The last thing Cheryl Kamarauskas wants is for one of her clients to fall through the cracks: it can be a matter of life or death.

As the patient navigator at the 357-bed North Shore Medical Center, Kamarauskas is in charge of making sure that the cancer patients who come to her hospital get help steering through what can be a complicated and exhausting path to treatment.

''It's just too much information when someone is diagnosed with cancer, too much to understand at once. It's a hard time and you get sidetracked and forget appointments. You forget important information,'' she said. ``What we're trying to do is eliminate the barrier to care for patients.

Kamarauskas, who earned a degree in health science from the University of Florida and last year completed an MBA at Nova Southeastern University, started working at North Shore four years ago as an office manager. Last year, the medical director decided the hospital needed a patient navigator after attending a conference of the American Cancer Society.

In 2005, theACS had launched its patient navigator program in partnership with the National Cancer Institute Patient Navigation Research Program. The program, which operates at 60 hospitals and clinics across the United States, focuses on facilities where large number of patients lack either insurance or Medicaid and may not get the attention they need. The ACS plans to expand the program to 50 new locations over the next five years thanks to a $10 million donation from drug-maker AstraZeneca.

When Kamarauskas heard about the position, she jumped at the chance.

After a month-long training program with the ACS, Kamarauskas, who is also assistant director of the hospital's C. Gordon Griffith Cancer Center, launched the program in March. Typically, she juggles 20 cases, making sure patients have appointments coordinated and know when to be where.

''The transportation is the No. 1 thing,'' she said.

Kamarauskas is usually called to a patient just after they receive a cancer diagnosis. Invariably, this is an overwhelming moment, so she provides some literature and gives them a card, assuring them she will be available when they need her. Sometimes, getting through to a patient can take three or even four visits.

'If they're coming for radiation, they're coming for several weeks. Those first three encounters, let's say someone is not very pleasant. I just keep saying, `Hi, how are you,' and three weeks later they open up,'' she explained. ``It's very hard on them, physically and mentally. There are some of them who just won't open up and there's nothing you can do.''

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