There’s one patient that sticks out when South Sound physician Dr. Ari Malka reflects on his friend Sirena Sagdahl’s skills as a nurse.

Sagdahl had pulled the doctor aside to share some concerns: The patient had been in the emergency room before, Sagdahl said, with injuries that did not seem like accidents. Sagdahl was concerned about domestic violence.

Such a topic is “very sensitive,” and hard to broach with a patient, Malka said — so Sagdahl turned detective, investigating the patient on social media and identifying the criminal record of one of the patient’s associates, which lent credence to her hypothesis.

Carefully, Sagdahl reached out to the patient to share domestic violence resources — if needed — and a voice of support.

It was a moment that helped Dr. Malka reflect on the “minute slice” of life that medical professionals get with a patient — the tiny window which is often all that doctors and nurses have with someone — and how he could best use that time.

“It wasn’t just above-and-beyond care,” Dr. Malka said of Sagdahl’s work in that case. “We all just do our part and that’s what’s expected of us. It’s the exceptional person … (who puts) that much time and effort, calling after hours on her own time. … It was really inspirational. It made me rethink how I approach these things in the ER.”

For her drive to heal, comfort and educate her patients, Sagdahl is The Mirror’s Hometown Hero this month.

About 41% of women and 26% of men have reported being impacted by intimate partner violence during their lifetime, according to the Centers for Disease Control. It’s “a huge crisis” for which everyone should consider keeping their “spidey-senses” up, Sagdahl said.

And looking out for it is an example of what Sagdahl’s family calls “total patient care” — the idea that you see the whole human being when you treat someone, not just the slice of them that’s come to your office, she said.

Dr. Malka was the one who recruited Sagdahl for her current role: An advanced registered nurse practitioner at the Tacoma wing of Dispatch Health, a healthcare organization that provides in-home urgent and emergent care like the kind typically received at a hospital.

It’s a non-traditional approach to medicine that is sometimes called “urgent care on wheels,” Sagdahl said.

And it gives her time to shine to catch and fix things that might otherwise go unnoticed — like the time a patient mistakenly started taking the wrong medicine, and Sagdahl found the right container in that patient’s bedroom.

“I really get to sit and focus,” Sagdahl said. “We have a unique opportunity when we’re actually in the home to find some of these things.”

Nursing a dream

Born and raised in Federal Way, Sagdahl’s journey to nursing excellence began, at least in part, with the nursing sitcom “Julia.”

As a child, Sagdahl would “run around the house in (her) little white slip, pretending to be a nurse,” she said.

By middle and high school, her career interest took a left turn — she decided to pursue a journalism career instead, and started working for her school paper and taking classes on television production.

But a traumatic brain injury at 16 suffered from a horseback riding accident forced Sagdahl to change those plans. The injury had affected her thought process, and especially so her writing ability. She took a job with a family practice doctor — he was the husband of her gymnastics coach — to work as a receptionist in his office.

Regulations on practicing medicine were looser back then, Sagdahl said, and she soon landed a lab work job at a family practice wher she could take x-rays, perform EKGs, draw blood, and give shots as part of her on-the-job training.

“I decided well, maybe I should go to nursing school,” Sagdahl said, and so she did.

During her thirty-year career at the emergency room at Puyallup’s Good Samaritan hospital, Sagdahl met people pursuing an education past their teens and twenties — a concept that inspired her to pursue her nurse practitioner degree.

“I thought, well, I can either keep doing what I’m doing, or I can work with patients and, and do more,” she said. “And at some point, I decided, I guess that I wanted to do more with patients.”

Nurse practitioners have more authority than registered nurses and can create a patient’s care plan, make prescriptions and diagnoses, order tests, and supervise other medical staff.

Patient education is something Sagdahl is passionate about — explaining how medicines work, what symptoms to expect, and demystifying other parts of the healthcare experience.

