Ricardo is the nurse care coordinator for a 3 year old patient with Acute Lymphoblastic Leukemia. Because of her unique leukemia genetics and the distance she has to travel for treatment, she has had multiple complications, including a line infection that led to the removal of her port and a PICC placement. Recently, she was diagnosed with COVID-19, and care had to be rearranged so that she could be sedated at the last minute in the Procedure Center. Ricardo has taken all of these challenges in stride to offer the best possible care for this patient.

Once patients reach the final cycle of treatment in leukemia (known as Maintenance), they need less in-hospital treatment and only come in for Vincristine administration and an occasional lumbar puncture with chemotherapy administration. The Maintenance cycle lasts upwards of one to two years. Due to the caustic nature of Vincristine as well as the danger imposed by infiltration, the majority of patients have to keep their central line through Maintenance.

As this patient began to approach this cycle, Ricardo noticed that, because she is Philadelphia positive (a specific high-risk chromosome), she does not receive Vincristine at all through Maintenance but only comes in every 6 weeks for lumbar puncture. After discussion with both her primary team and the sedation clinic on 7th Floor, Ricardo arranged to have the patient's PICC line pulled, an infection risk that would have been very difficult to maintain long-term, and to plan for her to continue her Maintenance therapy with only an occasional PIV for her sedation. We also discussed the possibility of using gas induction for lumbar punctures so that she could get a PIV and labs while already asleep.

This is just one example of how Ricardo is always thinking of ways to make his patient’s experiences just a little bit easier, and it is obvious by how much his families love him that he is doing a wonderful job.