Palliative care

Dr. Neal Steil, left, and his wife, not pictured, will be long appreciated by Lynn Cason and his wife, April, right, for their palliative care. Thanks to the Steils, Lynn got a unique and meaningful band concert, below, while he was a critical Covid patient at Cullman Regional. Photos by David Moore and, below, Rachel Steil. Palliative care

So, you think you know what that really means?

Story by David Moore

Dr. Neal Steil and Rachel, his nurse practitioner wife, have opened a palliative care clinic at Cullman Regional Medical Center, a service typically found only at large academic hospitals.

Palliative care … you may think you know what that is, but chances are you know only part of the story. It does not always equate with the comfort care hospices provide terminal patients. It can be administered along with curative intent to improve quality of life.

Here are two enlightening examples: • One of the Steils’ patients was bedridden with advanced cancer. Though he was terminal, their treatment did not focus solely on treating his medical problems and keeping his pain at bay.

Among other things, Neal asked what his favorite hobby was. The man said he sorely missed taking his grandson target shooting. He’d accepted the loss of that joy. Still, it saddened him.

Thinking outside the medication chest, Neal devised a unique prescription.

“I got him a couple of Nerf guns and a target,” he chuckles. “He used those the rest of his life and went out Nerf guns a-blazing.” • Lynn Cason is a former patient of the Steils. He was admitted to Cullman Regional with Covid just prior to the 2021 football season, sick enough to spend three months on a ventilator.

As booster president of the Vinemont High School Band, Lynn had been keenly disappointed to miss every performance that season.

Thinking again outside the medicine chest, the Steils devised an elaborate plan to remedy that. Pulling together a team to help them – including respiratory and physical therapists, nurses and

maintenance staff – they moved Lynn to a room overlooking the helipad then brought in members of the prep band to play on the landing site.

Thrilled, the number one band booster watched the one-of-akind performance from the opened window in his room.

“Neal was adjusting the ventilator the whole time,” Rachel says.

“That,” he says, “is palliative medicine.”

“That’s our job,” Rachel adds. “Isn’t that awesome? We get to wake up every day and try to make this world a little better place.”

Palliative care clinics are a relatively new model of healthcare for patients with advanced or lifethreatening diseases.

“It’s really a different approach to care,” Rachel says. “It looks at the quality of life – what is important to the patient. We set goals on how to achieve that.”

Much broader than hospice care, palliative care can be provided at any stage of chronic illness. Palliative caregivers collaborate with a patient’s physicians and care providers to improve outcomes and quality of life.

For instance, older patients with chronic obstructive pulmonary disease – COPD – might go to the ER because of acute respiratory problems. Traditional emergency treatment is intended to get patients back home to follow up with their regular physician.

But healthcare providers know many of those patients will return within months, if not weeks, with the same symptoms.

“Outpatient palliative care is a way to keep patients from ending up in a health crisis,” Neal says. “It teaches them how to manage those symptoms, how to treat them at home, without having to repeatedly go to the emergency room.”

This entails helping patients understand what the body or disease is doing, why certain medications were prescribed and what to expect.

“It’s also a lot about listening,” Rachel says. “What is going on to contribute to the situation? If you’re short of breath, use a symptom management plan to help minimize anxiety. I like to say we treat the patient and not the numbers.”

In palliative care, medication isn’t utilized just to improve numbers. It focuses on achieving a quality of life between those points to allow patients a level of independence to achieve what’s important to them. “We spend time getting to know the patient and what’s important them,” Neal says. “Do you want to garden with your grandchild? OK. How do we get you out in the garden?”

Technically, I-65 brought the Steils to Cullman Regional to open a palliative care clinic, but their actual route was not so direct. Rachel Williams grew up in Dadeville wanting to be a nurse, even though her mom taught English and her father was a DJ and owned a local Christian radio station. She remembers going hunting with Rachel Steil, left, talks with Taylor Aaron, a certified medical assistant with her father and initially the clinic. Rachel earned her nursing degree and, in 2009, her master’s in being reluctant when he nursing from the UAB School of Nursing. Seeking more knowledge, she asked her to help him went to Samford University in 2017-19 for her DNP – doctor of nursing field dress a deer he’d practice. According to the National Library of Medicine, nearly 80 shot. percent of nurse practitioners hold master’s degrees, while only “OK,” he said. “But 14 percent earn DNPs. Photo by Mary Beth Sellers. you can’t be a nurse if you don’t.” So she helped and was never bothered when something squeamish arose during her nursing career. Rachel started at the UAB School of Nursing in 2002, graduated with a BSN degree in 2006 then went on to earn a master’s in nursing with a focus in healthcare administration in 2009. Upon graduating with her BSN, she got her first nursing job at UAB’s oncology unit. It was there she met Dr. Neal Steil, an intern. They dated nine months, got engaged and married nine months later. A German descendant whose family came to the U.S. about 1900, Neal grew up in Ashland, a Cullman-sized town in northeast Kentucky on the Ohio River. The family moved to Birmingham in

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Dr. Neal Steil goes over patient charts with Stephannie Gaskin, a certified medical assistant for the clinic who lives in the Summit community in Blount County. Neal’s interest in palliative care led him to pursue a fellowship in that field in 2009-10. “It’s one of the rarer specialties,” he says. “Only about 200 fellowships in palliative care are given annually across the country, compared to several thousand for cardiovascular studies.”

