Stem Cell Transplant Nurse, Dora Loun

I recently came across Dora Loun's LinkedIn profile, and her bio as a stem cell transplant nurse piqued my interest. However, when I had a conversation with her, I realized that what I thought she did and what she actually does are vastly different.
Dora's experience in critical care nursing provided her with the perfect foundation for caring for some of the most severely ill patients. I usually ask my guests to walk me through a typical day in their life as a nurse, but Dora took a different approach.
She instead described what her patients go through before, during, and long after a stem cell transplant. This was an intelligent move because hearing about the patients' hopes and dreams for the future, anxieties about the treatment, physical ailments from the medication's side effects, the isolation of loneliness, and the bond they form with their nurses gave me a deeper insight into Dora's work. And Dora's work entails providing hope for the future, care for the present, and comfort when time has run out. In the five-minute snippet: She’s going to need a lot of coffee. For Dora's bio, please visit my website (link below).
Dora's LinkedIn
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Transcript

[00:00] Michelle: I recently came across Dora Loun's LinkedIn profile, and her bio as a stem cell transplant nurse piqued my interest. However, after our conversation, I realized that what I thought she did and what she actually does are vastly different. Dora's experience in critical care nursing provided her with the perfect foundation for caring for some of the most severely ill patients. I usually ask my guests to walk me through a typical day in their life as a nurse, but Dora took a different approach. She instead described what her patients go through before, during, and long after a stem cell transplant. This was an intelligent move because hearing about the patient's hopes and dreams for the future, anxieties about the treatment, physical ailments from the medication side effects, the loneliness of isolation, and the bond they form with their nurses gave me a deeper insight into Dora's work. And Dora's work entails providing hope for the future, care for the present, and comfort for when time has run out. In the five-minute snippet, she's going to need a lot of coffee.  Well, good morning, Dora. Welcome to the podcast.

[01:37] Dora: Good morning, thanks for having me.

[01:40] Michelle: You're welcome. Thank you for saying yes. I met you on LinkedIn. I saw your comment on somebody's post, and then I looked at your profile and I was like, wow, stem cell transplant nurse, bone marrow transplant. That's so cool. I want to talk to her. So thank you so much for saying yes.

[02:03] Dora: It's my pleasure. Glad to be here.

[02:08] Michelle: We're going to get started by just telling everybody kind of how you got into nursing. What was your motivation, what areas you've worked in, and then where you are now.

[02:24] Dora: So, you know, like most nurses, I wanted to help people. I wanted to take care of people, and I'm kind of an adrenaline junkie, so I really wanted to be a paramedic. And then I found out how much they make, or actually don't make, rather. And in the area where I'm from, most of them are actually volunteers so even less of a viable option for feeding my family. So then I found out about flight nursing, and it kind of combines paramedic with nursing, and I thought, oh, my gosh, that's it. That's what I want to do. So I went to nursing school, and I was looking for something to do because I needed something I could get to in and out of school fast and was going to be a viable career option. So kind of all of those things were sort of happening at the same time. And so I went to nursing school, and I had intended to eventually go into flight nursing. And so you need critical care experience and some emergency experience. And so right out of the gate, I went to ICU. Oh, then life happened. And, you know, I never did make it back around to ER, but I did ICU for two and a half years and then went into home health for a little bit and then back to ICU. And then I kind of stepped away for a while from the bedside to take care of my kids. I started my consulting where, which is a combination of navigating and health coaching, helping people get through the health system while trying to take care of themselves in a way that they didn't need. The health system so much was my focus. And then my kids grew up and I decided to go back to bedside. So I went back to ICU and did that for almost a year and then got laid off if you can believe that, as an ICU nurse. They closed my hospital and three others in the Houston area, which is where I'm from. I was looking for a job and it was kind of hard to believe, but I was having a hard time getting a phone call back, you know, as an experienced ICU nurse. And then this travel recruiter called me and had a conversation with him and he talked about, you know, what travel nursing was and how it, you know, how great it is, which it really is, has a lot of upsides, although it does have some downsides. But, you know, my husband and I, both of our kids, you know, our kids are grown. We, don't even have a potted plant. So, like, let's do it. You know, my husband is self-employed, and so he just comes with me. And so I, I've gone back to staff a couple of times, but one of my assignments was at a bone marrow transplant unit and they had an attached ICU. So if their patients needed, got sick enough to need ICU level care, then they went to their own, you know, integrated ICU. So I was hired for my ICU skills for that assignment, and I kind of got a crash course in BMT stem cell transplant, and I just fell in love with it. It was just, you know, we're all kind of experiencing burnout because of COVID and different things. And I was just kind of, kind of looking for something different anyway and it just really kind of ticked that box for sure. I could still use my critical care experience. It wasn't like I was, you know, putting that behind me. It was just, it's probably one of the best units I've ever worked on before or since. And it was just a really good experience. so I just kind of kept on with that, even though not all the units have an attached ICU. So I don't always get to use those skills. But that's kind of how I got to where I am now with the bone marrow transplant.

