Its reputation for successful blood-cancer treatment is often what draws patients from around the world to the center's Bone Marrow Transplant Program. But when patients are discharged, what usually stands out in their minds is the superb quality of the program's holistic, team-oriented approach to medicine, which begins even before they step through the doors of the Seattle Cancer Care Alliance to check in for treatment.
Guiding the medical team to ensure the best possible experience for each patient is a responsibility that Dr. Michael Linenberger takes very seriously when he serves as attending physician on the inpatient service, a role he assumes two months each year. A similar team-oriented philosophy pervades his other leadership roles at the Alliance, where he serves as medical director of apheresis and cell therapy and medical director of the regional marrow-collection center for the National Marrow Donor Program.
"Patients who are treated here may be very ill and their treatment is complex," said Linenberger, a member of the Clinical Research Division and an associate professor of medicine and hematology at the University of Washington. "We have excellent nurses, physician assistants and fellows, but the attending physician must lead the team. Staff look to him or her for that, and it's the way I've always practiced."
Ali Johany award
His dedication and mentorship drew recognition last month when he was awarded the Clinical Research Division's 2005 Ali Johany prize for excellence in patient care. The annual prize honors a Fred Hutchinson physician who has provided exemplary clinical medical care and compassion on behalf of the center's blood stem-cell transplant patients and their families.
Dr. Marc Stewart, Alliance medical director, described Linenberger as one of the Alliance's most dedicated and experienced clinicians.
"Mike sets the example for excellence as a standard in patient care," said Stewart, a member of the award's nominating committee. "But beyond that, he has always been committed to teaching and training young physicians. He truly recognizes how important it is to foster a team approach to the care of our patients."
Others on the nominating committee include Dr. Fred Appelbaum, Clinical Research Division director; Louise Schilter-Harms, nurse manager of the Alliance inpatient transplant unit at 8NE of the UW Medical Center; and Aleana Waite, director of quality/risk management and patient family services at the Alliance.
Nominators base their selection on feedback solicited from faculty and patient-care colleagues. Award recipients receive a gift of $10,000 from a $150,000 fund donated by former center patient Dr. Ali Johany of Saudi Arabia.
Waite said that Linenberger's colleagues described him as having a unique "systems perspective."
"He is known for always considering the impact an action will have on the patient and the staff and physicians, and is able to calmly sort out best options and set priorities," she said. "Everyone loves working with him."
Hematology fellowship
Linenberger's medical career in Seattle began in 1986, when he started his fellowship at UW in hematology, the branch of medicine that deals with blood diseases. After fellowship, he remained at UW as a faculty member in the Division of Hematology. His research involved studies on stem-cell biology and the effects of certain viruses on blood-cell formation. He remained clinically active with a weekly clinic and attending on the UW inpatient Hematology/Oncology service, the UW Hematology Consult service and the inpatient medicine service at Harborview Medical Center.
"When the Alliance opened up, I moved here and began working solely with the transplant program after being appointed as the medical director of apheresis and cellular therapy," he said.
Apheresis is a process in which a person's blood passes through a specialized instrument, which separates the blood into cellular and liquid components and collects the white-blood-cell portion that contains the circulating blood stem cells. The procedure is used to harvest stem cells from transplant donors and is also used to collect stem cells from patients, which may be modified and frozen prior to their infusion into the patient as part of their cancer therapy.
Challenges, opportunities
In line with the Alliance's mission as a comprehensive cancer center, the clinic's Apheresis Unit under Linenberger's direction now includes many routine therapeutic procedures in addition to stem-cell collections. His responsibilities include day-to-day management of the service, including donor safety, making sure that all procedures are well documented, supervising the staff and reviewing all reports of adverse events.
His other leadership role at the Alliance, that of medical director of the region's National Marrow Donor Program (NMDP) marrow-collection center, is to oversee the harvesting of marrow cells from unrelated donors who are deemed suitable tissue-type matches for patients seeking transplants through the NMDP registry. The NMDP maintains a registry of individuals who volunteer to be called upon to donate blood or marrow if they are found to be an appropriate match for a patient in need.
"Every month I'm not attending on the inpatient stem-cell transplant service, I'm attending on marrow harvests," he said. "From my perspective, this is a fun and very gratifying position because it involves working with healthy volunteer donors from the Northwest community. These are people like you and me who sacrifice their time and are willing to undergo a fair bit of pain to help save the life of a total stranger."
Stem-cell transplantation, he said, provides unique challenges and opportunities within the field of hematology/oncology. "The management and care aspects on the inpatient service may become very intense. The challenges include medical, psychosocial, emotional and, in some cases, unfortunately, do-or-die situations. The patients and their caregivers often come from far away and must stay here for months, and their life during the inpatient phase literally revolves around what happens here on a day-to-day basis."
The two months he spends each year attending on the inpatient-transplant service he described as "usually very busy and often very demanding."
Just how intense the experience can be from a caregiver's point of view is something that Linenberger discovered last summer, when his sister and her husband traveled from a small town in southwestern Kansas to Seattle for a stem-cell transplant at the Alliance. His brother-in-law had been diagnosed with acute myeloid leukemia, which had been brought on by treatment he had received earlier for Hodgkin's lymphoma.
"It was a pretty devastating experience for the family," Linenberger said. "After his diagnosis and initial treatment in Wichita, knowing what I know, it was clear he would need a transplant."
His brother-in-law and sister stayed with Linenberger during the treatment and recovery period, providing Linenberger with a unique opportunity to see a transplant patient's experience not as a physician, but as a family member.
"It really drove home the holistic approach of Fred Hutchinson," he said. "It began even before they got to Seattle, with phone calls, literature mailed to them — everything they needed to help prepare for what lay ahead."
Help for hard times
Being part of a program that provides such thorough care is one of the great rewards of his work, as is the opportunity to work with like-minded colleagues.
"On the inpatient service, I love interacting with the physician assistants, nurses and fellows — they are all intelligent, curious people," he said. "Seeing patients recover from their transplant is also a very rewarding aspect of the job."
The difficult times can be rewarding for different reasons, he said.
"Some of our patients don't do well," he said. "As the attending physician, that's where you really can apply your skills, helping patients and families prepare for end-of-life issues. It's my job to make sure that the team provides them with both the medical and the psychosocial support they need during those hard times."
