Registered nurse Mary Lou McCurdy parks outside an apartment complex in the Eastern Shore town of Princess Anne. She walks up a flight of stairs, knocks, walks in. Her sharp blue eyes quickly assess.
Nicole Brown, bald from chemotherapy, hunches on a couch, her 11-month-old daughter Miracle asleep beside her. When Brown sees McCurdy, her eyes well with tears. The nurse rushes to her side and rubs the back of a woman who has become her friend. “It makes me sad to see you sad,” says McCurdy. “Want me to sing you a song? Believe me, it will make you laugh.”
Brown, 38, rarely laughs these days. In February 2014, she was diagnosed with stage 4 breast cancer the same day she learned she was pregnant. Johns Hopkins doctors delivered Miracle early, by cesarean section at 28 weeks, so that Brown could start chemotherapy. The infant weighed just 2 pounds, 10 ounces.
McCurdy has been case manager to Brown and Miracle since last October, when mother and child, released from The Johns Hopkins Hospital, returned to Princess Anne. She’s one of 72 case managers in Maryland, including seven on the Eastern Shore, helping people who are enrolled in insurance plans managed by Johns Hopkins HealthCare.
Members of the Priority Partners, Employer Health Programs and US Family Health Plan insurance plans can be referred to case management or can request it. Most case management clients are members of Priority Partners, the managed care organization for Medicaid and the Maryland Children’s Health Program. They have one or more conditions, such as diabetes, cancer, obesity or HIV, as well as challenges with transportation, language or housing that impair their ability to access services and information.
These registered nurses serve as assistants, advocates and sounding boards. They organize transportation to doctors, connect people with housing and child care, recommend dentists, research treatment options, offer nutrition advice and bolster sagging spirits. The goals: improve health, reduce emergency room visits and trim hospital stays.
The case managers work with some people for just a few months, guiding them through a pregnancy or particular challenge. But they remain with others for years, sharing moments of despair and hope.
Brown has experienced more than her share of challenges. Her other daughter gave birth to a son just months before graduating from high school. Then Brown received the devastating news that her cancer was spreading. McCurdy responded by adding the teen and second baby to her caseload, working even harder to lift Brown’s spirits.
On a recent visit, though, Brown sounds defeated. “I’m just tired,” she mutters, her head in her hands. Brown is tired of treatments that don’t cure her, tired of wondering what will happen to her family after she is gone. And she’s tired of trudging up and down those exhausting stairs.
But she’s not tired of McCurdy, who telephones or visits every day. “She’s a rock,” says Brown. “Some days I don’t expect her to call, but she does. It breaks up my day.”
“She Tells Me to Never Give Up”
On the Eastern Shore, each Johns Hopkins caseworker manages 65 to 70 clients in a territory spanning the entire state of Maryland east of the Chesapeake Bay Bridge—some 4,834 mostly rural square miles. All live on the Eastern Shore and know the local doctors.
Case manager Mary Beth Watson, for example, still spends hours with patients at Peninsula Regional Medical Center in Salisbury, where she was an oncology nurse before switching to Johns Hopkins HealthCare case management five years ago. She met Gene Cooper Jr., 50, at the hospital as he began chemotherapy and radiation for cancer in his brain, lungs and lymph nodes.
“My goals are to make sure he knows who to call when he needs to call, and make sure if he’s not feeling well that there’s somebody he can reach out to,” says Watson.
Cooper says he was “raised old-school” and doesn’t like getting help. He quit high school after 10th grade and has always supported himself in construction, building houses “from the foundation up,” he says with pride.
But now, unable to work and addled by the chemicals coursing through his system, he’s grateful for Watson’s cheery assistance. “I get grumpy,” he says, “and she tells me to never give up.”
Watson visits Cooper at the hospital and at the Roaring Point Waterfront Campground in Nanticoke, where he temporarily shares a one-bedroom trailer with his fiancée and their two dogs. The nearest grocery store is 35 minutes away; the hospital is just as far. Cooper hopes his friends can remove the unhealthy mold in his own Salisbury home, which is much closer to the hospital and stores, so he can move back before the campground closes in November.
“Like a Sister”
Michelle Robbins has been Florence Bumbrey’s case manager since Bumbrey was diagnosed with diabetes three years ago. Now Bumbrey, who lives in Fruitland with her husband, Robert, and their chihuahua, Lady, faces a new challenge. A rare cancer, epithelioid hemangioendothelioma, is growing in her lungs.
Bumbrey, 58, is trying chemotherapy, but doctors don’t know if it will help. “I’m going to be a fighter to the end,” Bumbrey tells Robbins. “Sometimes I just lie in bed and cry because I don’t know how I got this type of cancer. I’m praying for a cure.”
As the two chat, Robbins encourages Bumbrey to keep taking walks with Lady and asks what she’s planning for lunch. More than once, Robbins has looked at the food in her patient’s pantry, suggesting easy improvements, like switching from white to whole-grain bread.
“She’s more like a sister,” Bumbrey says of Robbins. “I can talk to her. When I get some medical news, I call Michelle. She gives me good advice.”