[07:13] Michelle: Okay. Wow, that is a really interesting journey. And it just goes to show that, you know, it's never just linear I guess. In nursing, there are so many specialties you can jump around so much. I was really surprised about your move from ICU to home health. I was like, those are on two different ends of the spectrum. Right.

[07:38] Dora: And that was a move to try to be more at home with my family before, you know, I kind of eventually stepped away just because I was, you know, my kids were young and they were, they were old enough that they were doing school activities and baseball and, you know, all of those things and working twelve-hour shifts just was not conducive to that, you know, to being there. And so I chose home health because I was able to, you know, have, you know, a quote-unquote normal schedule and kind of be able to have some control over my time. And it worked out really well until it didn't.

[08:33] Michelle: That's very cool. It's just I get a picture of being a NICU nurse whenever I would float to, like, mother, baby. We have that lens as a critical care nurse, right?

[08:47] Dora: Absolutely.

[08:49] Michelle: Yeah. And I could see that with home health, it's like, did you walk into some of those situations and be like, this patient's like, super sick, or do you try to find things that maybe you normally wouldn't?

[09:06] Dora: I think there might have been some of that at the very beginning, but, you know, as in probably any specialty change, once you kind of, kind of find your groove, that probably didn't happen quite as much. I know there were times that I thought that, you know, what am I doing here? Because this is not how my brain functions. But like I said, I did it for just two years. So, yeah, a little over two years. So, you know, it wasn't that bad as far as that goes. But I think the hardest part for me was the triaging over the phone aspect. So, you know, in home health, at least in the companies that I worked for, you take a turn in taking call, and so you take the phone calls after hours and on the weekends and being able to determine how urgent that issue was was probably a little harder for me because I have that critical care brain because, you know, if you were in my ICU, I would do this, this and this. But in a home setting, it's a completely different kind of ball of wax.

[10:30] Michelle: So true. Okay, Dora so what does a stem cell transplant nurse do? Like, take us through a day in your life.

