Staying Busy

Her mother would claim she was a bit of a problem child, but Cindy Lawrence's childhood craving for constant action may have steered her to a perfect-fit career.

A 15-year veteran coordinator with Duke's organ transplant programs, Lawrence knows why the work suits her.

"I think I like the challenge, the fast pace, the never being bored. I get bored pretty easily," she said with a chuckle. "My mother used to hate that when I was a child. I would say, 'Oh, what is there to do? I'm bored. I need something to do.'

"So I like a lot of challenge and a lot of action. I like the fact that when I come in to work, I really never know exactly what the day's going to be like."

As one of three transplant coordinators in the lung transplant program, Lawrence has a clue about the basics of her day ‚ what time she'll probably start working and when she hopes to leave ‚ but after that, it's up in the air. A transplant coordinator "keeps the wheels turning" in a complex program where timing and teamwork are vital.

Lawrence and her fellow transplant coordinators, all nurses with master's degrees, screen all patient referrals and schedule promising candidates for evaluation.

Once a patient is admitted to the program, Lawrence's connection begins in earnest. There are outpatient regular visits until a donor organ comes a waiting period now averaging nine months, down from 12 months in previous years. When a donor matches, Lawrence or a colleague oversees a flurry of activity, then post-operative care coordination, teaching, rehabilitation and follow-up care throughout life. Fifty to 60 patients receive lung transplants annually, and about 400 people are in some phase of the program.

"The really neat thing about it is that when it works well, it's such a miracle," Lawrence said. "I mean, patients go from being chronically sick to chronically well. The chance to improve the quality of your life is pretty phenomenal."

In Dr. Vic Tapson's eyes, Lawrence and the other coordinators are a lifeline for the patients. "The most important thing that Cindy and other coordinators do is just serve as facilitators for every aspect of transplant," said Tapson, medical director of the lung transplant program. "They're essential to the program for the communication, seeing a patient from start to finish."

The lung program began eight years ago, but by then Lawrence was an old hand in transplant care. After five years as a nurse specializing in the care of kidney patients at Duke, Lawrence had joined the kidney transplant team as transplant coordinator in 1985.

Over the next seven years, she saw the evolution of the liver transplant program and worked with both liver and kidney patients. She helped start the kidney/pancreas program in 1989, so she was a natural pick for the transplant coordinator's slot when Duke launched a new service for lung patients. Once with the lung program, she also helped patients in the heart transplant program, giving her the distinction of having worked with all the established solid-organ transplant programs.

"Cindy has more years of experience in transplant than anyone else on the team," said Tapson. "Her knowledge of immunosuppressant drugs (to prevent organ rejection) has been very valuable. I really learned a lot from her, especially in the beginning. Cindy has been a tremendous source of experience."

It's her knowledge of people, not facts, that makes her stand out to patients.

"She seems to understand the patient's perspective," said Kathy Flynn, who underwent a double-lung transplant nearly four years ago. "She's never condescending; she treats you on an adult basis.... she treats you like you're fully capable of understanding."

Lawrence said she tries to be realistic with prospective transplant recipients. While transplant offers a chance for amazing improvement ‚ and extension ‚ of life, the process isn't all roses. Complications often arise, particularly infections for lung recipients, and recovery is demanding physically. Some patients who enter the program become too sick to survive the process and must be taken off the waiting list. Lawrence uses the straightforward approach with those patients.

"I tell them that it's because it's such a major operation. If you're so chronically debilitated, your body just won't survive the operation," Lawrence explained. "You have to work really hard after a lung transplant to get those lungs working really well... you have to have muscle strength to breathe with stiff lungs that are full of fluid in the early stages of the game."

She's realistic with her patients because, above all, she wants to prevent the worst occurrence in her job ‚ "when it doesn't go well."

"I hate it when people say to me, 'I wish I had never done this.' And that happens, not very often, but it's happened a few times and I just hate that."

Transplant recipients and coordinators often develop close relationships, and Lawrence recognizes many of the names on the daily faxes detailing medication levels.

"I know the very first kidney transplant recipient that was ever done here. He's on his second kidney now, but he's still alive and doing well," she said. She clicks off patient cases like family memories. "This one has a liver. And this one has a kidney and this one has a heart. I know almost all of them."

The boundary between professional and personal life is sometimes blurry for Lawrence and other coordinators. Patients need round-the-clock accessibility to the coordinators. Recently, Lawrence volunteered to serve on the board of Second Wind, a national organization that provides support for lung recipients and other pulmonary patients.

Despite the intensity of her career, Lawrence exudes calm and good humor.

"I have a really, really nice outside life," she smiled. "This kind of job can really eat you up if you let it, so I have to make a very conscious effort to maintain my life. I have learned over the years that balance is incredibly important. I've learned to just say, 'OK, there may be a couple of other things I'd like to get done, but there's always tomorrow. I have to go home.'

"My family comes first. I have two daughters, and I make it my business to be at all their softball games and band concerts and church plays. I teach youth Sunday school and (am in) the ensemble at my church, so my music is a nice diversion for me," she said. "And I play strings on a keyboard in the orchestra ‚ I can be a whole string section, the violins, the violas, the cello, all at the same time!"

Like she says, she needs to keep busy.

Written by Karen Hines.