The first time Holly Rute was called in to UPMC Presbyterian for a possible double-lung transplant she was put in a room and, when her family needed food or a drink, she was left nervous and alone.
The second time, on April 11, when her husband and 11-year-old daughter went out to dinner, Mrs. Rute had the company of Kate Fitzpatrick, 21, a junior nursing student at the University of Pittsburgh and one of UPMC's new Transplant Guardian Angels.
It was "very comforting," said Mrs. Rute, 43, of Lewisburg, Union County. "Just the title of her position is comforting, just to have someone come in and say, 'I'm your guardian angel.' "
The six guardian angels, students in nursing and social work, were hired in February and March to help transplant candidates and their families called in for potential surgeries navigate the sprawling medical complex and transplant-related events.
Sometimes the transplants take place; other times the organs aren't right and the patients are sent back home, as Mrs. Rute was for a second time.
Either way, the angels are there to make the experience at Presby (heart and lung transplants) or UPMC Montefiore (transplants in the abdominal cavity) less intimidating or frightening.
"UPMC is very overwhelming. It's huge, people don't know where to go," said Rachel Roscoe, a freshman nursing student at Carlow University and at 19 the youngest angel. Through April 10, she also was the only angel whose patients -- a double-lung transplant and a liver transplant -- actually got their surgeries.
"They have questions about their surgery," added Ms. Roscoe, who lives in Oakland but is from Youngstown, Ohio. "Families want to know where to stay if their patient is going to be there long-term. They need to know the location of the cafeteria ... things to do during the operation."
Angels either have, or can get, the answers to all those questions -- and some the patients and families don't even think to ask.
Such was the case with Ms. Fitzpatrick.
"She's the one who suggested they get a room because it would be late," Mrs. Rute said. The angel had the number of Family House, affordable housing near the hospital, and she loaned the family her cell phone to make a reservation.
"She was really coming up with ideas, things we weren't thinking of," Mrs. Rute said.
"She was just there to sit with me, answer any questions we had."
The idea for the Transplant Guardian Angels came out of a group started in the unit late last summer to improve the patient's overall experience, said Deb Maurer, the UPMC transplant administrator. The group uses a methodology known as patient- and family centered care, which puts first not just the patient's medical needs but his physical and emotional comfort as well. Students reporting to the group shadowed some liver and lung transplant patients who had been called in for potential surgeries, and, Ms. Maurer said, "one of the lung transplant families suggested they needed a guardian angel" to help them through the experience.
The idea struck a chord with the care group. Ms. Maurer; Patti Lane, the transplant patient relations coordinator; and Joanne Sherer, assistant director of the Montefiore operating room, were assigned to assemble the angels program.
A decision was made to hire nursing and social work students because of their interest in patients. Part-time, on-call positions, the jobs were advertised online by UPMC by winter break.
The first two angels were hired in February and the rest last month. "Within a couple weeks, they were interviewed, hired and oriented," Ms. Maurer said. They got their pagers and their work schedules soon after.
Their orientation was like a crash course in Transplants 101, compiled from the feedback of the many departments that interface with the transplant service, including doctors and transplant nurse coordinators, and employees from parking, the emergency room and admitting.
Among the angels' orientation activities:
• Shadowing a transplant team evaluating patients with their families;
• Learning the contents of a checklist for every transplant type;
• Shadowing social workers to learn what they could do for patients' families;
• A scavenger hunt, in which they had to find places and items like ATM machines, Starbucks, cafeterias, family waiting areas, elevators and main entrances;
• Classroom time during which they learned about things like organ allocation and what it means when a patient is summoned for a possible transplant; and
• A tour of the transplant operating room.
The angels were upbeat throughout training, as they have been since, even though most of their patients have been sent back home.
"I've been a nurse for 25 years. It's reinvigorated me in the nursing profession," Ms. Maurer said.
"In the units, surgeons are saying, 'Where are the angels? ... When are they going to be on call?' The transplant surgeons are unbelievably supportive."
There's been no official survey, but Ms. Maurer said the early anecdotal evidence is that the patients and their families are happy to arrive at Presby or Montefiore and be greeted by a smiling young woman in casual street clothes who says, "I've been assigned to you as your Transplant Guardian Angel."
Angel Shari Squeglia, 32, Oakmont, a part-time social work major at Pitt, said her first patient, who went to Presby hoping for a lung on April 10, "had a lot of questions about the program. ... [She] was glad to have someone there."
As of April 11, Carol Shuler, 24, of Friendship and a graduate student at Pitt's School of Social Work hadn't gotten any calls on her pager. Instead, she'd been visiting the liver and kidney clinic in Montefiore every day and shadowing both potential donors and recipients.
She also visited Family House, where she found patient relatives "really excited [about the program]. They wanted to know the name of the family member who thought of the program, but we couldn't tell them," because of privacy rules.
The angels are, for the most part, looking for experience to augment their studies.
"I wanted to learn how to communicate and interact with transplant patients. A transplant is such a stressful experience, I thought I could benefit from it," said Michelle Maramag, 21, of Oakland, a third-year nursing student at Pitt.
As a freshman, Ms. Roscoe, who visited her patients after their surgeries and found them happy to talk to her, has not yet had any clinical experience. By being an angel she said, "I might get one-up on everyone" in her class.
Some years ago, Ms. Squeglia had serious surgery for a brain disorder called a Chiari malformation that required removal of a vertebra at the bottom of her skull. She said she wanted to do something that would be "giving back a little more."
But, so far, she's found herself benefitting too.
"I love it, absolutely love it. It's the best thing I ever signed up for," she said. "It's a really great experience to see what it's like to go through the process."
Pohla Smith: firstname.lastname@example.org or 412-263-1228.