[10:30] Dora: So it's probably easier to take you through the journey of the stem cell transplant as the patient, and you'll kind of see it from our point of view. So the patients who come in for a stem cell transplant have generally failed other treatments, meaning chemotherapy, radiation, and other immunotherapies. And so just replacing their whole system for making their blood cells is kind of the hope that is going to cure them. Our patients are generally leukemia, lymphoma, multiple myeloma, and blood cancers, essentially. We also do them for other reasons, like sickle cell or pernicious anemia, things like that. So the patient will come in and we give them high, high doses of chemotherapy. That's one to hopefully knock back as much of the cancer cells as possible. Hopefully completely knock out the cancer cells is the hope. That process, however, ruins their immune system, essentially, and it sort of kills their body's own mechanism for making white cells, red cells, and platelets. So we're giving them new stem cells to fix that problem. Basically, we're killing their bone marrow and then bringing it back with either their own stem cells or somebody else's. And so the transplant itself is very anticlimactic. It's just like any other infusion. It's just a little bag of cells. It looks like kind of diluted blood. It's kind of a pink liquid, and it just goes in like any other IV. And then in the, in the days following that, we, you know, we check their CBC daily, of course, with, you know, chemistries and all the things that you normally would, because their white cell is going to drop, their red cells going to drop, their platelets are going to drop. And it sort of a process where it's kind of a u shape where everything goes down and then it all comes back up. And in that timeframe, we'll be giving blood and platelets almost daily. They'll get one or the other or both every day because their body's not making them anymore, and so you have to replace them. They'll also lose their white blood count. And we watch their ANC, which is their absolute neutrophil count. And they'll be on neutropenic precautions. So they'll be in isolation. All the rooms have their positive pressure room versus, like for TB, you have a negative pressure room because TB, you want to keep all the germs in the room, whereas with stem cell patients, you want all the germs to stay out of the room. So it's a positive pressure room. And of course, we're wearing masks and all the things that go along with that. And the medications that they get for anti-rejection really chews up their potassium and magnesium because it requires those electrolytes to work properly. So we're giving lots of potassium, lots of magnesium, usually IV. These patients are going to go through all the things you think of with cancer treatments, chemotherapy, and radiation therapy.  They're going to have nausea, vomiting, diarrhea, and fatigue. They're going to lose their hair. Not all of them, but most of the time they'll lose their hair. And we try to make it fun. When it's time to shave their head, these patients get a shower and linen change every single day without fail. They were extra precautions. We were extra cautious about everything. They're on a special diet. They don't get any, like, they're not going to eat a salad. There are no fresh fruits or vegetables. They all have central lines because the peripheral line is not going to be big enough for the stem cells to go through. They're all going to have a central line. So you're going to take extra precautions about the central line. There's, each unit I've been in does it a little bit different, but there's always the, you know, taking the extra steps to make sure that things are clean and things are sterilized and you're protecting them from any type of opportunity for infection because that can kill them. Anything. You know, there, there's a lot of dry mouth involved. We use things like Biotin and encourage frequent oral hygiene. We're very careful about their feet to make sure that, you know, they're, they're taking care of their feet just kind of like you would with a diabetic, because if there's anything, you know, they get a hangnail and it can be an issue. We, most of these people are what a nurse would call a walkie-talkie. They're generally pretty independent, but we're extra cautious for falls. So these patients are gonna they're all gonna be on fall precautions, so they get a bed alarm at night. We, of course, educate and encourage them to ask for help if they're feeling any sort of dizziness or wooziness. But we do encourage them to get as much exercise as possible. Some units will have stationary bikes that they can use. We encourage them to walk the hallways. There's actual research that shows that the more active a patient is through their process, the better their experience is. They're less likely to decline due to deconditioning. And so we absolutely encourage them to do all of those things. So they're generally with us an average of 21 to 28 days, depending on whether they're an autologous or an allogeneic patient. The autologous are going to be generally a shorter term stay, and it's kind of generally an easier road for them because they're getting their own cells back, and they're generally smoother because you don't have the risk of GVHD. And so the medications that they get are going to be a little bit different. They're not going to have the anti-rejection medications, which are standard for the allogeneic, because they're getting somebody else's cells. And where those cells come from makes a big difference to their course and how they respond. I don't know exactly what they're called, but ten things that have to line up to be a perfect match. And so ten out of ten, of course, is going to have different risk factors for graft versus host disease than what we call Haplo, which is five out of ten is hap. Those are usually like parent or child matches. Often it can be a roller coaster, and we try to prepare our patients that it's probably going to be one of the hardest things they're ever going to have to go through. But it's worth it in the end, because when it. When it works out, it works out really well.

[20:07] Michelle: That's an amazing journey, and I really like that you used the journey instead of kind of like what, what you do on a daily basis, because it gives a much clearer picture and a better, a deeper understanding of actually what your patients go through. And so I would imagine that you know, being with you for a month or so, you as a nurse, you come to know your patients really well. And would you say that you form strong relationships with your patients?

