Near or far, ‘it takes a village’: Patient experiences The Meaning of Care thousands of miles away

Down 35 pounds in October 2022, Jamey Bremer was looking forward to his annual wellness visit, which he was sure would come with a pat on the back from his Methodist primary care provider.

Instead of the “attaboy” he was expecting, Bremer recalls what family medicine physician Paul Vana, MD, told him verbatim: “He looked at me after listening to my chest and said, ‘Jamey, you’ve got a heart murmur.’”

For someone who’d never felt healthier, the news was beyond baffling. But looking back, Bremer said, it marked the assembly of a team of individuals – some of whom he’s never met – that’s gifted him more time to count his blessings.

“Indelible moments”

Testing revealed that Bremer had a blocked aortic valve, so he got on the books for an end-of-year valve replacement at an Omaha hospital. But after undergoing a preoperative CT scan in December 2022, Bremer learned that he might require much more than heart surgery. 

A nurse from Dr. Vana’s team called immediately following that scan – which captured images of Bremer’s neck and torso – and instructed him to come in for bloodwork as soon as possible.

“They said they found a nodule on his thyroid, swollen lymph nodes, spots in his lungs and lesions on his liver,” said Alicia Bremer, who had accompanied her husband to that scan. “I just knew that none of those words together ever mean anything good.”

Not even home yet from that imaging appointment, Jamey Bremer and his wife changed course and made their way to Methodist Physicians Clinic.

“There have been so many indelible moments in which Methodist has truly saved us, and this would be one of them,” Alicia Bremer said. “That his primary care team would be so on top of results from an outside facility.”

International collaboration

Jamey Bremer was soon referred to Methodist pulmonologist Sumit Mukherjee, MD.

“That man saved my husband’s life,” Alicia Bremer said.

“Yeah, he’s been a blessing to us, for sure,” Jamey Bremer added.

Per the recommendation of Dr. Mukherjee, Jamey Bremer underwent a biopsy of his thyroid and one of his swollen lymph nodes on Dec. 21, 2022. The pulmonologist gave warning that biopsy results might be delayed with the holiday weekend quickly approaching. But he also ensured the couple that he’d keep watch for them despite being hours away from departing for a family vacation in Greece.

The evening of Dec. 23, as Dr. Mukherjee’s family was winding down from a busy day in Athens, the physician pulled out his phone to check on his patient’s biopsy results.

They were in, and there it was – what Dr. Mukherjee had feared: Jamey Bremer had medullary thyroid cancer. 

Knowing the Bremers were in a time zone eight hours behind, Dr. Mukherjee texted his patient, requesting to chat via phone at his earliest convenience. And then Dr. Mukherjee got to work.

He reached out to a number of colleagues so that he’d have a treatment plan mapped out for his impending conversation with the Bremers. One of those colleagues was medical oncologist Yungpo Bernard Su, MD, with Nebraska Cancer Specialists – a network of oncology experts at Methodist Estabrook Cancer Center. 

Ironically, Dr. Su was also vacationing with his family at the time – in Spain. 

“Regardless of where we are, we’re sort of always on the clock,” Dr. Su said with a laugh. “But for good reason. Because it often means peace of mind for the patient and being able to move forward with a treatment plan without delay.”

When Dr. Mukherjee and the Bremers finally connected on Christmas Eve, Dr. Mukherjee was careful not to rush the conversation. 

“Unfortunately, I spend so much of my time telling people they have cancer that I just know how these things go,” Dr. Mukherjee said. “These conversations come with a lot of questions, a lot of unknowns. Their mind circles, and rightfully so.”

“Who provides that kind of care these days? You tell me,” Alicia Bremer said. “Who spends at least 45 international minutes on the phone with someone, walking them through the game plan step-by-step and answering every single question? And that was after the time he spent on the phone interrupting Dr. Su’s family vacation. Listen, I don’t know who these men’s wives are, but they’ve got to be among the most patient and understanding individuals out there.”

According to Dr. Mukherjee’s wife – Chrissta Mukherjee, an attorney and mother of two who fully understands not having a nine-to-five job – she rarely gives her husband’s time-consuming work a second thought.

“First and foremost, he’s an incredible physician,” Chrissta Mukherjee said. “And he’s truly passionate about what he does. It’s who he is. And part of being a supportive spouse and family is supporting him in what he does best. There are patients on the other end who are often caught in the middle of life and death. A couple hours out of a trip is pretty minimal compared to that.”

Dr. Su, who also deeply values the support and understanding of his wife and family, said it’s what he loves best about working with Methodist providers.

“We’re all so dedicated to doing whatever’s needed for the patient whenever it’s needed,” he said. “We’re dedicated to communicating. We all have each other’s mobile phones, and we’re always reaching out, collaborating. To the average person, it may seem above and beyond, but to us, it’s not. It’s just what we do.”

