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May 23, 2011

For Va. responders, tiny patients pose huge challenges

By Amy Jeter
The Virginian-Pilot

NORFOLK, Va. — Blaring pagers punctured a quiet May afternoon.

A 22-month-old boy plagued by fevers, vomiting, chills and coughing wasn't getting enough oxygen in his blood. His doctor at Renaissance Pediatrics in Chesapeake called for transport to Children's Hospital of The King's Daughters.

Karen Callaway slung a stethoscope over her neck, grabbed a laptop and hurried to the KD1 ambulance.

At nursing school in Ohio, Callaway swore she never would work with children. On her pediatric rotation, her 8-year-old cancer patient died within four months.

Somehow, though, her first job required two weeks in a neonatal nursery. Callaway was amazed by what medicine could do for those tiny babies. "It was like, I can do this," she said.

Twenty-five years later, she's a staple of CHKD's 33-member transport team.

Thirty years of good work
This year, as the Norfolk hospital celebrates 50 years of treating the youngest patients in South Hampton Roads and beyond, the transport team marks 30-plus years of delivering those children to specialized pediatric care.

The team's nurses, respiratory therapists and paramedics usher young patients from hospitals or doctors' offices within 200 miles of CHKD. To travel further, they hop on Sentara's Nightingale Regional Air Ambulance or a fixed-wing plane.

They are experts at threading a breathing tube through a child's narrow windpipe; at tapping an infant's tiny vein for an IV; at infusing a preemie's lungs with a liquid that helps the baby to breathe.

"When we call 911, and they come with the fire trucks and the police and the ambulance, and they have equipment that's really made for adults, it's not very reassuring to the parent," said Dr. Dionne Harewood, a physician with Renaissance Pediatrics. "And it's really scary to the child.

"But when you have the transport team, they always know how to handle a 2-year-old or joke with a 6-year-old to make them feel comfortable."

Paramedic George Markham swung KD1 into the afternoon sun, joining the Midtown Tunnel traffic.

The soft-spoken, spectacled 58-year-old is a certified physician assistant and a medic with 25 years of experience. Working with children sharpens his diagnostic skills, he said: "Kids can't help themselves."

Portsmouth's trees and warehouses scrolled by, reflected in the sunglasses of the team's third member, respiratory therapist Ed Azares.

In the seat behind Callaway, he propped his left foot on the center consul, almost Zen in his calm.

Azares is 28 and a graduate of Virginia Beach's Tallwood High School; this is the only professional world he's known. His sister, a CHKD pediatric intensive care unit nurse, introduced him to it when his chemical science major wasn't the perfect fit.

Azares loves being the eyes and ears of the physicians back at the hospital. He knows you have to connect with the children immediately. "If they don't like you, they will tell you they don't like you," he said.

Markham parked the ambulance in front of a sprawling brick building across the street from Chesapeake Square Mall. The team pulled a yellow stretcher out of the back and wheeled it inside.

They stopped in front of an examination room. The boy, Ashton Thomas, sat on his grandmother's lap, his mother nearby. His eyes were closed, and his breaths came in rasps through a clear mask feeding him oxygen.

"Take a listen to his heart and lungs," Callaway told Azares. "Get his temperature, blood pressure and basic information, then get him on the stretcher."

She took the mask from Ashton, who sucked on his fingers.

Azares buzzed around, talking softly.

"Can I see a toe?" he asked. He carefully affixed a lighted blood-oxygen monitor to the boy's foot. "No owie. There you go."

Callaway called a report back to the attending physician in the CHKD emergency room. Judging from the crackles she heard in Ashton's right lung, he probably had pneumonia and could use a chest X-ray.

Markham carried the boy to the stretcher, wheeled it back to KD1 and loaded their patient into the truck, behind an empty incubator and its lift. Overhead compartments held plastic bags with syringes, needles and fluids, along with crayons, picture books and a pink plush rabbit. Medication chilled in a small refrigerator in a corner.