[20:43] Dora: Absolutely. In most other specialties, you know, we're taught to be caring, but not to get attached, to try to form some sort of connection with your patient, but don't get too involved, you know, kind of that sort of arms link relationship with your patients. And you cannot take care of a patient for a month and be at arm's length with them. It's just that it's impossible. And in reality, it's not really good for the patient because most of these patients, some of them will have somebody that can be in the hospital with them. And if they can, we absolutely encourage that. But, you know, these people are in a strange place, surrounded by people who are not their family or chosen friends. They are going through one of the most difficult things they will ever have to go through in their life. And you have to be that support system for them because a lot of times there is nobody else just because, you know, these people have to go to work, somebody's got to keep the insurance on them, you know, that kind of stuff. And that's one of the things that makes it a really hard place to work, and it also makes it really rewarding.

[22:28] Michelle: Yeah, I would imagine getting so close to your patients that things happen, and obviously, every patient doesn't make it out of that process. And so when you lose a patient, I would imagine that hurts really deeply. And you have to kind of do a self-assessment on kind of how you protect your emotional state? How do you pay attention to that? Are there certain things that you do so that you can process that, the loss of a patient in the best way possible?

[23:13] Dora: So for better or worse, having an ICU background, I already have some of those things in place because, you know, 85% of the deaths in a hospital happen in ICU. So I've had to bring some of those same self-care and self awareness skills to bone marrow transplant. But it is a little harder because you do get to know them, and you get to know them on a level you don't with other patients because you learn about, you know, their journey to get there and you learn about their kids and their grandkids and their, you know, what they want to do when they get out of there. And their hopes and dreams and there is a closer camaraderie between the nurses that I've seen than in other places. Just because you have to have somebody that gets it to be able to have the conversations that, like, wow, this is so devastating that nobody else is really going to get it. And I think you have to have good coping skills. And, you know, nurses are known for our wine and coffee as our coping mechanisms, but you have to have other things. There has to be something else. There has to be something in your life that gives you hope for the future, and you have to really take care of yourself. And I think one of the things that was really a good experience for me personally is because I have the ICU background and I spent most of my time taking care of the sickest of the sick of these bone marrow transplant patients and the ones that we did everything we could do. And just, you know, you can't save everybody having an opportunity to work in the part of the units that the people get better and they go home and then they come back and they, they bring candy or they, you know, bring whatever, and they, you get to see them after their hair's grown back. And those are the ones that have to keep you going because there was a point where I was like, why are we doing this? This is awful. These people go through all of these horrible experiences and then they die anyway. Like, why are we doing this? And then to be able to see the ones that it works really well for and they're able to make it to that wedding that they were trying to live for or watch their grandson be born or whatever it is that has made them keep going to be able to celebrate that with them. Those are the ones that you really have to hold on to.

[26:40] Michelle: That was very well said. And, you know, there's some parallels. I could say the same thing for the NICU. When we have those micro preemies that are born at, like, 400 or 500 grams and they're staying six, seven months in the NICU and NEC gets them at the end and they end up passing away. It's tragic. You've formed bonds with that family for so long, and then they're gone, and it really makes you think about exactly like you said, like, why am I doing this? But then when, when the parents bring back their baby that's now two years old and chubby, and then you're like, yeah, that's why we do it. Exactly that satisfaction. So you did a really good job of explaining that. And, you know, my listeners know that I've had my own cancer journey. I had breast cancer in 2009 and the mastectomy and the chemo and all of that. And it's quite an experience and one that I don't think, you know, I think the nurses definitely are very insightful into what the patient's going through just because they visually see so much suffering and all the changes that chemo brings. Is it a last-ditch effort for a lot of these people?

[28:16] Dora: Very often, yeah, this is it. There is nothing else that we can do for you. And sometimes they, sometimes that fails and they have to come in. Like, we've had patients that had an auto first in that field and they had to come back from for an allo. And those are the ones that are really hard because, like, I've already done this. I don't want to do this again, but here we are. Those are tough.

[28:56] Michelle: Yeah. So what do your patients need in terms of education?

