes says both jobs require the same basic skillsets: good nursing skills, empathy, flexibility, and, above all, strong listening skills. As transplant co-ordinator, she leans on her top-level coordination work. It’s well-suited to the soft-spoken mother of three and grandmother of five.
Beirnes grew up in a military family and moved from place to place according to wherever her father was stationed. She married her high school sweetheart, a fellow military brat, and their life together started off similarly full of movement: his work brought Beirnes and their children steadily north from Calgary. It was in Red Deer that Beirnes completed her nursing training as an adult learner. By the time she and her family arrived in Edmonton, Beirnes was ready to work. Luckily, in April 1988, the Cross was hiring.
As BMT co-ordinator, Beirnes is with patients from their initial referral all the way to their transplant and recovery. In that first meeting, she talks the patient through the procedure, step by step, addressing any concerns and making sure the patient is as comfortable and informed as possible.
Despite so many years on the job, there are some things that Beirnes says never get any easier. “It’s always hard when a transplant fails,” she says, or when a disease thought to be in remission comes back. When that happens, Beirnes tries to focus on the patients that she has helped stay cancer-free or, even if the disease has returned, on the milestones they have achieved thanks to treatment: seeing a new grandchild, for instance.
Janet Kraemer is one such patient. She was diagnosed with multiple myeloma in 2002 and came to the Cross from Ardrossan for her autologous stem cell transplant in 2004. That’s where she met Beirnes. Right away, the two bonded over their shared love of painting; Beirnes told Kraemer about a particularly interesting annual workshop in Jasper that she should consider attending once she was discharged from the hospital. Months later, at home, Kraemer called Beirnes on a whim and invited her to come along to that workshop. They’ve made the trip together almost every year since then.
“She was so compassionate and warm,” Kraemer remembers of Beirnes’s bedside manner. “She looked after me so well, like a mother – I don’t know if she’d appreciate that, because I’m older than her,” Kraemer says with a laugh. “It wasn’t just a job for her. She cared and went the extra mile as a nurse.”
The two women became close enough, in fact, that when Kraemer went back into treatment in November 2011, Beirnes told her that she would be there for her as a friend, but she would no longer act as Kraemer’s nurse.
Beirnes looks out the sunroom window. There are tears visible in the corners of her eyes. “If things go well, you go home feeling well,” she says. “But when you have a patient that you’ve known for many years suddenly not doing so well, that’s the hard part. And I can’t divorce myself from that when I leave this building.”
To help give her life some mental balance, about a decade ago Beirnes took up long-distance walking. She’s since completed 12 full marathons, two ultra marathons, and more half-marathons than she can remember. Beirnes is also a member of the St. Albert Painters Guild, takes art classes in St. Albert and spends time with other artists in her community. She hopes that retirement will give her more time to pursue both.
And while BMT technology may have grown by leaps and bounds since her early days – and will continue to grow in new directions now that she’s gone – Beirnes says that the patients, by and large, will remain the same. “They’re scared,” she says, “because they don’t know what’s going to happen. It’s the unknown. Will it work? Will it not work?”
Beirnes spent the last two decades answering those questions, providing untold amounts of comfort and compassion in the process. Whoever replaces her has some big – and thanks to all those marathons, well-worn – shoes to fill.
An autologous bone marrow transplant is a multiple-step process. It’s intimidating but, fortunately, many patients have undertaken the BMT successfully. Here’s what it looks like.
- A doctor refers a patient to a BMT co-ordinator. For some diseases, such as multiple myeloma, BMT is a standard treatment. Other times, patients will receive a referral only when they’ve relapsed, and their disease has returned.
- The team prepares the patient for treatment. He has a central line (a type of catheter) implanted into a large vein in the chest, and Canadian Blood Services will test the patient for any transmissible diseases.
- Treatment begins. The patient may get an initial dose of mobilizing chemotherapy, to kick-start the process of moving the stem cells from the bone marrow. Next, the patient starts his daily filgrastim injections at home. Filgrastim works to push stem cells from the marrow into the bloodstream for later harvest.
- Once the patient’s stem cell levels are high enough in his bloodstream, he visits the Cross Cancer Institute, where a Canadian Blood Services nurse collects the stem cells. This is followed by a two- to three-week break.
- The patient is admitted to the facility, where he receives high-dose chemotherapy. Once the chemo is complete, his harvested stem cells are re-infused.
- Recovery. The patient can expect to be off work for anywhere from three to six months after his transplant is complete. During this time, he will slowly regain his strength, energy and appetite.
Note: There are only two locations in Alberta that do stem cell collections: the Cross in Edmonton and the Tom Baker Cancer Centre in Calgary. This information is specific to the Cross’s procedures as Beirnes describes.