Friday, October 31, 2014
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A day in the life of CHOP

From sunrise May 19 to sunrise May 20, a deep, inside look at the healing that takes place at Philadelphia’s premier franchise.

Scott Bartlett (left), chief of plastic surgery, and Chris Derderian, a craniofacial fellow, perform surgery on Gerard McGrenaghan, 17, of Gloucester County, at Children´s Hospital of Philadelphia. (Sarah J. Glover / Staff Photographer)
Scott Bartlett (left), chief of plastic surgery, and Chris Derderian, a craniofacial fellow, perform surgery on Gerard McGrenaghan, 17, of Gloucester County, at Children's Hospital of Philadelphia. (Sarah J. Glover / Staff Photographer)
Scott Bartlett (left), chief of plastic surgery, and Chris Derderian, a craniofacial fellow, perform surgery on Gerard McGrenaghan, 17, of Gloucester County, at Children´s Hospital of Philadelphia. (Sarah J. Glover / Staff Photographer) Gallery: Day in the life of CHOP
24 Hours at CHOP Video: 24 Hours at CHOP

Even more than the Phillies, Children's Hospital of Philadelphia is this city's championship franchise, consistently ranked No. 1 in the country for pushing the envelope with innovations in children's health care.

On May 19, Children's Hospital gave Daily News reporters and photographers unprecedented access to groundbreaking treatments, including a complex facial reconstruction surgery and an experimental approach to a rare disease of the pancreas that no other hospital in the Western Hemisphere is equipped to offer.

We were also privileged to meet a stream of families who were in town seeking world-class treatments for their children for the childhood cancer neuroblastoma.

Here, dispatches from our marathon 24-hour visit, starting at sunrise May 19:

More coverage
  • Visiting London
  • Big Jimmy and Baby Caleb
  • Chat replay: Read comments from one of the doctors in the story, and from one of the parents. And patient updates.
  • Special Section: Health Innovations
  • 5:49 a.m. (sunrise). From outside, the hospital looks utterly still, its lights twinkling against the gray of dawn. Inside, hundreds of workers are on the job, either wrapping up their night shift or tending to early-bird duties. John Todaro, a maintenance man, is 49 minutes into his rounds on the fourth floor, prepping 18 operating rooms for the 74 surgeries that will take place today.

    "Gowning up" as if he were a surgeon, Todaro tries out the scrub sinks every morning to make sure the sensors are working. Sometimes, on a Monday, he will start them early so the water is warm when doctors and nurses go to use it. He tests the electrical systems, tries every single lightbulb, double-checks the backup power. "The medical staff is incredibly busy. They don't notice these facility-type things," Todaro says. "Me being here, seeing it, gets it done."

    6 a.m. Children's security guards gather for a morning meeting that is like a TV cop show roll call, except that the presiding officer, Sgt. Rocco Cugini, doesn't send his force off warning, "Let's be careful out there." He says, "Let's have a wonderful day." In the security command center, a video feed from one of the hospital's 500 security cameras captures the first stroller to arrive.

    Meanwhile, in a basement laboratory, baby-formula technician Starlene Ross gowns up for her shift. In a sterile room that is as scrupulously germ-free as the operating rooms at Children's - Ross even sanitizes her calculator - she helps custom-mix formulas for about 100 fragile infants a day.

    7 a.m. In the pediatric intensive-care unit (PICU), Melanie Smith, the nurse in charge of the 12-hour night shift, is handing off responsibility for two dozen critically sick children to Leanne Cimato, the charge nurse for the day shift. "We fix most of them," Cimato says.

    When the unit loses a child, the nurses never really shake it. Twelve hours from now, when her shift is done, Cimato will roll down the window in her car and drive down I-95 singing Weezer songs at the top of her lungs to clear her head for re-entry to the outside world.

    7:15 a.m. Outside, in the parking lot, Sue McGrenaghan is walking arm-in-arm with her 17-year-old son, Gerard, who faces major surgery today to bring his recessed forehead into better alignment with his jaw. It's a reunion for Children's and the McGrenaghans, who live in Gloucester County.

    Gerard McGrenaghan was born in 1993 with several birth defects, including a malformed heart. He had open-heart surgery here at 6 days old and spent the first three months of his life in the hospital.