[29:03] Dora: Oh, my gosh. So that is a huge part of what we do. Just because, you know, so much of it is time just spent waiting, waiting for numbers to go down, waiting for numbers to come up. So there's education on, you know, what the process is, what managing side effects, prevention of bleeding, because, you know, prevention of infection and follow up care and helping them understand that the 21, 28 days if everything goes well, that they're in the hospital is just the beginning of the journey, that when they leave us, they're like a newborn. Their immune system is like a newborn. So helping them to navigate living their life outside of the hospital is, we're talking about that through their whole stay. Like, the things that are going to happen when they leave here the first 100 days from transplant are the most important time as far as infection and rejection and teaching them about their rejection medicine, the fact that you have to. Yes, you have to take it every day and come into the clinic to get blood work done because, yes, you're still going to need blood transfusions and platelet transfusions. Not as much, not every day. Otherwise, we couldn't send you home, but at least once or twice a week, you're still going to need transfusions. You're still going to need potassium, you're still going to need magnesium. You're still going to need all of these things. And that just because we discharge you home from the hospital doesn't mean that you're well, that there, it's at least a year, some people, it's too years before you can really go back to work and be around people. And so it's a big, overwhelming process. Like one of the units I worked in, they got a big three-ring binder of information before they came in and we would talk about stuff. Every time you walk in the room, you're educating on something. So education is huge in bone marrow transplant.

[31:43] Michelle: Well, Dora, how do you stay up to date on all the latest in your field?

[31:50] Dora: Wow. So there's so much happening all the time. And believe it or not, I get a lot of information off of LinkedIn. I'm connected and following a lot of people who are in the research space. And I also. I have a lot of discussions with ER's, and, you know, I ask a lot of questions to anyone who I think has the answers, and I just. I just research and read, and I read everything I can get my hands on, so just constantly learning. There's so much to learn. And the stem cell transplant is just a scratch on the surface. Now you've got CAR T. That's also something that is done generally in the BMT units. And now they're coming out with this CAR NK transfusions, and they're starting to use these things for lupus and other autoimmune diseases. And there's just so much information out there that it's. It's an exciting world for cellular therapy, and I really feel like that's the future. And so I just read everything.

[33:16] Michelle: That's great. I mean, like you said, it's. It's constantly changing, so you just have to stay up on it. I saw that there were some professional organizations, so. Oncology nursing society, American Society for Transplantation and Cellular therapy, and association of Pediatric Hematology. Oncology nurses. Are you aware of those? Are you a member of any of those?

[33:45] Dora: So, I'm aware of the site. That's where I got my chemo certification from. So I'm. I'm involved with them. I'm not really aware of or involved with pediatric chemo because I don't do PEDS. I have a strict rule that all of my patients have to be full-grown. Fully grown and one patient in the bed at a time. So, anyway, I don't. I'm not, you know, involved with them. The bone marrow transplant one I'm also aware of, but I have not joined as a member.

[34:29] Michelle: Okay. I know nothing about this field, so I was just doing my research, and I found those three. And there's also a certification for your job, so. Blood and bone marrow transplant certified nurse, or BMTCN, is that correct?

[34:46] Dora: Yes, and I've looked into that one. And you have to have two years of experience, and I'm still, you know, a baby BMT nurse, as it were. So that's definitely on my radar to work on. I just need more experience to qualify for it. There's also the OCN, and OMC that a lot of the BMT nurses also have. They'll be dual-certified in BMT and oncology. That's also on my radar as well.

[35:26] Michelle: Well, other than ICU experience, is there any other type of experience that would help somebody get into the field that you're into?

