'None of us practices in a vacuum'

Ali Johany Award recognizes Paul Carpenter's outstanding collegial approach to patient care and clinical research
Dr. Paul Carpente seated in his office
Last week, Dr. Paul Carpenter received top honors from his Clinical Research Division and Seattle Cancer Care Alliance colleagues for treating patients and families with exemplary medical care and compassion. Photo by Stephanie Cartier

For Dr. Paul Carpenter, teamwork isn't an overused buzzword or a hoped-for goal. It's essential to how he cares for pint-sized and adult patients fighting to survive cancer or its aftermath.

His respect for every member of a clinical-care or research team is just one reason Carpenter was recently lauded by his Clinical Research Division and Seattle Cancer Care Alliance colleagues. The physician-researcher was awarded his division's 2006 Ali Johany Award for excellence in patient care at the Sept. 12 grand rounds. The annual prize honors a Hutchinson Center physician who has provided exemplary clinical medical care and compassion on behalf of the Center's patients and their families.

If Carpenter had listened to his college career advisers, he never would have become a doctor. "They thought my aptitude for math meant I might not find the human/biology interaction such a match, so I decided to be a physicist," he said. "But I knew within a month of starting physics that I did need the human side, so I switched back to medicine. It's the interaction with patients that makes it relevant."

Expertise and dedication

Carpenter, who came to the Center through a fellowship 11 years ago, still looks for that balance as he straddles the worlds of patient care and research. He works with pediatric bone-marrow transplant patients, does long-term follow-up care for both adult and pediatric patients, and conducts research studies. And whether he's caring for a desperately ill child or writing up clinical-trial results, Carpenter credits the Center's collaborative culture for his success.

"None of us practices in a vacuum," he said. "When I look back on all of the interactions that are so critical for patient care, it's not just my work. It's the combined effort of a unique and talented care team."

"Attending physicians tend to be like a spokesperson or coordinator of the team, but the whole package we present to patients and families is really a combination of everybody's efforts. I can call up any number of my colleagues at the Center, and they each have state-of-the-art expertise and advice that I can factor into my decision-making. I go to the families with a lot broader knowledge base that is very helpful in communication."

Carpenter is quick to acknowledge the contributions of the entire medical team, including nurses who share insights to help him communicate with taciturn patients; lab workers who run critical, unscheduled tests; the palliative-care team, whose members establish relationships with families from the onset of care, easing tough conversations if a prognosis worsens; and long-standing faculty who serve as resident experts for fine-tuning treatment. "It's all sorts of little things that add up to better patient care," he said.

Monica Cays, an SCCA pediatric nurse, said Carpenter's calm and sincere demeanor helps her patients and their families. "He inspires confidence and hope in an otherwise frightful environment," she said.

Carpenter's expertise and dedication set him apart, said Gretchen Roewe, a pediatric social worker at the SCCA. "Families and staff immediately warm to Dr. Carpenter's caring disposition, smile and Australian accent. Paul goes the extra distance to help families understand and access care they need and to help them become active participants in this process. This ranges from using graphs and research articles to teach parents about their child's disease and treatment, to advocating for a patient's access to medications and services following treatment."

Dr. Fred Appelbaum, senior vice president and Clinical Research Division director, commends Carpenter's approach.

"Paul is very careful, thoughtful and thorough, both in his research and his clinical care," said Appelbaum, a member of the award's nominating committee. "During his fellowship, Paul spent a great deal of time in laboratory research, and although his work was progressing very well, he subsequently chose to concentrate more on clinical research and care because, I believe, he knew that was where his heart was. He realizes both the potential and limits of modern medicine and understands that even when our treatments are not successful, a great deal can be done to help the patient and the family during those most difficult times."

Others on the nominating committee include Dr. Marc Stewart, SCCA medical director; Louise Schilter-Harms, nurse manager of the SCCA transplant unit at the University of Washington Medical Center; and Aleana Waite, SCCA director of quality/risk management and patient family services. Johany award winners are selected based on feedback solicited from faculty and patient-care colleagues. Recipients receive a gift of $10,000 from a fund established by former Center patient Dr. Ali Johany.

"Paul is an outstanding clinician who approaches patients with compassion," said Dr. Jean Sanders, director of the Center's pediatric stem-cell transplantation program. "His clinical research is important in exploring new ways to treat graft-vs.-host disease (GVHD). He has an excellent work ethic, and he is a team player."

Rosemary Ford, nurse manager of the SCCA transplant clinic, said Carpenter's diligence in keeping abreast of new research and methods improves patient care. "His comments at the Standard Practice Committee are consistently thorough, founded in current best practice and research and always have the patients' best care as first priority," she said. "In the clinic, his interaction with the children and their parents is consistently compassionate. His expertise in transplant medicine is obvious to both the patients, their families and the nursing staff."

Clinical studies

When he's not doing bedside care, Carpenter delves into research. He finds it inspiring to be part of improving care through clinical studies. His efforts mainly focus on GVHD, a potentially life-threatening post transplant complication in which the donor T cells recognize the transplant recipient's tissues as foreign and attack them.

Patients with GVHD are often treated with steroids, but long-term use of these drugs can bring many deleterious side effects. Carpenter recently launched a new study to more rapidly taper steroid exposure by adding a steroid-sparing agent to the pharmaceutical mix. "We hope that by adding just the right amount, we can achieve the goal of significantly reducing patients' steroid exposure, which should have important downstream benefits, such as reducing infection risk and decreasing complications like diabetes and bone disease," he said. "We hope this will ultimately lead to better survival."

Carpenter, in collaboration with Dr. Jerry Radich, recently finished a study examining the use of Gleevec, a targeted-therapy drug, within the first 100 days of transplant in high-risk patients with leukemia. He's also analyzing the results of a trial he led to study how well the drug sirolimus works as a secondary therapy in treating patients with chronic GVHD who have not responded to previous systemic treatment.

While Carpenter admits that patient care can be exhausting, the rewards keep him going. "Working in one-month rotations as an attending physician can be grueling, but there's something very satisfying about coordinating a team that is dedicated to doing the best thing for the patient. I love interacting not only with the patients and families, but also with the members of the team," he said.

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