Courtney Hughes’ pathway to her nursing career is not your average one, but then Courtney probably isn’t your average kind of girl.

Courtney was leading an active life, busy working as a prison officer doing lots of physically demanding work leading bush regeneration projects with crews of inmates, and on top of that doing Crossfit and playing full contact league. She was fit, strong, and healthy.

Except that she wasn’t.

Courtney saw the bruises she bore after footy matches as a badge of honour, showing how tough she was. She put the fact that she bruised much more than her team mates down to the fact that she must have been taking bigger hits than the rest of them. She was, she thought, just “taking one for the team”. Like so many of the people we support through bone marrow transplant, it was quite by chance that she found out that she was unwell. She had made an appointment with her GP for a completely unrelated check-up, and her doctor took one look at her and said, “You’re as white as a sheet, and don’t look great. We’re going to run some bloods.”

The next day, while she was driving with her mum, Courtney took a call from the head of haematology at Canberra Hospital who told her that she needed to present herself to the cancer centre in Canberra the next day.

“I didn’t even know what a haematologist was at the time,” Courtney said. “And I thought, ‘Cancer centre? That’s a bit much, isn’t it? Meanwhile Mum, who’d heard the call because we were on speaker, was dissolving into a puddle of tears on the floor.”

Courtney’s parents went with her to Canberra hospital where she had a bone marrow biopsy. “I’m so sorry!” she said to the staff there. “This is all a bit much. I’ll be out of here soon and you can give this bed to someone who really needs it.”

It turned out that the person who really needed treatment in hospital was Courtney herself: She was diagnosed in 2019 with Acute Myeloid Leukaemia (AML) with FLT3 mutation, a genetic mutation which increases the likelihood of relapse in AML. And from there the whirlwind of treatment began. Courtney was fortunate enough to have a week’s grace in which to undergo an egg collection for fertility management post treatment, but that harvest lead to some severe and incredibly painful complications. After that came a bone marrow transplant in 2020 with her sister as her donor.

The transplant went well, and the small amount of graft v. host disease (GvHD) that presented itself was managed well with steroids. Unfortunately, that treatment led to avascular necrosis and a full hip replacement.

“But just four months after that, I completed my first triathlon!” said Courtney. (That’s an indication of the type of person Courtney is.) “Yes! I’ve got my life back!!”

Courtney’s bedside nursing degree

After such a successful outcome, and impressed by the incredible care she received in hospital and wanting to give back, Courtney decided to leave her role in corrective services in 2021 and study to become a nurse. She moved back home at the age of 30 to her parents’ place and became a student once more. But in November 2023, when she had just finished her studies, Courtney began to feel that odd fatigue again. “I couldn’t even swim a single lap, and I knew something was wrong.”

Courtney had relapsed, and needed another bone marrow transplant, this time from an unrelated donor from Germany.

It was difficult news at a time of such joy with Courtney having just completed her nursing degree and looking forward to starting her graduate nursing position at Cooma and Bombala Hospital. “Everything changed when I relapsed. I worked so hard for three years to get this nursing degree. Only to relapse again.”

Courtney received her nursing degree from her hospital bedside whilst undergoing a second bone marrow transplant. She is grateful to have been given “gate leave” to attend her graduation ceremony. “Stoked, actually! I looked pretty crook, and I nearly fell over on stage. The Chancellor nearly had to hold me up! But I was there, and so were my parents and grandparents, cheering me on. It was incredibly special.”

Now free of AML!

Six months later and the news is good. Courtney is now free of AML. The transplant was successful, and has now fully engrafted, meaning that Courtney is officially a chimera. She’s still Courtney, of course, but her entire blood system has the DNA of her German donor.

Sadly, there is some not so good news as well. Courtney has developed some GvHD complications and at the time that we interviewed her for this article, she was back in hospital in Sydney trying to get that under control. Her complications have been so severe that she ended up being flown from her home town to hospital by helicopter.

It’s a long journey

“It’s a long journey,” she says. And she’s not referring to the 8-hour drive from her home town in Bega to her treating hospital in Sydney, though that was also a struggle for her and her family. She’s referring to the stem cell treatment process.

“It’s something that will continue for the rest of my life. It’s not like you have a transplant and it’s all done and dusted. Not at all. I will continue to have tests and probably treatments off and on to deal with the side effects of the stem cell transplant. It tapers down, but it never stops, not really. But that’s OK. I’m grateful to be here to be part of my family, to start my nursing career, to be an aunty to my beautiful tribe of nieces and nephews. I’m really lucky to have had not just a second, but a third chance at life thanks to my donor from Germany.”

And she’s determined to start her nursing role at Cooma Hospital later this year. “I’ll be there in those blue scrubs with bells on!”

Courtney’s aware, though, that it might not be as easy for her as for other new graduates, and she’s arranged to ease into her role starting with four days per week until she regains her stamina. “I might still need to be driving up here to Sydney to see my haematologist. That’s an 8-hour drive.”

Arrow is here to help

We here at Arrow are only too aware of the burden a stem cell transplant can have, especially for people who live regionally. Travel costs mount up with regular trips to and from the hospital.

Courtney is grateful for the gift of travel and petrol vouchers that Arrow provided. “Never underestimate the difference you make with the work you do. You have no idea what a difference it makes to know that there is help available, especially for us the petrol cards you gave us. It was a real help with all the driving I’ve had to do from home to hospital every week.”

And hopefully one day we can help Courtney with a nursing scholarship too as she makes outstanding progress through her nursing career, which we have no doubt she will.