Spotlight on Neal Samara, a Jordanian TPN Consumer

Liz Tucker

In July, 2006 during an appointment at the Mayo Clinic, my physician, Darlene Kelly, MD, asked if I would talk to a new TPN patient at St. Mary’s Hospital.  I agreed, and so she introduced me to Neal Samara, the TPN patient, and her father, Dr. Mohammad Samara from Amman, Jordan.

We spent almost two hours together.  Neal and her father asking questions about different aspects of living with TPN; while I asked questions about Neal’s history and how she came to be on TPN.  She is married and her husband is an engineer for a major company in Amman.  They have five children, two girls and three boys, ranging in age from nine to sixteen.  It was obvious she was very proud of her family.

Differences in Care

Neal had a thrombosis in the mesenteric vein that resulted in gangrene in her small bowel.  Surgery removed all but one foot of her small intestine. Luckily her large intestine was not affected.  The original surgery occurred ten months previous to her trip to the US.  When she went home she wasn’t able to maintain her weight and had to be hospitalized again.  They inserted a catheter and put her on TPN.  She told me a number of things about TPN in Jordan are very different from here in the U.S.  They don’t mix all the components together in one bag but instead give a number of small bags with different components over the course of the night.  For example, dextrose would be in one bag, lipids in another, potassium in a third, etc. Because of that, TPN is not done at home, only in the hospital.

The second big difference has to do with the catheter.  Neal told me that the care given her Hickman catheter was much different than what she was taught to do at the Mayo Clinic.  The emphasis is not on sterility.  Consequently Neal got a blood infection and had a fever over 104 degrees for two weeks while they gave her intravenous antibiotics.  Her fever did not go down until they pulled the catheter.  Neal had spent four of the last ten months in the hospital and she was still very underweight.  It was at that point that her father decided she should come to the Mayo Clinic in Rochester, Minnesota.

Forging a Friendship

Dr. Samara is a highly regarded pediatrician in Amman, but getting a visa from the United States to bring Neal to Rochester was difficult.  Once at Mayo, Neal was hospitalized because she was so emaciated.  Tests were done and once she was stabilized a new catheter was placed.  I met she and her father a week or so after she started her training to take care of her catheter and do TPN at home.

Neal and Dr. Samara’s questions for me ranged from how long I had been on TPN, to whether had I traveled, to what were the problems with doing TPN at home. They were in awe at how healthy I looked.

As luck would have it, three days later I ended up at St. Mary’s with a blood infection of my own.  Our rooms were across the hall from each other and we spent a great deal of time together walking the halls, sitting outside and just talking.  I was more and more impressed with her positive attitude and hard work to make sure she could do TPN once she got home, as well as her father’s unwavering support and help whenever she needed it.

Long-term Solutions

Dr. Kelly did a tremendous amount of work finding a source for a premixed TPN solution that would work for Neal, and then a doctor in her region who would be able to carefully monitor her condition.  Because the thrombosis was caused by a hereditary blood problem, Neal has the added complication of having to take significant doses of cumadin. 

Neal and her father stayed an additional month in Rochester so she could take human growth hormone (HGH) shots.  The hope is that the HGH will help her one foot of small bowel absorb better so she won’t need quite as much TPN.

Building Bridges

After my hospitalization I drove down at least once or twice a week to take Neal and her father shopping, to take pictures of the Mayo Clinic and just talk about our lives and the world in general.  They told me several times that their impression of the United States was changed dramatically by coming to this country and their experiences with the people here.  They both said that without exception everyone they met here or who had taken care of Neal in the hospital was kind, generous and helpful.  They were also amazed by the fact that so many people here smile.  People in Jordan don’t smile nearly as often; particularly not at other people when they are out in public.  Before the end of their stay, Dr. Kelly and her mother, Dorothy, brought Neal and Dr. Samara to my house for a visit.  Neal and Dr. Samara brought all the ingredients needed to make a real Arab meal.  It was wonderful.

      Neal and her father have returned to Amman, but we plan to keep in touch.  They are wonderful human beings and it is a privilege to call them friends.