[35:36] Dora: Um, oncology obviously would be a good one. I think some infusion experience would be helpful. Just because you're just constantly giving them something. If it's not blood, it's chemo or electrolyte, that would be good. Even a clinical nurse would probably be beneficial. Just because they understand the long-term goals. Because these patients are long-term patients. They're not in acute care. Generally they're in and out within a few days. They come in, you never see them again or, you know, you have the frequent flyers, but generally they're there for a few days and you, you fix their immediate problem and you send them on their way. Whereas, you know, these patients are with you for a long time and their journey is going to be long. And so somebody who is looking at the bigger long-term picture like a clinic nurse or primary care nurse or even, you know, any one of the specialties that you're, you are looking at caring for this condition, you know, this is a chronic condition essentially, so you're caring for that, for the long term. So that would be a good place to come from to get into BMT for sure. And there are BMT clinics. So the patient comes into the clinic, they have a specific clinic that they go to. They're not going to go see their oncologist or their primary care for almost anything. When a patient is on their BMT journey, they come to the BMT clinic for everything. They are their primary point of care and contact.

[37:44] Michelle: Okay, well, thank you for delineating that. So besides nurses, what other disciplines do you work with?

[37:58] Dora: So we have PT and OT a lot. You know, these patients are at high risk for debility because one, because you're in the hospital for a month and two, you know, the weakness that gets involved with the process. So we work with PT and OT quite a bit. We work with speech-language pathology as well because, you know, some of these chemos cause what we call chemo brain. So there can be some cognitive deficits that are involved and speech helps us with that. Renal gets involved a lot of times gastro because we can have renal issues, and we have liver problems because of the treatments. Neuro gets involved. There's neurotoxicity that can be involved in some of these medications that we give. So it's really kind of all hands on deck with these patients. You know, just about any, and everybody can think, think of, you know, would.

[39:15] Michelle: You say your primary providers there are, are they oncologists? Are they hematologists? Are they, like hospitalists in the unit?

[39:27] Dora: Generally, they are hematology doctors. Hematology-oncology. It's a subspecialty of hemotology. And so these doctors who do this and take care of these patients are specialized in this, in bone marrow transplant. So they are generally heme-onc doctors that kind of split off into BMT. And they take point on these patients. They are their primary provider versus a hospitalist. Usually, there's not even a hospitalist involved. It just. It's the heme-onc doctor, and then they'll consult other specialties if needed.

[40:19] Michelle: Well, in my research, I came across this little bit of information, and I thought it was quite interesting. So this comment was made by Professor Edward Donald Thomas, the 1990 Nobel Prize winner in medicine, for his development of bone marrow transplantation. And so his comment was for nurses. And he said, "Nurses and nursing are my secret weapon, without whom I could not have achieved my goal."  So I thought that was so cool. What do you think of that comment?

[40:58] Dora: I think he was ahead of his time. You know, there was a time when nurses were seen as doctor's assistants, and where we have come full circle to where nurses are being recognized for their own contributions, as they should be, which is why I think he was ahead of his time because he realized that, you know, nurses and doctors are not the same. We don't do the same thing. We don't. It's a completely different mindset. It's a completely different view of the patient. And, you know, there are things that I do as a nurse that the doctor has no idea what I do, and vice versa. And we are all colleagues in taking care of this patient, whatever that looks like. And so, you know, like I said, he was just ahead of his time.

[42:03] Michelle: Yeah, I think so, too. And I just loved it. Just like you said, we're two different disciplines, and I think so often the love kind of goes one way where we see a really competent, caring, compassionate physician, and, you know, we have a lot of respect. And this physician making this comment and realizing the importance of nurses and the nursing profession is just heartwarming to me. And it made me feel good as a nurse, so I loved it, and that's why I included it. First, I want to thank you for giving us kind of a bird's eye view of bone marrow transplants, and stem cell transplants. The work that you do, it's so important. It's so crucial. It was something that I knew very little about except for being a chemo patient, and I know how that feels, and it does not feel good. And I could just imagine what your patients go through and you as a nurse, seeing that feeling, that forming those relationships and just having all the critical thinking skills that you need to have and all the assessment skills. It's a really interesting nursing specialty, and I thank you for sharing that today. So now I want to talk about your work as a freelance healthcare consultant. What are you doing in that realm?