“I used to say that I couldn’t discharge a patient without a highlighter pen,” she said. “Patient education is a huge piece of what we do as nurses all the time anyway. As nurse practitioners, we just go that step further.”

That passion extends to teaching. Sagdahl served for seven years as the program director for the Certified Nursing Assistant (CNA) program at the Puget Sound Skills Center, a SeaTac-based career and technical education center for high school upperclassmen.

“I absolutely loved it,” she said. “Just to be able to be part of that next generation of nursing … I really enjoyed that and enjoyed motivating students to go on into nursing. … I have absolutely considered going back.”

And Sagdahl also makes time for touch — the simple act of physically touching another patient.

In the last few years, when nurses have been “so overworked, and so inundated,” it’s been especially hard to find those moments to slow down with a patient, Sagdahl said.

“I had a patient the other day … I finished giving her a breathing treatment, touched her arm, and said I’m so glad you’re feeling so much better,” Sagdhal said. “She looked at me and said, ‘Thank you for touching me.’ “

Making the impersonal personal

When Dr. Malka, a physician Sagdahl worked with at Good Samaritan, took a new role as regional medical director at Dispatch Health, he turned to Sagdahl.

“You want to be there for everybody,” Sagdahl said, “for everybody to feel like they’ve received that quality care, that compassion. And I don’t know that everybody always feels that they’re receiving that. … When I went to dispatch health … (Dr. Malka) said, ‘I want you to take the time with my patients.’ That was important to me when choosing where I was going to go next as a nurse practitioner.”

Malka, an emergency medicine physician, has since left that role at Dispatch Health. He still works in the Good Samaritan system in the South Sound area.

Medicine can be, in many respects, a “very impersonal business,” Malka said. Nurses and physicians have many patients to see and no shortage of work to complete.

But Sirena was and is an “expert” in the art of following up with patients, he said, and he knew she’d be a great fit once she’d completed her education.

“Calling her just a nurse doesn’t give it justice. Sirena was a super star from the moment I met her,” Malka said. “She understands the human aspect of medical practice. She relates to people really well, shockingly well. No matter the disparity in age,, culture or even language, she’s just so down-to-earth, approachable, and patient that it just comes through. You know she actually cares. The physical touch is just one aspect of how she’s able to do that.”

Dispatch fields six cars in the greater South Sound, each typically piloted by a duo. Dispatch takes most major insurance plans, including Medicare Advantage and Managed Medicaid.

At Dispatch, Sagdahl and her teammates typically see six to 10 patients per day, spending around 30 to 45 minutes with each patient. The staff report to their office, load up their supplies, and hit the road for a full day of visits automated by a computer system.

The calls run the gamut – urinary tract infections, congestive heart failure, COPD flare ups, etc.

Many of their patients are healthy elderly folks who don’t drive anymore. Others are homebound and can’t physically get to the hospital. And sometimes they’re “the mom with three kids” who can’t easily wrangle them all up for a sudden trip to the hospital, Sagdahl said.

Whoever they are, Sagdahl appreciates the “convenience factor” that means she goes one-on-one with each patient, in a place where they’re comfortable.

Visiting patients in their homes is a totally different experience, and many patients feel more empowered by it, Sagdahl said.

Several times, a patient has been told they need to go to a hospital, but decided they wouldn’t go, Sagdahl said — only to be convinced once she came in person and walked them through the concerns she had for their symptoms.

Having a human check someone out at home can give them the reassurance to say: “I really should go to the emergency room,” Sagdahl said.

On her visits, Sagdahl carries a black notebook — filled with notes on resources for services in the South Sound area.

One patient might mention a day center he goes to, or a book drop-off service by the Pierce County Library. Like a bee pollinating a field as it works, Sagdahl notes all of those services, and shares them with her other patients.

“It’s these little side conversations that you get into with patients as you’re in their home, that would never happen when they’re in your setting,” she said. “That’s the thing that’s remarkable. … They’re driving the conversation much more than when they’re coming to you.”