    He has been back for a handful of mostly minor surgeries since then, but this one is big, involving months of recovery. The McGrenaghans are running late. "He was in no hurry to be here," Sue McGrenaghan said.

    8 a.m. Back in the PICU, a team of residents (beginner doctors) is completing this week's "mock code drill," in which a more senior doctor, Akira Nishisaki, has presented the group with a ridiculously complex crisis involving a lifelike plastic baby whose heart has stopped.

    With CPR and a string of inspired judgment calls, the doctors revive the doll. The relief on their faces when the plastic baby in the mock drill cries is entirely real.

    Twenty minutes later in the operating-room wing at Children's, plastic surgeon Scott Bartlett has his brow knit in concentration as he coordinates details of Gerard McGrenaghan's morning surgery. At 8:30, a team arrives to wheel him in his bed to the operating room.

    9 a.m. Now Bartlett has begun. In surgery, he will saw through a large bone in Gerard McGrenaghan's jaw, allowing the teenager's forehead and jaw to gradually realign using an appliance that will pull them into place. The operation is expected to last four hours.

    Sue McGrenaghan won't be waiting alone. Gerard McGrenaghan's father, sister, and brother, and his sister's fiancé, have all converged on Children's this morning to be with him. "We travel as a pack," Sue McGrenaghan said. "He has lots of support."

    9:40 a.m. Gerard McGrenaghan's pack is gathered in a waiting room, where they look oddly calm. "I've learned to tone it down," his mother said. When he was a newborn, "he looked like a little blue chicken," she said. "We couldn't even hold him." Now he is a black belt in karate.

    Gerard McGrenaghan's father, Pat, acknowledged: "I'm a little nuts inside." Although they are divorced, he and Sue McGrenaghan are warm toward each other and in sync as members of Team Gerard.

    10 a.m. Andy Reid is in the house! The Eagles coach tries to visit Children's Hospital every spring, and his visit to Unit 5 West is well-timed for Alexis Jeffries, 13, of Levittown. "Today's my birthday," Jeffries says. It's her first day as an official teenager, and she's stuck in the hospital with a kidney stone.

    11 a.m. Thursday story time is winding down in the Connelly Family Center, a homey refuge for patients and their parents.

    Zoning out as they listen to an Irish storyteller are 16-month-old London Dally and her parents. London, a cancer patient, is at Children's for a round of inpatient chemo. (Our sidebar, "Visiting London," has more about her.) Right now, she's holding hands with her father, Ben, as she sits on the lap of her mother, Susan Ratti.

    When London gets squirmy, Ratti absentmindedly removes the child's socks and strokes the soles of her bare feet to soothe her. If it weren't for the pole hung with bags of intravenous treatments, this could be the tableau of a loving family anywhere.

    Noon. Nurses and surgeons and baby-formula technicians and maintenance men all have to eat. While today's 441 inpatients are dialing for room service (options include build-your-own pizzas and fajitas), the hospital staff crowds a stadium-size lunchroom. Children's employs 10,456 people, making it one of the region's top employers.

    1 p.m. In a patient room, Christie Brundege, a 22-year-old mother from Uniontown, near Pittsburgh, coos at her 4-month-old son, Troy, who is about to undergo a diagnostic test for a rare condition called hyperinsulinism.

    With luck, Troy will turn out to have a specific form of the disease that only Children's and two European hospitals are able to diagnose, using an experimental radioactive drug. If that's the case, he stands a good chance to be cured with an intricate surgery developed here. A baby from Argentina is at Children's for the same test; if all systems are go, they could both get a surgical cure the next day.

    Troy has been living at various hospitals for the last month, logging his baby-book milestones in clinical settings. At Children's Hospital of Pittsburgh, "he got to see the Easter Bunny," Brundege says. Two days ago, he shared his first laugh at Children's.

    1:15 p.m. Troy goes under anesthesia to log his first experimental PET scan with the radiological drug 18-fluorodopa. In a few hours, his frightened mother will know whether her baby can receive the curative surgery.