Gray cabinets concealed a breathing machine, an IV pump, a defibrillator and other equipment. The trucks hold enough to treat conditions ranging from seizures to respiratory distress in patients from under 1 pound up to the size of their parents.

"Ashton! Ash!" his mother called from the front.

Callaway opened her computer and began to type. Azares watched the boy's face and the screen recording his vital signs, as the truck rumbled to life.

Bad things happen
Ashton is one of about 100 patients the team will transport this month. They also help treat patients in CHKD's intensive care units.

"They're a valued resource," said Dr. Joel Michael, a member of Emergency Physicians of Tidewater who is based at Sentara Obici Hospital. "We're lucky to have them."

Over years, they see hundreds - even thousands - of children. But for most, one face stands out.

Perhaps a child they bonded with. Someone whose feistiness they admired, whose recovery inspired them deeply or death hit them hard.

Azares remembers a 2-month-old baby with a terminal metabolic disorder.

He cut out a Snoopy sticker to affix a breathing tube to the baby's face, and the mother loved that small note of whimsy.

One day about a month after he'd started treating the child, Azares missed a call from a nurse as he was leaving work for the day. He picked up the message when he got home: the baby's mother wanted a new Snoopy sticker for her son before he died.

Azares returned the call, but it was too late.

"I guess they really appreciated what I did for their child," he said. "Small things go a long way."

Callaway's most memorable call came on a cold February day four years ago. The transport office phone rang a half-hour before her shift ended.

"Come home now," said Zach, her 12-year-old son.

Bryce, her 13-year-old stepson, was in serious trouble.

"He's blue," Zach said. "I think he's going to die."

Bryce had asthma. His inhaler was empty, but Callaway and her husband hadn't known it.

He'd spent the day playing outside. Then, he ate two heaping bowls of chili, and went to help his brother bathe their puppies.

The shift from cold, dry air to warm, moist air aggravated Bryce's asthma. He left the room for a treatment, but Zach didn't hear the whir of the machine. He went to check on his stepbrother.

Bryce was facedown on the floor. Unresponsive. Foaming at the mouth.

The nurse relieving Callaway arrived early that day, and Callaway raced down I-264 to meet Bryce at Sentara Leigh Hospital.

The emergency physician looked at her quizzically. Why was she there? No one had called for a transport - yet.

Soon they did.

From the CHKD ambulance, nurse Lisa Hawkins phoned ahead to Sentara Leigh. There, the nurse put Callaway on the line to brief her colleague.

"Karen? What are you doing there?" Hawkins said.

On the way to CHKD, Callaway rode in the front of the truck, like the mothers, not in back like the nurses.

"It was very, very strange riding in the front of that truck, knowing it was my son in the back," Callaway said. "It was like something out of a bad nightmare."

Bryce stayed in the pediatric intensive care unit for 12 days. He was in the hospital for three and a half weeks.

He made a full recovery. Now, 17, he's recently been accepted at the Virginia Beach Technical and Career Education Center.

The experience gave Callaway a new insight and bond with her patients' families, she said: "It helps those parents to know I do understand what you're going through."

Azares pushed open the back door of KD1, unstrapped the stretcher from the floor, and lowered it to the ground with Markham's help.

In a treatment room, Callaway updated a nurse, and Azares transferred Ashton to a bed. "Good cough," he said, wiping the child's tears with a towel.

Ashton's mother and father joined their son to await a doctor.

Then Markham reappeared.

Years as a paramedic had taught him a hard truth: Bad things happen to nice people. He'd learned you can't second-guess yourself, and you can't carry the difficult cases with you. But he also discovered "it's really nice to help people."

There wasn't one patient who touched him most, Markham said: "All my patients make an impression on me."

He handed Ashton a toy car, then slipped away to clean the stretcher and restock the truck.

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The boy was diagnosed with pneumonia, treated and released the same day. His doctor reports, "He's doing great."