“Social workers don’t give advice. They give attention:” Meet ET Master Trainer Heather Lawyer

Amy D. Waterman, PhD Transplant News

Heather Lawyer’s decades long career in transplantation education began by accident in a restaurant. Today she’s an Explore Transplant Master Trainer who reaches out to dialysis providers around the country.

While a strong transplant advocate, Heather also believes that the most powerful education helps providers and patients understand all of their options. “I stand in awe of the nurses, technicians, social workers, dieticians and secretaries who work tirelessly with those on dialysis, for whom there are no other options. Dialysis is a life-sustaining safety net for those living with End Stage Renal Disease, and thank goodness for that,” she told us.

We connected with Heather to learn more about what it has been like to work in both dialysis and transplant, learned a lot about the most pressing challenges facing educators and patients right now, and heard what keeps her motivated and inspired:

Q: Can you tell us about why you decided to be a social worker?
A: After college, I considered going to law school, but realized that was not my path. I took a few night classes in social work and heard its basic tenet: “to enhance the fit between person and environment.” That idea blew me away because it is applicable in any situation. I was compelled to continue with the coursework, so I quit my job to become a full-time student in the MSW program at St. Louis University with a concentration in health. I was drawn to the profession not because I “always knew I wanted to help people,” but because I found myself comfortable sitting with other people’s troubles. I am able to listen, sort through what is being said and ask the right questions. Social workers don’t give advice. They give attention.

Q: What made you decide to work in the area of transplant?
A: In graduate school I was waitressing and hadn’t found my social work “career” job yet. A regular customer’s wife was the administrator of an outpatient dialysis clinic and looking for help. After my shift, I walked over to the clinic and met my first social work colleague. I didn’t know anyone with kidney failure and had no idea what dialysis was, but I needed a job. I stayed for ten years.

Transplant was a natural segue from dialysis. I’d already worked with hundreds of dialysis patients and families over those ten years in the unit. Those who were medically eligible for transplant had so many other barriers to work through, such as understanding the process of referral, evaluation and listing for transplant. I always felt there was a disconnect between dialysis and transplant despite working with the same population of people, and it bothered me. Next, I became the first Outreach Coordinator for Kidney Transplant at St. Louis University Hospital, providing one-on-one and group education on kidney transplantation to patients, families and providers.

Q: In your current role, how do you work with and support patients?
A: I loved providing transplant education to as many people as I could touch, but felt it was time to re-focus my energy. So, I returned to direct clinical social work practice at an out-patient dialysis unit. I had come back to my roots, so to speak, and had a new perspective.

Q: Did you have a different experience when you came back to dialysis after working in transplant for so many years?
A: People were starving for information and had tears in their eyes when I sat with them to explain the transplant process. No one had ever done that before. I understood why. Dialysis professionals have so much on their plates, and though transplant education and referral may be a priority in theory, it often got pushed to the bottom in the wake of a crisis in the unit or in someone’s life. As an experienced social worker with a background in transplant coming back to the unit, I can now better assist patients in identifying their barriers to transplant, because they are different for everyone.

Q: Have any experiences with patients moved you in particular ways, or provoked thoughts you didn’t have before?
A: I met Susan in a dialysis unit when I was an Outreach Coordinator. She was young, appeared healthy-ish and was eager to talk. When I realized she had been on dialysis for years and never attempted to get a transplant, I asked her why. She told me about all the people who depended on her, who she loved and couldn’t let down. She was “getting by” on dialysis, but transplant could change everything and not in a good way. Her Medicare would go away in three years. Susan knew she was supposed to be rehabilitated and get a job with insurance, but it didn’t seem realistic. She told me, “I still have health issues that will keep me from making a living that I could actually support my family with. I can’t take that risk. So I sit here.”

Q: What are the most pressing challenges in your work right now?
A: Conversations like the one I had with Susan make me wonder why we would we pay for people to stay on dialysis for life, but only pay for transplant support (through coverage of immunosuppressive drugs) for three years. Fiscally it’s not sensible, since transplant surgery and medications are less expensive than lifelong dialysis. The dependence on one modality is what bothers me the most.

The challenges in the dialysis world to properly educate patients about transplant are inherent in the dialysis/transplant disconnect. Providers who are in the trenches are motivated to do what is best for their patients. I’ve never met a Patient Care Technician who would want their patient to sit on dialysis instead of go for transplant. But, both fields are businesses and make a profit when they have more patients. Despite efforts to mandate dialysis providers to educate patients on transplant, I don’t see the culture shift yet.

Q: What motivates you every day in your work?
A: Every interaction is an opportunity to make someone’s day a little better. I can’t fix every problem a patient has, but I can give my full attention.

Meet the rest of the Explore Transplant team