Faith, Love and Case Management Grant a Father’s Wish
by Beverly D. Brill R.N., C.C.M

After suffering major complications from a stem cell transplant, doctors didn’t think Anthem Blue Cross and Blue Shield member Melvin could survive outside a hospital. Together with his determined wife, Anthem’s Beverly Brill helped him get home.

They said it was impossible

Doctors told Melvin and Caroline they would never have children together. Although devastated, it didn’t diminish the couple’s faith. “Sometimes you just don’t know what God has in store for you,” said Caroline, an Anthem Blue Cross and Blue Shield member in Jeffersonville, Kentucky.

Soon after, the couple’s resolve would be tested again when Melvin was diagnosed with non-Hodgkin’s lymphoma (NHL), or cancer of the immune system. Over the next two years he battled the disease into remission. And five years later, they received surprising news: Caroline was pregnant.

“We had a beautiful little girl, Caitlin, and Melvin was in remission. Finally we began to feel at ease,” recalled Caroline.

Then the unthinkable happened. Melvin’s cancer returned, and this time only a stem cell transplant could save his life. “He was very afraid, but determined to go through with it,” said Caroline. “He wanted to live so he could raise Caitlin.”

Every complication imaginable

As with all transplant procedures, an Anthem case manager was assigned to the family. During their first telephone call, Beverly Brill, a registered nurse and certified case manager at the Centers for Clinical Excellence at Wellpoint in Mason, Ohio, explained how she would be a liaison between the family and their health care providers.

“My job is to be their advocate; there to help members get the most care from their policy and reach their recovery goals,” she said. “Melvin’s only goal was to be well and back home with his daughter as soon as possible.”

Intensive infection control procedures, frequent follow-up visits and an emotionally challenging recovery make transplants especially stressful for members and their families. To prepare Caroline, Beverly explained the support resources that were available and briefed her on what to expect after the procedure.

But no one was prepared for how many setbacks Melvin, 58, would face: pneumonia; acute renal failure; severe muscle wasting; sepsis; hypertension; infections; depression and more. Most seriously, he went into respiratory arrest three times, leaving him on a ventilator and in the intensive care unit for the next six months.

“He had nearly every complication imaginable,” said Beverly.

Despite everyone’s best efforts, Melvin remained in grim condition unable to move, breathe, speak, drink or eat on his own. The prognosis was so poor that Beverly suggested hospice care. Instead, he went into respiratory failure and was moved to a long-term acute care hospital, where doctors thought he’d never leave. Caroline wasn’t convinced — he had to go home, she said.

“His eyes lit up whenever Caitlin came to visit. I knew he wouldn’t make it if he stayed in a nursing home or hospital. And I couldn’t just watch him die,” Caroline insisted. “I told him, ‘I’m not letting you give up.’”

Although she knew others thought she was being unrealistic, Caroline was relieved that Beverly remained her ally: “No matter what, she always said, ‘Let’s see what we can do to help you take him home.’”

But could Caroline, an administrative assistant with no medical training, handle the intensive care that Melvin would require? To find out, the physicians required that she prove she was capable of handling suctioning his tracheotomy tube every two hours, administering breathing treatments, dispensing medicine and food through his stomach tube, checking his vital signs, managing his wound care, bathing and bathroom duty.

“Her care at the hospital had to be flawless for us to even consider discharging him,” said Beverly. “But she shocked us all and passed with flying colors. In all my years of case management, I’ve never had a case this complex or worked with anyone quite as determined as Caroline.”

Soon after, Caroline requested a leave of absence from her job and took Melvin home.

Maximum quality of care

Walking into a living room full of medical supplies shocked Caroline at first, but she quickly fell into an exhausting routine that began each day at 6 a.m. and went long into the night. She learned to identify when Melvin needed help from the tiniest of motions or just a flicker in his eyes.

Caroline’s parents helped care for Caitlin while Beverly ensured that Melvin received the maximum quality of care from his doctor and his physical, occupational and speech therapists, and the necessary medical equipment and medical transportation for his numerous doctor visits.

For every emergency and every question Caroline counted on Beverly to help her communicate with the physicians and make decisions. “We spoke on the telephone all the time,” she said. “Beverly cared so much about our family, we couldn’t believe she worked for an insurance company.”

Even though the Burns family lived in a rural area and access to home health and medical equipment was scarce, Beverly relentlessly searched for providers that would serve them. After much cajoling, she even convinced Melvin’s primary care physician to drive nearly an hour for a check up at their home…on his day off.

“At the time Melvin was in really bad shape and very weak. I was amazed and grateful that she was able to get our doctor to make a house call. Even Melvin expressed that he couldn’t believe she would do such a thing,” Caroline said.

And when not one speech therapist in the area wanted to take on his case, Beverly found someone who was willing to travel to their home and do it for an affordable price, no less.

“Bev is one of my most engaged case managers,” said Carole Cline, staff vice president, Centers of Medical Excellence, Health Solutions. “She really goes the extra mile with all of her members, but this went far beyond the norm. Even though she was managing 40 other cases at the same time, she persisted in finding providers that would serve Melvin while maximizing his benefits so the family would have more available later if they needed them.”

The payoff for Caroline and Beverly’s hard work came quickly. One week after coming home, Melvin got out of bed and used his rolling walker. He was on his way.

“You can never give up”

Now months later, Melvin can drive a car with supervision, walk into his doctor appointments, use the bathroom, and is working towards eating and drinking on his own. Caitlin is often perched on the arm of his chair joining him in his physical therapy and breathing exercises. Nothing makes Melvin happier.

“I never imagined I could do it,” Caroline said. “But you can never give up, even when you’re told that something is impossible. I had to believe he could come out of it and that he could get better.”

And while there are still setbacks and disappointments and weeks where they have seven doctor appointments, Caroline says her faith, which she shares with Beverly, keeps her spirits up and eases her fears.

“I don’t know if all the case managers are like Beverly, but she’s been wonderful. I don’t believe anyone else would have done what she did for us,” she said.

As Melvin’s health continues to improve, the telephone calls from Kentucky to Ohio are less frequent, and Beverly admits that when this family’s case closes soon, she’ll miss hearing Caroline’s ever-calm, Southern drawl. “She’s more than a positive person, she’s as near to a saint as I’ve ever met,” said Beverly. “Without her, I don’t believe Melvin ever would have improved, let alone been able to be home.”

Because of the remarkable story of her work with this family, Beverly was honored to present the case at a recent continuing education meeting of her peers. After her hour-long presentation, she said there was nothing but silence. Then one by one audience members rose to their feet and applauded.

Thanks to the unwavering love of his wife, and guidance from Beverly, Melvin can now stand by himself.