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With whole-hearted energy and scalpel-sharp intellect, Jessica Merkel-Keller ’04 (Bridgewater, N.J.) is examining life-and-death issues at Lehigh Valley Hospital Center. She is studying the success rates of hospital-performed cardiopulmonary resuscitation, patient and family perceptions of CPR, and physician training in CPR.
A pre-med student seeking a B.A. in bio-medical ethics and B.S. in neuroscience, Merkel-Keller is working with Stephen Lammers, Helen H.P. Manson Professor of the English Bible, as part of Lafayette’s distinctive EXCEL Scholars program, where students collaborate with faculty on research while earning a stipend. Many of the 180 students who participate each year go on to publish papers in scholarly journals and/or present their research at conferences.
Perception is crucial to their work, says Lammers. “Studies show that on television shows, such as ‘E.R.’, CPR is successful 85 percent of the time. In reality, for in-hospital codes, the success rate is closer to 15 percent. We’re studying CPR success rates outside of trauma and emergency room situations, and by success, we don’t mean just surviving the code. We mean discharge from the hospital, even if it is by wheelchair.”
“Part of the motivation for our work,” says Lammers, “is the belief that patients and their families have unrealistic expectations for what CPR can do. We are collecting the data to see just how successful CPR is and then how best to transfer that information to patients, families, and practitioners.”
Recipient of four awards for teaching or scholarship, Lammers is coeditor of On Moral Medicine, an award-winning book in medical ethics, and Theological Voices in Medical Ethics. He serves as ethics consultant for Lehigh Valley Hospital Center, working with residents and medical students, and is a member of the hospital’s Institutional Review Board and Ethics Committee.
Fascinated by health care since she “was the size of a small table,” Merkel-Keller says she is working with hospital bio-statisticians collecting and collating data on in-house, non-emergency codes.
“For example, is age a factor? Our findings are inconsistent with some of the research literature. Age seems not to be a predictive factor when it comes to survival. How about the length of the code? Do people who receive CPR for five minutes do better than people who receive it for 20 minutes? Or an hour? Maybe 45 minutes is established as the cut-off point. We just don’t know,” says Merkel-Keller.
“Our goal is to help health-care providers and families make informed decisions on whether or not to issue ‘Do Not Resuscitate’ orders,” she says. “One of the biggest issues in health care is what our realistic expectations should be of our technology.”
While national data does exist on CPR use in a non-emergency/trauma context, Lammers says he wanted local data, which Merkel-Keller has been gathering and sifting through. One result of their work is the discovery that many Internet Web sites “portray CPR in a far more favorable light than actual survival rates indicate,” says Lammers. “Just because you survive the code doesn’t mean you will survive the cancer. CPR is not some divine cure-all.”
Though Lammers says their research may culminate in journal articles, the research has a threefold practical application. First, Lammers plans to create a poster that compactly and efficiently educates health-care practitioners on CPR. Second, Lammers, with Lehigh Valley Hospital Center pulmonary specialist Dr. Joseph Vincent, plans to make grand rounds at the hospital with physicians and educate them on CPR with an education sheet. Third, Lammers envisions developing a similar information sheet for patients and their families.
Calling Merkel-Keller’s efforts “extremely valuable,” Lammers describes the would-be surgeon or gerontologist as “very energetic, a go-getter, who works really hard, is multi-faceted and despite our serious discussions, someone who is fun to be around. She keeps her sense of humor in some tough situations.”
He has included the student in his Institutional Review Board meetings, ethics committee work, and bioethics consultations. “I have particularly enjoyed how generous Dr. Lammers has been with his time,” she says.
Envisioning herself as part of a new generation of doctors, Merkel-Keller wants to earn a master’s degree in bio-ethics before going on to medical school.
She credits Lammers for broadening her horizons. “He has been a true mentor to me and he is extremely generous with his knowledge and his time. It never would have occurred to me to merge medical care with ethics. He’s opened my eyes as to new directions for modern medicine. The EXCEL program is a key reason I came to Lafayette; it allows me to pursue graduate-level, career-defining research before I even have my degree in hand. Lafayette has provided the ideal learning environment though its small classes and highly accessible faculty. I feel extremely lucky to work with Professor Lammers.”
What Merkel-Keller puts into her studies is also a strong dose of medical reality. For the last four years, she has been an emergency medical technician with the Easton Emergency Squad. She knows firsthand, she says, what it is like to see victims of drownings, electrocutions, gunshots, stabbings, fatal falls and other dire medical emergencies.
“I am on duty at least once a week,” she says with passion. “Our squad is residential, so you spend all 12 to 20 hours with your squad on call. Where the squad goes, you go when on call. It’s a huge time commitment and it is emotionally demanding work, but it is important to me to have the real-world experience. I take my academic studies and balance them against serving the public as an EMT.”
The hands that one day may wield a scalpel help Merkel-Keller find solace in her pressure-filled world. A skilled sculptor, she says that her work with modern ceramics allows her to escape the heart-rending decisions of medicine.
“It’s stressful being an EMT, going to a hospital, seeing sick and dying patients. I’ve seen some horrible stuff, like attending to violent assault and rape victims; you try to separate your worlds. Working as a sculptor allows me to use another part of my brain, to be creative, to liberate my emotions.”
Merkel-Keller adds, “I’ve found a healthy release in my art — it provides me freedom from the stress of caring for others.”
Last January, she took a Lafayette interim session course in Russia and Poland. She served last semester as chair of the McKelvy Scholars Spring Lecture Series, “Our Modern World,” and is a sister at Pi Beta Phi, where she has served as efficiency chair and resident adviser. She is a co-president of Lafayette Cancer Society and was a biology teaching assistant last year. Her hobbies include silver smithing, ceramics, disciplined equestrian, and skiing.