    At roughly the same time, Gerard McGrenaghan is coming out of surgery. His pack moves to the PICU to meet him. Sue McGrenaghan, looking more frazzled than earlier, stands at his bedside as he comes to. "I get through the crisis. Then it catches up," she says. Occasionally, Gerard McGrenaghan shifts in his bed, and his mother's head immediately turns toward her son.

    2 p.m. In the cardiac intensive-care unit, cardiologist Gil Wernovsky is beaming over a happy confluence at his unit today.

    In one room, there's 24-year-old Jimmy Axten, a very early - and very lucky - survivor of open-heart surgery pioneered here for newborns with a heart defect known as hypoplastic left heart syndrome (HLHS). He's back now for a relatively straightforward heart-valve replacement.

    When Axten was born in 1986, three out of four HLHS babies who had open-heart surgery as infants died. For a newborn then, "the stars had to align - a whole lot of them," Wernovsky says.

    Down the hall is 4-month-old Caleb Reed, born two decades later with the same rare defect and a great chance of survival. (See "Big Jimmy and Baby Caleb" for more about both.) At Children's in 2011, 95 percent of babies who have surgery for HLHS will make it, provided they don't have extra risk factors like low birth weight.

    3 p.m. Who knew? Children's has a pool. (It's a big therapy pool, about the size of a lap pool in a good business-class hotel, and is in Children's Seashore House building on the farther reaches of the hospital's campus.

    Sara DeHoratius, an occupational therapist, has changed into a black-and-pink racer-back bathing suit for her appointment with 8-year-old Nash Yankalunas, who has cerebral palsy and is recovering from surgery that will make walking easier.

    Nash wants to play with a water gun, but after a few squirts, DeHoratius says, "We gotta work." She guides him to the wall so he can practice pushing off with his feet.

    4 p.m. The bed meeting is Children's Hospital's state of the union. Every day at 9 a.m. and 4 p.m., nurses and administrators from each unit in the hospital convene for a call-and-response update on how many beds are open, how many nurses are on duty, and how many discharges and transfers are expected.

    It's a minibreak for the nurses, who laugh and share wisecracks. But people rush out of the room intermittently as their cellphones ring. Some take a call midmeeting to put out fires on the spot.

    5 p.m. Everyone must sanitize their hands before going into the neonatal intensive-care unit (NICU), including the 165 visiting neonatal nurses who have traveled from all over the country to attend a conference at Children's today.

    Tucked in a back room, Markeyta Harrison looks lovingly at her son Aiden Budd, who at 110 days old has recently moved up from his isolet to a tiny crib and is just now enjoying a gentle ride in a baby swing.

    The 34-year-old Harrison, who lives in West Philadelphia and works as an office manager at Abington Memorial Hospital, delivered Aiden at 23 weeks. At that point he looked like "a cellphone with a head," she says. He's still fragile enough that Harrison will need to learn CPR before he's discharged.

    5:30 p.m. Troy Brundege's experimental PET-scan results are in, and his father, Garret, has joined his wife, Christie, to hear the outcome. Children's surgeon-in-chief Scott Adzick has good news: The baby has the "focal" type of hyperinsulinism that Children's can usually cure surgically.

    The operation to trim away the diseased part of Troy's pancreas is scheduled for the next afternoon. (It will end up taking Adzick five hours to complete, after which Christie and Garret Brundege will solemly shake the surgeon's hand while Troy's grandmother jump ups and hugs the man.)

    6 p.m. By day, Children's thrums with the energy of a huge, famous teaching hospital, with visiting nurses and NFL coaches coursing through the halls. Come evening, it becomes a quieter community of sick children, loving families, and their caregivers.

    Take 7-year-old William Hutchinson, now up and about in a blue Nike tracksuit after donating stem cells this morning to his 17-month-old brother, Marcus, who has a rare skin-cell disease. "It didn't hurt," William says. "And Mom was here." For toughing it out, she treated him with a Nintendo DS Lite gaming system. His favorite game so far is Super Mario Brothers.

    7 p.m. And here comes 16-month-old London. Fresh from her second round of chemo of the day, she's running up and down the hallways of the oncology unit with her father pushing the IV pole behind her. A total ham, she stops and twirls as her mother holds the IV lines above her head so she doesn't get tangled. She blows the nurses kisses.

    London's grandmother Verna Dally dutifully follows with her digital camera, nudging our photographer out of her way to capture the precious moments.

