On frequent trips overseas with Operation Smile, an international charity that provides free surgery for children with cleft lips and palates, Sarah Gutknecht used to joke that the only continent she wouldn't visit was Antarctica.

Penguins don't have lips, she'd say. Besides, she was needed elsewhere.

Her outgoing manner and cheerful spirit endeared her to patients at home and abroad, and they remained intact even as cancer weakened her.

Gutknecht, a pediatric nurse practitioner — the first to hold that position at Gillette Children's Specialty Healthcare in St. Paul, colleagues say — died of the disease on Aug. 24. She was 54.

News of her death prompted an outpouring of gratitude and sadness online from parents of children Gutknecht had treated. "We are so thankful to her for the amazing care and compassion she showed to us and our daughter," one wrote.

Her colleagues noticed it, too.

"She cared deeply about the very difficult decisions that patients and their families faced, in terms of their medical conditions," said the Rev. Helen O'Brien, Gillette's lead chaplain. "I think you have to have a big heart to be in this work for as long as Sarah was in it. You have to be willing to work in conditions that we don't know anything about ... to help people navigate that uncertain future."

Dr. Tom Novacheck, a pediatric orthopedic surgeon at Gillette and longtime colleague of Gutknecht's, said she had a way of putting her young patients at ease.

"She was committed to learning because she thought two things: Help improve a patient's life and, secondly, if she could learn something she could pass that on to someone else," he said.

Her whimsy and sense of humor drew people to her and made them feel important and loved, Mary E. Kautto said of her old friend, with whom she regularly traveled to reservations in the Dakotas to treat children with cerebral palsy, spina bifida and juvenile arthritis.

"It was just in her soul, it was just part of her," said Kautto, of Gillette's marketing department. "When we did these outreach clinics, and go to these small towns, clearly that was her element, caring for people."

"I think it was her way of giving back," said Novacheck, who hired Gutknecht at Gillette.

Gutknecht went on nearly 30 missions to six continents with Operation Smile — everywhere from Venezuela to Jordan to Thailand — helping patients as young as 9 months old. She also spent time with Healing Hands for Haiti, a charity that works with people with disabilities. (She did eventually visit Antarctica, on a personal trip.)

After a diagnosis of pancreatic cancer last year, Gutknecht wrestled with whether to undergo chemotherapy, knowing "the outcomes weren't good," said her sister, Amy Nelson. Gutknecht ultimately decided to pursue the treatment, Nelson said, so that she could continue to help care for their father, whose health was failing.

"Even with getting chemotherapy, she made several trips to Florida," Nelson said of her older sister, adding, "She made time to FaceTime my 82-year-old mother every night at 7:30."

The second oldest of five children, Gutknecht was raised in Albert Lea by parents Arthur and Suzanne, who instilled in her a sense of responsibility and a desire to help others.

In one of her last journal entries, dated July 23, Gutknecht wrote, "I have tried very hard to accept my situation, emotions have been all over the map," she wrote.

Gutknecht is survived by her spouse, Ann Kools; parents Arthur and Suzanne Gutknecht, brother Scott and sisters Anne Schreck, Julie Savelkoul and Amy Nelson; nieces and nephews, and "her faithful dog," Otto, a shelter rescue. A celebration of life will be held at 2 p.m. Sept. 17 at the University of Minnesota's McNamara Alumni Center.