“Our job is never finished”

A number of physicians designed a multidisciplinary treatment plan for Jamey Bremer, which included the surgical removal of his cancer before replacing his aortic valve, then continuing his cancer treatment with cell-targeted therapy in the form of a daily pill. 

Methodist head and neck surgical oncologists Oleg Militsakh, MD, and William Lydiatt, MD, worked together on the long and complicated removal of Jamey Bremer’s thyroid and affected lymph nodes. And the January 2023 surgery, which went smoothly, was followed by “impeccable” postoperative nursing care, Jamey Bremer said.

“They were so good,” he added. “Every one of those nurses worked together without missing a beat. I really was blessed with the best care at Methodist.”

But it wasn’t long before Jamey Bremer’s seemingly good luck began to run dry. His heart surgery was delayed twice – first because of a more emergent case in which a patient needed Jamey Bremer’s surgery slot, and then because of a positive preoperative COVID-19 test.

“Asymptomatic,” Jamey Bremer said. “Oh, I was mad. Especially knowing that the next step in my cancer treatment was on hold until after this surgery. I looked at my wife and said, ‘Alicia, cancer is winning.’”

In March 2023, he was able to undergo heart surgery with an Omaha surgeon, but in June, he began showing signs of infection. He eventually tested positive for salmonella, which was treated with two weeks of at-home IV antibiotics. In August, another infection necessitated the involvement of Methodist infectious disease physician Rudolf Kotula, MD.

“Before we even got blood cultures back,” Alicia Bremer said, “Dr. Kotula told us, ‘I can’t believe I’m going to tell you this, but I think it’s going to come back for salmonella again.’ Sure enough, it did. From that point on, Dr. Kotula was absolutely insistent that we do all these things, look in all these places and leave no stone unturned until we figure out where this was coming from.”

Dr. Kotula spent several hours – often after he came home at the end of a long day in clinic – researching what he calls “an extremely rare, unheard of occurrence.”

“Nobody gets into medicine because of the good hours,” he said. “We’re not just doctors. We’re detectives. And our job is never finished because it’s not really a job at all – it’s a calling.”

Dr. Kotula – along with Methodist cardiothoracic surgeon HelenMari Merritt, DO, and Methodist cardiologist John Higgins, MD – determined that Jamey Bremer’s mechanical heart valve was harboring the salmonella. According to Dr. Kotula, bacteria tends to gravitate to foreign material inside the body. He believes that at some point, Jamey Bremer contracted salmonella – likely from contaminated food – which traveled from his gastrointestinal tract into his bloodstream before attaching itself to the valve. That infected valve would likely continue making Jamey Bremer ill unless it was replaced.

The new treatment plan? Attack the salmonella with a more rigorous course of IV antibiotics before undergoing another valve replacement – this time with Dr. Merritt.

“After sitting down with her, we knew without a doubt that she was going to be able to help Jamey and fix this the way it needed to get fixed,” Alicia Bremer said.

And she did.

“Blessed with the best”

Dr. Merritt will be the first to credit the team of individuals that came before her in playing a role in Jamey Bremer’s care.

“Our overall efforts as a group are what led to such a successful outcome,” she said.

^{Jamey and Alicia Bremer reunite with the key members of Jamey's care team for a photo in December 2023.}

And those efforts, she admitted, are rarely made without sacrifice.

“It’s a certain lifestyle that you must accept as a physician,” Dr. Kotula said. “That lifestyle largely revolves around medicine and family, and medicine often comes first.”

But quality medicine, Dr. Mukherjee said, seldom exists without the all-in support of a family.

“My wife could tell you of countless times where she’s asked, ‘Hey can you pick up the kids at 5 o’clock?’” Dr. Mukherjee said. “Well, 5 o’clock rolls around, and I’m texting her, saying, ‘Hey, I’ve got someone coding in the ICU. I’m sorry. I’m not going to be able to make it.’ It’s hard for her to rely on me sometimes, and as a spouse, that’s a difficult space to be in – especially when you have children. But there’s simply no way I could do what I do – and do it well – without her, without my family.”

He added: “It takes a village.”

Perhaps nobody understands that better than Jamey and Alicia Bremer, who’ve been given more time together to witness their kids pursue their dreams in nursing, volleyball, golf and beyond.

“I just really can’t tell you how blessed I feel,” Jamey Bremer said. “Blessed to still be here for my wife and kids. Blessed with the care team I have. Blessed with the best.”

“One-hundred percent,” Alicia Bremer added. “There are a lot of places you can find extraordinary care. But what we’ve experienced is The Meaning of Care. And there is a difference. Truly.”

^{Jamey and Alicia Bremer reminisce over Jamey's health journey that began to unfold in 2022.}

Photos by Dan Johnson and Nick Bohan