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Getting a diagnosis of cancer is like entering a labyrinth. The mental maze of treatment options, hopes and dead ends can even take physical shape — a dark place with long hallways, small rooms and scary machines.
Sparrow Hospital’s Herbert-Herman Cancer Center, opening Tuesday, is dedicated to tearing the walls out of the labyrinth and letting in the light. The $64 million building will replace the cramped cancer center in Sparrow’s main hospital across the street and meet a growing need for cancer treatment.
The curvilinear, art-filled, facility centralizes cancer care in one place, so patients don’t have to thread a maze of radiologists, surgeons, social workers and other specialists. It houses state-of-the-art linear accelerators for pinpoint precise radiation treatment.
Its patient-centered design is graced by countless human touches, large and small, including an assemblage of sculpture, painting and photography that incidentally bestows Lansing with a new, major art gallery.
The names on the building are Lansing legends. Dr. James Herman, medical director of Sparrow Hospital’s Cancer Center, and his wife, Susan, and James Herbert, CEO of the Neogen Corp. and his wife, Judith, donated a combined $2.5 million.
Shortest possible path
A cancer center is one of those places you drive past for most of your life, glancing sideways, trying not to picture what’s inside.
But one sunny day, you will probably find out, for your own or a loved ones’ sake.
Gordan Srkalovic, Sparrow oncologist and director of clinical trials, is looking forward to the open space, the high tech, the light and the art that fills the new facility, not for himself, but for his patients.
“They deserve it,” he said. “Coming here is a big part of their life. Some of them come here daily for treatment. They spend as much time with us as they do in their own house.”
An aging population, earlier cancer diagnoses, improved treatment of other killers like diabetes and heart disease, and better awareness of the need for testing have contributed to a rise in the number of cancer diagnoses in recent years. The trend will continue as the Baby Boomers get older, according to James Herman, director of Sparrow’s cancer center.
“We anticipate more cancer, going forward, and according to the statistics, we have space built in for growth,” Herman said.
Herman said the cure rate for cancer has reached 70 percent, but that success has only contributed to the traffic in the halls.
“In the past, people might be diagnosed at an advance stage, where there really wasn’t much you could do,” Timothy McKenna, director of Sparrow’s breast clinic, explained. “There wasn’t much of a life expectancy, so there wasn’t a lot of cancer care involved.”
Sharon Cosgrove, Sparrow’s breast health navigator, has been an oncology nurse for 20 years and worked at Sparrow for five years.
“Our waiting rooms are so crowded. People are standing on top of each other,” she said.
Space is a big problem for Corrie Bourdon, one of the newer members of Sparrow’s cancer team. As a cancer genetic counselor, Bourdon is on the cutting edge of treatment, testing patients and their families to see if they share genes that cause cancer.
When Bourdon joined the staff at Sparrow about a year ago, there wasn’t even room for her office in the cancer center. She works three stories above it.
In Bourdon’s field, families are tested — and sometimes treated — together. The day before we talked, she worked with a family of two siblings, each with three kids.
“Unfortunately, we had to test all of their kids for this cancer condition,” she said. Such family meetings are almost impossible to arrange in the old center.
“The great news about the new cancer center is that there is going to be so much more room,” she said.
Without a new facility, Herman said, his next hire would have to set up shop in the hallway.
“It would be like putting another sardine in the can,” he said. But space is only half of the problem. The other half is design. Even if a cancer center finds room for growth, starting from scratch is a seldom-granted luxury. At most hospitals, including Sparrow, cancer facilities have grown on an ad hoc basis, wherever things could fit in.
When Cosgrove marches her patients from radiation to medical oncology, at opposite ends of Sparrow Hospital’s sprawling Michigan Avenue complex, she feels like a bowling ball in a very long alley.
“Sometimes you see people pull up to the door and their spouse is helping them and you’re like, ‘Who’s going to help the spouse?’” she said.
At the new cancer center, a full circle from the waiting room to the treatment areas and back takes a few seconds.
“In designing the building, we tried to provide the shortest path for the patient from their arrival to treatment — 10 or 20 steps and you’re in a room, seeing your provider,” Sparrow’s planning and design director, Staci Bakkegard, said.
The rigorous rule of patient-centered design starts even before people enter. Parking and entrances are covered, with access directly from each floor of the parking lot. Anyone who has played the updown-up-down elevator game at a large hospital while visiting a relative day after day, knows how old that gets.
The sidewalks near the entrance are heated for Michigan winters. The system even got a test this spring when the city was hit by an April snowstorm.
The pride of Sparrow’s cancer center is its multi-disciplinary approach. Herman doesn’t base cancer treatment on anecdotes or gut feelings. Each patient is treated by a team of pathologists, surgeons, radiologists, a genetic counselor, a social worker and other specialists.
It’s no sewing circle. Bakkegard called the conference center where they meet the “war room.” Herman pushes them to compare, check and challenge each other’s findings with scientific rigor.
“They have a diagnosis, and everybody comes together to discuss the best plan of action,” Bakkegard said.
Sparrow oncologist Joseph Meunier said the centralized concept is “a Mayo Clinic concept, where patients shouldn’t have to travel to multiple doctors’ offices for the same problem.”
“In one morning, you will be able to see everybody without leaving the building,” Meuner said. “To bring everybody together in a newer space is fantastic for patients in mid-Michigan.”
Bouncing from one specialist to another, reconciling sometimes contradictory advice, is one of the most demoralizing parts of getting cancer.
