Video: Mike Royal Won’t Leave the Nest

Mike Royal remembers the exact date the first study participant enrolled at the AIDS Clinical Trials Group (ACTG) Network’s Washington University site in St. Louis, Missouri, USA.

“It was Jan. 5, 1988, which is the day after my birthday,” says Royal, R.Ph, the site’s pharmacist.

Click here to watch a video of Royal explaining why he became a pharmacist and how he knows every patient’s name at his site.

The ACTG’s Washington University Clinical Research Site (CRS) was one of the Network’s first domestic locations established in 1987. Originally, Royal began working as a pharmacist at Barnes-Jewish Hospital in 1983 when the first patients living with HIV and AIDS sought treatment. As physicians and nurses struggled to figure out how to treat this new disease, they turned to Royal to help them manage patients’ many medications. This experience inspired him to help create the St. Louis Effort for AIDS, the first AIDS service organization in the city.

When the ACTG site began hiring at Washington University four years later, Royal was working with chemotherapy patients, but still volunteering with the St. Louis Effort for AIDS. He was approached about applying for the pharmacy position within the ACTG’s Washington University site.

“The pharmacy director approached me and said ‘this seems to be your area of expertise and interest’ and he told me about the position within the ACTG site,” Royal says. “I was hired the Wednesday before Thanksgiving in 1987 and I have been there ever since.”

Royal’s road to becoming a pharmacist was influenced by his love of cooking and his parents’ hope that he would pursue a career in the medical field. He wanted to be a chef. They wanted him to be a doctor.

“Pharmacy seemed to be a good compromise between science, medicine and cooking,” says Royal. “Pharmacy has the science and medicine part. And when I first started out, pharmacists still made things the old way – ointments, creams, tablets, capsules and suppositories – that’s cooking. So pharmacy seemed to be a great way to merge everything.”

Royal comes into the office around 5:30 a.m. each day, reviewing the appointment book and pulling patients’ charts. When people express interest in joining an ACTG enrolling study at the Washington University site, Royal reviews their list of current medications to ensure none of the drugs they are taking would negatively interact with any drugs being tested in the study. He assists the site’s study coordinators or nurses with adherence checks to establish if a patient has been taking their medications as prescribed. If needed, he meets with investigators to discuss dose changes.

“Mike counsels patients and their families, teaches clinicians and staff, and helps other pharmacists on a regular basis,” says Lisa Kessels, RN, ACRN, who also works at the St. Louis site. “He is the go-to person in the community for physicians and other health care workers when they have questions about medication management. He demands perfection from himself in his work, and gently urges others to do the same.  He does this with a kind and motivating teaching method; and those interactions usually end with that gregarious, full-bodied laugh that frequently fills the unit.”   

On the Network-level, Royal serves as the Vice Chair of the Pharmacy Subcommittee. The committee develops training tools and tries to standardize pharmacists’ roles at each site. He admits creating Network-wide standard operating procedures for pharmacists is difficult as laws vary from state to state in the US.

“As a founding member and the first Chair of the Pharmacy Subcommittee, Mike set the goals and standards to which those of us on the subcommittee still adhere,” says Andrea Weiss, R.Ph, Pharmacist at the ACTG’s Johns Hopkins site in Baltimore, Maryland, USA. “The many accomplishments of the subcommittee can be attributed to his tenure as chair. He is a wonderful mentor and has always been very generous in sharing his ideas and any tools that he has developed during his many years of practice as an ACTG pharmacist.  He’s my consultant on all things ACTG and even some things that aren’t – like recipes for Irish Stew and his famous cupcakes.  It is my pleasure to work with Mike on the subcommittee.”

Royal says his job as a pharmacist at a research site is both professionally and personally rewarding. Currently enrolling trial A5294 explores whether adding the drug Boceprevir to the standard combination of drugs to treat hepatitis C virus (HCV) and HIV will help people with the co-infection better control or even cure their HCV. Royal says patients with HCV and HIV endure many side effects from the current standard of treatment and he hopes this new regimen will prove successful.

“Ever since those first enrolling studies A012 and A019 back in the 1980s, it hit me that my job is allowing me to be on the cutting edge of research and helping to save lives,” Royal says. “I know our study volunteers as human beings, not as research statistics. If one of my colleagues asks me how patient 299 is doing, I tell them ‘I don’t know numbers, I know patients’ names.’ It’s important we relate people to research instead of subjects to research. What I enjoy the best about my work is giving a human face to things.”

When he’s not working at the Washington University site, Royal can be found taking classes. He’s earning a master’s degree in literature with an emphasis in Irish mythology.

“I’m learning Gaelic,” he says. “As part of my program, I have to translate a book written in Gaelic.”

He continues his charity work in his spare time. Royal is a member of the Show-Me Bears, a group that raises between $80,000-100,000 annually for HIV service organizations in St. Louis. Last year, the group was able to send 40 children and their families to Camp Hope, a camp for children living with HIV, for a week.

“The other little know secret is that Mike is a very creative and accomplished baker,” says Kessels. “His signature dessert is cupcakes, which he brings in to share with his ‘work-family.’  Each cupcake event starts off with an orientation session because you never know what concoction he has thought up this time! I understand that others in the ACTG have heard about this talent and want him to bring them cupcakes to the Network meetings, which I am sure he will figure out how to do in the near future!”

Royal says he’s happy to cook for his colleagues at the St. Louis site, calling them “family.”

“We work well together and we take care of each other,” Royal says. “One of our study coordinators graduated with a degree in clinical research and we threw her a graduation party. And when my dad passed away a few years ago in Seattle, everyone at the site asked what they could do to help me get there. I can’t imagine not working here because leaving would be like leaving the nest.”