1994 where his father, the late Condit Steil, was a pharmacy professor at Samford University and his mother, Rhonda, was a pharmacist. After graduating from a magnet school in 1998, Neal went to the University of Kentucky, earned a bachelor’s in biology in 2002 then graduated from medical school four years later.

“That was my plan all along,” he says. “I was always drawn to science.”

His passion for UK – Big Blue – was obvious when they married in 2008.

“Our wedding colors were blue and white,” Rachel laughs. “Our wedding cake was blue and white, as were the bridesmaids’ dresses. That’s how big a fan Neal is.”

After Neal completed his residency and internship at UAB, he did a fellowship in palliative care, a rare specialty. Rachel was the nurse manager at O’Neal Comprehensive Cancer Center at Acton Road.

In 2010 the Steils moved to Lexington, Ky., where Neal worked at St. Joseph Hospital. Rachel quit nursing to be a stay-at-home mom to their first two children.

In fall 2013, the Steils returned to Birmingham where their third child was born and Rachel’s mother, Lynn Abrams, had advanced-stage ovarian cancer.

“We moved to be close to her,” Rachel says. “With my background in oncology, I knew the prognosis was pretty grim. But now she’s great. We’re super, super thankful for that. She’s been done with treatments seven years.”

Watching the positive impact Lynn’s nurses made on her mom inspired Rachel to return to nursing, something she never planned to do.

Neal focused on palliative care at his new job at the Birmingham VA Medical Center. After three years, however, he moved into the ER, partly burned out from the intensity of his work and partly because the schedule fit better with raising now three kids.

For her part, from 2017-19, Rachel attended Samford, earning not just a degree as a family nurse practitioner, but also a doctor of nursing practice. Then she worked for a Birmingham hospice.

“I really enjoyed that,” she says. “It’s a privilege to walk that journey with someone, to be able to help give them a beautiful death.”

In July 2020, Neal started working one day a week at Cullman Regional to relieve the load on a nurse practitioner who was providing limited palliative care there. As the workload increased, Rachel started driving to Cullman to help. She’d leave the kids with her mom, work five or six hours a few days a week, then be home in Birmingham to fix supper. It was a good schedule – but short-lived.

In November 2020, direly sick Covid patients slammed Cullman Regional with a vengeance. Neal went full time in the critical care unit, designed with 11 beds but now running over capacity with up to 24 patients on ventilators.

Rachel’s limited hours exploded, and she and Neal – along with hundreds of others – worked 14-16 hours daily for weeks on end. There were days they got home at 3 a.m., woke at 7 a.m. and drove back to Cullman Regional.

Recalling the pandemic tsunami, Neal says it was surreal. But amidst all of the suffering, all of the hard, incredibly stressful work, the Steils felt a sense of growing amazement.

“A part of what made us fall in love with the hospital is that the quality of care in that critical time never fell off,” Rachel says. “If something needed to be done, someone was there to do it, even if that was not their job.”

“I remember people working on one floor while their family member was in the CCU as a patient,” Neal adds. “We believe the quality of care was unimpeded,” Rachel says. “It was really incredible. It was surreal – but it was also inspirational.”

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They also realized something else.

Even before the surge hit, they found themselves brainstorming during their commutes to and from Birmingham – thinking that with their backgrounds and interests they could help a lot of people if they someday opened an actual palliative care clinic. And, after working through the surge in Cullman, wasn’t it obvious that Cullman Regional was the perfect place for it?

“Why shouldn’t Cullman have palliative care?” Neal asked. “We have the training to do it.”

The medical center and the Cullman Regional Medical Group, comprised of its employed physicians, agreed with the Steils.

“The hospital strives to recruit doctors and other providers who bring specialized services, talent and experience to enhance healthcare in our community,” says Jennifer Malone, Cullman Regional’s director of marketing and PR. “This is certainly an example of that.”

Since the Covid surge, the Steils started working for Cullman Regional Hospice, she as a nurse practitioner, he as its medical director.

A ribbon cutting for Cullman Regional Palliative and Supportive Care Clinic is planned for the near future. Meanwhile, the Steils have started seeing patients in dedicated offices and exam rooms on the fourth floor of Professional Office Building No. 1, sharing a waiting room with an existing primary clinic.

Adding the palliative clinic to their existing positions with hospice, Neal grins and says, “We will be ‘fuller’ time.” But doing that much more good.

The Steil family in Cullman for Christmas 2021: top photo from left, Jack, 11, Neal, Miriam, 6, Rachel and Sarah Kate, 10. Above, Neal and Rachel took Jack with Good Life Magazinethem on one of the medical mission trips they’ve made since 2018 to Honduras. Photos provided. Editor’s note: For information on Cullan Regional Palliative and Supportive Care Clinic, call: 256-735-5075. It’s not a substitute for primary care, however a referral from a primary care physician is not necessary. Services are covered by Medicare, Medicaid and most private insurance companies.