“The biggest thing we’ve found is that patients hate waiting,” Herman said. “They hate going around looking for answers ‘he said that, she said that.’”
The conference room has audio-visual media equipment that will be indispensible for Sparrow’s growing cancer support groups as well. Part of Sharon Cosgrove’s job is to educate breast cancer patients on options for treatment before they consult with doctors, but she struggles to find space, let alone the technology, to show them the needed information. She has had to cancel a few meetings in recent months because of logistical clashes.
“It’s just crazy how we manage that space because we have totally grown out of it,” she said.
Debra Batterbee, health navigator on prostate cancer issues, said the prostate cancer support group at Sparrow is nearing 40 men and needs more room.
The new conference room and communication tech will also enhance Sparrow’s partnership with the Mayo Clinic, an extension of the multi-disciplinary teams that form up behind each patient.
Patients can get a second opinion from the Mayo team if they want. Consultations via Skype will happen fast.
“Everybody likes cancer treatment in big institutions but they like to sleep in their own bed at night,” Herman said. “That doesn’t happen for most people in Michigan.”
Sparrow’s cancer center also has a largely unheralded but robust clinical trials program that will expand in the new building. Herman said about 100 clinical trials, where new treatments are tried out and carefully tracked on eligible patients, are going on right now at Sparrow.
“And we are expanding it,” Herman said. “Not many community centers have that. We are the biggest community clinical trial program in the state.”
Forgiving and flexible
In the vaults below the new cancer center, a brand new Elekta Versa linear accelerator pinpoints high doses of radiation treatment on the tumor while saving the surrounding healthy tissue.
The patient’s data is run through software programs that help the team develop a three-dimensional plan of attack.
“You can do all kinds of things you can’t do with a stationary, fixed geometric system,” Herman said Other accelerators do 3-D treatment, but this one is different, Meunier said.
“Instead of a gantry that swings around people, this is attached to the ceiling and wall differently, in a way that allows some unique approaches to hard-to-reach tumors,” he said.
Trying to stay absolutely still, under stressful and unaccustomed conditions, isn’t easy. The dire consequences of moving during radiation treatment make patients even more anxious. But the Elekta Versa is more forgiving and flexible than its predecessors, according to McKenna.
“When you’re trying to pinpoint things, like on the chest wall especially lung, or even on the chest wall, like breast cancer, there’s motion from respiration, and this can actually be synchronized,” McKenna said. “If there’s too much motion it will shut off so they are not damaging healthy tissue.”
“There’s a thing called the integral dose,” Herman said. That’s the total amount of radiation the body absorbs during treatment. “We spend all of our time trying to decrease that dose to the normal tissue. If you have cancer around the spine, with these machines, you can still spare the spinal cord and treat all the cancer around it.”
Bakkegard was especially proud of the normal glass and wood door to the vault. Many linear accelerators have have thick, vault-like doors that block radiation but make patients feel like they’re entering the Crypt of Terror.
“This big door bangs behind you as you enter the vault and it doesn’t exactly calm you before your treatment,” she said.
Instead of a heavily shielded door, the radiation is absorbed by an interior “maze,” consisting of a protective wall separating the vault from the hallway that resembles the entrance to a movie.
The protective wall is made of high-density concrete blocks that are easily disassembled to get machines in and out as technology changes.
The block wall is blanketed by an undulating, textured pattern that emphasizes the soothing characteristics of radiation and hides a formidable thickness of 3 feet.
Infusion of serenity
Every nook and cranny of the cancer center has some kind of humanizing fairy dust on it, from LED “skylights” to fireplaces to the ubiquitous art. (But no modern art — it raises people’s pulse, according to Bakkegard.) The third floor infusion area, where patients sit for hours to receive intravenous chemo treatment, received special attention.
“They designed the infusion center in an interesting way,” Meunier said. It’s a large space with a centralized nurses’ station, but it doesn’t feel large.
“We don’t want you to feel overwhelmed and walk in here and see 40 chairs full of people,” Bakkegard said.
Studies are divided on how best to design infusion centers. Some patients like to socialize and support each other; others prefer privacy. The new cancer center has it both ways.
Floor-to-ceiling partitions of frosted glass, with an etched floral design reminiscent of serene Japanese architecture, slide in and out of place between the bays.
“That is unique,” Meunier said. “If you want your privacy, you can have it. Maybe you’re on the same chemo schedule as four or five people you see every two or three weeks, you can open the space and be together. I’ve never seen that before.”
Each patient has a reclining chair with a reading light, a TV and pillow speaker. Outside the window is a cheerful view of a green roof that covers a part of the linear accelerator’s concrete enclosure a floor below.
Such calming touches permeate every part of the center, not only the infusion area. Every room, including the examining rooms, is appointed with warm wood surfaces and cool colors. Waiting areas are broken up so they don’t feel like bus terminals.
Patients lying down in CT scan machines and the linear accelerator gaze up at nature scenes of their own choosing.
The vibe is worlds away from the old cancer center and, in the view of the staff, finally matches the quality of care they have been providing all along.
“There are hardly any windows in our cancer center now,” Bourdon said. “Even if you’re looking out the window it’s depressing because the patient rooms face a parking lot.”
“It’s kind of dreary,” Cosgrove agreed.
“You’re already scared and you’re going through a lot of anxiety. This new center is beautiful and uplifting.”
“Realistically, we would practice medicine regardless of the building we’re in,” Meunier said. “But having more windows, more light, all that beautiful artwork, things that relieve our stress is going to be wonderful too.”