When registered nurse Tyrah Hickman cares for sickle-cell patients at the University of Mississippi Medical Center, she can feel the agony of the pain crises that accompany the blood disease.
Hickman has been there before. Diagnosed with sickle cell anemia at birth, the Clinton resident spent her childhood battling the disease, sometimes as a patient at UMMC's Batson Children's Hospital. “But as I grew up, I learned more about how my body handles it. I can manage a pain crisis now,” said Hickman, who received her bachelor of science in nursing from Mississippi University for Women.
At age 26, she's a beacon of hope for her patients in the Medical Center's sickle cell day clinic, which operates weekdays from 8-4:30 p.m. “Most are excited and happy to know there is someone here who can honestly relate to what they're going through,” she said.
Hickman teams with nurse practitioner Shundra Wilson to staff the clinic that reopened May 18 in refurbished fifth-floor quarters on the UMMC campus. The eight-bed clinic temporarily closed in its former location in August 2015 as the hospital began the process of finding and staffing a larger space with room to grow.
Wilson checks on a patient receiving fluids and medications in UMMC's sickle cell day clinic.
In the interim, the Medical Center continued to officer sickle-cell services in its Emergency Department and at a Monday-only clinic at the Jackson Medical Mall staffed by hematology/oncology caregivers from the UMMC Cancer Institute. That clinic's main purpose is to see sickle cell patients by appointment to keep them on track with medications and physical exams so that they can best manage their disease.
Sickle cell disease is hereditary. People born with it produce sickle-shaped blood cells that usually live no more than 20 days, as opposed to 120 days for normal red blood cells. The misshapen cells get stuck in blood vessels, blocking their flow, causing pain and damaging the body's organs, muscles and bones. Patients might have few problems, or they might have ongoing complications that shorten their lives.
UMMC is the only hospital in Mississippi that has tried to organize care for sickle-cell patients by creating a specialized treatment clinic. Sickle cell patients also are seen on a regular basis at emergency rooms at other metro-area and Mississippi hospitals, where wait times vary, depending on how busy staff is in treating those with life-threatening disease or injuries. Although sickle-cell patients can experience significant pain, it's usually not considered life-threatening.
Patients who use the day clinic typically are experiencing a pain crisis and need relief as soon as possible. The sickle cell nurses administer painkillers and fluids as needed while checking for other health problems that could exacerbate the crisis, require separate treatment or hospitalization, or call for later referring the patient to a specialist or their primary care provider.
UMMC's clinic devoted to the care of sickle cell patients is the only one of its kind in Mississippi.
On its first day, the reopened clinic saw eight patients. One required hospitalization because her pain wasn't relieved, Wilson said. The average clinic visit is three to four hours, she said.
“We give them IV fluids to help open up their blood cells and help them to move around,” Wilson said. Patients can be given a mild analgesic up to opioids based on their level of pain, she said, in addition to anti-nausea medications.
The Medical Center's patients include Robert Melton, who was diagnosed with the hereditary blood disease as an infant.
Melton has visited UMMC's sickle cell clinic at the Jackson Medical Mall and was seen about two months ago in the UMMC Emergency Department. “Sometimes, my painkillers don't work and I have to take something stronger,” said Melton, 33, a single father of four. “If that doesn't help, I talk to my doctors and they'll say come in and get some fluids and maybe a transfusion, and if that doesn't work, you might have to be admitted to the hospital.”
Hickman chats with Melton during a visit to the new clinic.
Hematology nurse practitioner Dana Delaski is one of the UMMC caregivers who help patients through a pain crisis and educate them on pain management so that they won't end up in the hospital.
“It's a great thing in multiple ways,” Delaski said of the day clinic. “Instead of the ED or a primary care doctor, you're in an environment that knows you. We can catch (a pain crisis) early, and give appropriate treatment. Our goal is to keep patients out of the hospital, and to help them live a good life.”
“The ER has been my second home all of my life,” said Melton, 33, who has two children with sickle cell disease and whose parents carry the trait. “This clinic will help a lot. People from surrounding areas who don't have very good clinics in their town want a comfortable place where they can be attended to right away.”
The former day clinic's location, which was not meant to be permanent, was in a limited portion of UMMC's day surgery operation. The new fifth-floor space includes eight patient bays separated by curtains and a comfortable waiting area for patients and family members, said Shelly Poole, a physical therapist and administrator in the Medical Center's rehabilitation services.
“Depending on demand, we will look at extending the hours as needed,” Poole said. “If a patient comes in and the bays are booked, they can wait in a private area until they can be seen. And, we will not have to share this space with any other services.”
Delaski, a nurse practitioner at the sickle cell clinic held Mondays in the Jackson Medical Mall, is the regular caregiver for patient Jimmie Lacey of Brandon.
Delaski said most patients seen in the weekday clinic also are patients at the Monday clinic. “We can communicate back and forth about a specific patient,” Delaski said. “The day clinic can let us know at the Jackson Medical Mall clinic if they're seeing a patient more often - someone who has been doing fine, but all of a sudden has a change. If someone's not on therapy, then we can get them on that. We all communicate very readily.”
Melton said exhaustion and stress can bring on a crisis that lands him preferably in the day clinic, but sometimes in the ED. “Sickle cell keeps me from doing a lot of things, but you have to at least try,” Melton said. “I try to work out to keep up my stamina, but sometimes, I'll hurt.”
Only 50 percent of patients with sickle cell disease survive beyond age 50. It most often strikes African Americans, and many of its victims are children who are very susceptible to infections because the disease often leaves them unable to fight dangerous bacteria.
Melton said Hickman made sure he knew about the clinic's reopening. “I'm a survivor. A lot of people who had sickle cell are dead,” he said. “We need the clinic. It's awesome.”
Said Hickman: “I'm just like them, trying to stay out of the hospital and to take the best care of myself. I'm also here as a patient to educate doctors, nurses and social workers about sickle cell and that we're in pain and trying to stay out of pain.
“I encourage our patients to not let anything stop them, and to be determined, to pray, and let the Lord take care of the rest.”