Don't Take It For Granted

Published on 29 June 2018

The average survival rate for a lung transplant patient is five years. While that may not sound like much, for Keith Fester, Pharm.D. ’09, BCPS, and his patients, it is time that is not taken for granted.

As a clinical pharmacy specialist in the Department of Lung Transplantation and Pulmonary Hypertension at Barnes-Jewish Hospital, Fester works as part of an interdisciplinary team responsible for managing one of the world's largest lung transplant programs.

How did you know you wanted to work in transplantation as a specialty area?

I initially never thought about transplantation as a career path. During my sixth year at the College, I had a rotation at Barnes-Jewish Hospital, and I realized that I enjoyed transplantation because it encompasses a wide scope of practice areas – acute care, infectious diseases, patient education, critical care, ambulatory care and more. Unfortunately, there are not many practice guidelines in the field of transplantation, so you have to think on your feet. Every hospital facilitates lung transplant surgery a little bit differently. The fact that every day and every patient is different keeps me engaged.

How did you get started in lung transplantation?

I completed my PGY1 residency at Saint Louis University Hospital and continued into my PGY2 specialty pharmacy residency in solid organ transplantation at New York Presbyterian Hospital, the university hospital of Columbia and Cornell.

New York-Presbyterian is an international referral center with some of the most well-known and well-respected physicians in the world, so I saw patients from across the United States as well as places like Japan, the Middle East and the United Kingdom. New York is such a melting pot that it was necessary to recreate the wheel when addressing patients from different cultures. I was able to get the same outcomes even though I was tailoring my approach to patients from different backgrounds.

After my residency, I stayed for an additional four years as the clinical pharmacy manager for pediatric transplantation at New York-Presbyterian Hospital/Columbia University Medical Center/Morgan Stanley Children’s Hospital of New York. While there, I focused on cardiothoracic and small bowel transplantation. This focus and experience made it an easy transition back to the adult lung transplant team at Barnes-Jewish Hospital and Washington University Medical Campus.

What is your role on the lung transplant team?

We are one of the largest lung transplant centers in the country. Our team consists of clinical pharmacy specialists, pulmonologists, thoracic surgeons, nurse coordinators, social workers, dietitians and other transplant experts. As a team, we rotate our time between inpatient and outpatient care.

In inpatient care, I help decide which medications are best for our patients and ensure medications are dosed appropriately. While a patient is in outpatient care, I help conduct pretransplant evaluations to determine if they are a viable candidate for transplant, as well as post-transplant follow-up appointments.

Once a patient has undergone a lung transplant, I work with them for the rest of their life to make sure they are taking their medications correctly. Being readmitted to the hospital is common for my patients due to their susceptibility to rejection and infection. There are a lot of little things related to medication management that can have a big impact on our patients. I also have the opportunity to work on committees, complete research, and educate the next leaders in pharmacy which I greatly enjoy.

How do you cope working in transplantation?

While I was working in pediatrics, I learned that it’s not just about the transplant patient – it’s about their families too. Parents, grandparents and siblings get frustrated that their loved one is sick, and I understand why they are frustrated because no one wants to see a loved one suffer. The reward of making a child better is huge.

When I came back to working with adult transplant patients, it was solidified that my patients are not alone. They have other people to live for and a chance to take what time they have left and make it valuable.

Patients coming back from transplant are so grateful for the opportunity to write the next chapter in their life, and every time you see them in the hospital, they know you by name. Our patients don’t take their second lease on life for granted.

Inspired by his patients never to take life for granted, Fester has vowed never to stop learning. He explains that life is always a learning process, and he takes every opportunity to learn more. He is thankful for the opportunity to help patients feel better – one breath at a time.

This story was first published in the spring 2018 issue of Script. Visit stlcop.edu/script to read more and access previous issues.

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