[43:44] Dora : So it's kind of a catch-all title because I didn't know what else to call it and really just try to help people who cross my path that just need help with whatever thing it is that they've got going on. So many people don't understand how our medical system works and what a pre-authorization is and which doctor they need to go to for, you know, whatever is going on with them. They don't understand how insurance works, and they don't understand so many things about how to take care of themselves and how to keep themselves out of the hospital. So those are the kinds of things that I touch on. I don't actively seek out clients as much as I used to. It's just kind of a referral basis. But I've helped people. It kind of started with my son, who, I had some difficulty with him kind of navigating through the behavioral health system with him. And I was just, like, reaching out to other people about, this is what I went through, and this is how hard it was. And, gosh, it sucks. Why does it have to be like this? And I had people contact me, like, oh, my gosh, I'm having the same trouble with my kid. And how did you do it? What did you do and who'd you talk to? And that's kind of how it developed, and it kind of went, kind of grew from there. And I'm adding some things now. I'm adding some legal nurse consulting and some writing into that as well. But those are relatively new, so I'm still figuring out how to integrate all that as well. But it's just something where I don't have to go in and, you know, I can help other people without being beholden to somebody. I guess now you would kind of call it a cross between navigating and health coaching. Like, when I started doing it, I didn't have a name for it. And, like, now that I've kind of seen some of the other things that, like navigators and health coaches do, I guess you could say I'm a cross between two things.

[46:19] Michelle: Well, I think it's a much-needed service because, as you said, health literacy, a lot of people don't have that, so they don't understand how to navigate the health system. And the other thing that I really like is that your focus is on more prevention and teaching them the things that they can do to keep themselves out of the hospital, out of the health system. And I think so often our profession doesn't focus on those things. We were more of a, you know, now you're sick, now we're going to fix you, but we didn't do anything to prevent you from getting sick.

[47:03] Dora: Right.

[47:04] Michelle: So I like that. I love what you're doing, and I think there's a real need for that. So that's great. Okay, a couple more questions as we get ready to close here. One of them might put you on the spot a little bit. So if you don't have an answer, just say, I don't have an answer. But is there someone that you recommend as a guest on this podcast Dora?

[47:31] Dora: I have a couple of types of people that you might be interested in, but I don't have specific names. I can get back to you on that when I have. When I can nail narrow down names for you.

[47:48] Michelle: That sounds great. I love the idea of different nursing specialties. And so, yeah, bring it on. Well, where can we find you?

[47:58] Dora: The best place to find me is just on LinkedIn. I generally keep my other social media to personal, family, and friends, so LinkedIn is really the best way to find me.

[48:13] Michelle: Okay, great. I have that LinkedIn link, so I will add that to the show notes. But that's all my questions for you today. You have really brought a lot to the table today in terms of helping us understand what you do as a stem cell transplant nurse, and bone marrow transplant nurse. It's a really fascinating specialty and one that I knew very little about. So, yeah, thank you so much, Dora, for coming on and sharing that with our listeners today.

[48:49] Dora: Oh, you're very welcome. It's been an honor and a pleasure to be here. Thank you so much for having me.

[48:56] Michelle: It's been my pleasure. You know, it's the end. So we're ready for the five-minute snippet. Are you ready?

[49:05] Dora: Sure.

[49:06] Michelle: It's just five minutes of fun. I find people get so, like, nervous about the five-minute snippet, but it's fun.  Would you rather have the power to fly or be invisible?

[50:03] Dora: Fly, hands down.

[50:05] Michelle: That'd be kind of cool.

[50:06] Dora: I love to travel. So I could go anywhere I want if I could fly. So absolutely fly for sure.

[50:15] Michelle: Love it. Okay. Would you rather live in a world without music or books?

[50:23] Dora: Oh, sounds like an awful place, either one. I guess I would have to choose a world without music because I am an avid reader, and I think that knowledge is power and, you know, getting it from books and you can just escape into another world with, you know, fiction books. So I think I would live without music.

[50:49] Michelle: So true. That was a really hard one. Okay, this is this or that morning or night?

[50:58] Dora: Night.

[50:59] Michelle: Oh. Do you work the night shift?

[51:02] Dora: No, but all things being equal, I'd rather work the night shift. I'm just not a morning person. I would just, you know, I would sleep till noon if I could.

[51:17] Michelle: You sound like a night shift worker in another life.

[51:21] Dora: Oh, yeah. I've worked nights, and I love nights. I just, you know, you miss out on everything else, so I just.

[51:29] Michelle: Yeah, so true. Favorite vintage band?

[51:39] Dora: You know, Van Morrison is a favorite. Or Tom Petty. Those would have to be in my top one, for sure.

[51:50] Michelle: Really good ones. Okay. Would you rather live in a world where it's always winter or always summer?

[51:59] Dora: Always summer, for sure. I like to be on the water, in the water. Swimming, boating, fishing.

[52:09] Michelle: Nice. Okay. Yeah, I guess if I had to choose, I would say summer as well. Even though when it gets super hot, I don't like it, I don't like the cold, either. I'm a big baby.

[52:21] Dora: Today is April 19, and I'm looking out the window, and it's snowing where I'm at.

[52:26] Michelle: What? Oh, my gosh.

[52:29 Dora: I should be able to see it. Can you see this now?

[52:34] Michelle: Oh, my gosh, yes.

[52:37] Dora: Yeah. So we came here because I wanted the snow. Like, that's what I came for. I came for the snow. And there are some absolutely beautiful mountains here, and the national parks are just amazing. I was not expecting it to still be snowing, though. Like, oh, my gosh.

[53:03] Michelle: You're like, I'm done already. Okay. Oh, my gosh. Favorite way to relax after a long day?

[53:14]  Dora: A hot bath and a glass of wine.

[53:18] Michelle: Sounds pretty nice. Okay. Coffee or tea?

[53:23] Dora: Both. So coffee is the reason that you know, hundreds of killings never happened. I'm a firm believer in that. So I, you know, there's the important coffee. That's the coffee first thing in the morning. There's the after-lunch coffee the Cuban coffee. That's the good coffee. The cappuccinos. Those are amazing. I picked that up in Miami. But tea is for, like, I'm drinking tea now. Tea is for a different enjoyment. Like, it hits a different pleasure center in the brain for me. Like, I feel like get you going and tea is kind of to mellow you out and kind of find your zen. So I feel like both are important.

[54:30] Michelle: You know, I have to agree with you there because I do drink coffee, but I drink tea at certain times when I want to really chill out. So. Yeah, you're right. It's a different vibe. Okay, last one. Pizza or burgers?

[54:49] Dora: See, this is complicated because I'm gluten-free. I've been gluten-free for, like, 15 years, and the options for gluten-free people have changed drastically over time, over that period of time, for sure. So I think given my gluten-free options, I like my pizza options better than my hamburger option. So that would be what I would have to pick.

[55:22] Michelle: Again, I have to agree with you. They have improved the pizza crust, the gluten-free pizza crust, a lot. But the burgers and the hoagies, they just still haven't made them to where I like them. So I'm with you.

[55:39] Dora: Yeah. Yeah. The buns are kind of, you know, although I had a really good patty melt with gluten-free bread the other day, so, I mean, if we could kind of get me some rye. So gluten-free rye, like, that would be, like, amazing. But I haven't found that yet. I don't think it's ever going to happen.

[56:06] Michelle: Yeah. Or just melt cheese all over it and then it makes it all better, right?

[56:10] Dora: Cheese. Yeah, cheese makes everything easier. For sure.

[56:15] Michelle: I love it. You did great. You passed. You passed the five-minute snippet. Dora, thank you so much.

[56:22] Dora: Thank goodness.

[56:24] Michelle: Well, you have a great rest of your day, whatever you're doing.

[56:28] Dora: Oh, thanks. You too. I appreciate you taking the time to chat with me and being interested, that's cool.

[56:36] Michelle: It was very fun. I learned a lot.

[56:39] Dora: Good.

[56:39] Michelle: Take care.

[56:40] Dora: Cool. Thanks. You too.