    8 p.m. Down the hall, Nico Cassabria, 4, is cranky. He lies with his father, Steven, in his hospital bed. His mother, Stephanie, sits next to them in a chair.

    Nico has Stage 4 neuroblastoma. It's a disease that was a death sentence a generation ago, but half of patients at Children's now survive it, thanks to research done here. Nico is in remission, but he's struggling tonight with a fever and a drop in blood pressure.

    Last night, Stephanie Cassabria watched American Idol contestant Lauren Alaina sing "If I Die Young," and she lost it. "He's in remission, and this is his last treatment," she says now, fighting tears. "But it's an aggressive cancer, so that's always in the back of my mind."

    9 p.m. And then there's 2-year-old Wyatt Fleming, whose inoperable liver cancer, diagnosed on Super Bowl Sunday, turned out to be a story of possibilities.

    Five days ago, at 6:30 a.m., Wyatt's family got a call that a liver was available for transplant and rushed to Children's from their home in Branchburg, N.J. Wyatt was in surgery by 9 that night.

    Tonight, he's sleeping quietly in the PICU. He's just starting to get back to his normal self, says his father, Matt, who's wearing a shirt with the Superman logo on it. But instead of an "S" on his chest, there's a "W" for Wyatt.

    Nearby, Gerard McGrenaghan is propped up in bed with a stuffed Phillie Phanatic by his side. His father, Pat, jokes about not wanting to tell his son the score of tonight's game because the Phils are losing. Gerard McGrenaghan is more alert than he was before, but his breathing is heavy. He sounds like a teenage Darth Vader.

    10 p.m. Now the hospital building goes into sleep mode. Lights are dimmed in the public areas and on the wards. A guard locks the main entrance; it won't reopen until 5 a.m.

    11 p.m. Gina Arnao-Shane is the ruler of the night realm. As nursing supervisor, she is the highest-ranking administrator in the hospital. She's been running the overnight showfor 23 years.

    She knows and trusts the doctors here: When one of her own children cut open her forehead during a trip to the Poconos, Arnao-Shane drove the child to Children's.

    Right now, Arnao-Shane is making her first round through the building. She's armed with a clipboard with four cellphones and pagers attached to alert her to admissions and emergencies. She's predicting a slow night, but that's relative. At 11:45, one of her beepers goes off with an update: Already, seven children have been admitted since 11 p.m.

    Arnao-Shane rarely sits down. "Sometimes," she says, "you just have to keep moving. . . . You can walk around and at 4 a.m. see a nurse sitting, and it's the first time they've sat since their 12-hour shift began."

    Midnight. Passing through the emergency room, Arnao-Shane runs into KristanMcGuckin, one of 85 employees on the Child Life staff at Children's. McGuckin, on the final hour of her 13-hour shift, wears a Dora the Explorer lanyard and is armed with bubbles and toys.

    Her job is to make the hospital visit easier for sick and scared kids. That can mean providing toys and movies or arts and crafts, or distracting a child during a difficult procedure. She also gives bereavement support to parents and is always on call.

    McGuckin has just left a family who had two children rushed to Children's that evening. The brother and sister had been riding their bikes home in the rain when they were struck by lightning. "They weren't seriously injured, but it was a really scary event," she says.

    Before that, she had shown a 4-year-old boy how to give an IV to a doll so he wouldn't be as scared when it was his turn. "He did great. Not even a flinch," McGuckin says.

    12:50 a.m. Leaving McGuckin, Arnao-Shane checks in on the oncology unit. Charge nurse Annie Davis wears a headlamp that allows her to go into patients' rooms to check on them without turning on the overhead lights and disturbing them.

    Oncology is quiet. No more chemotherapy will be done until morning. Davis reports that two patients' families have agreed to do-not-resuscitate orders. A third family is considering one.

    John Maris, chief of the division of oncology, will tell us later that it's a high number for one night, but not unheard of given the complexity of the cancers that Children's treats.

    1 a.m. It's lunchtime for some of the nurses at Seashore House when Arnao-Shane arrives at that building. This is largely a place for rehabilitation and long-term-care patients, including some who started at Children's as NICU babies and have been in and out of the hospital for years.

    "They have a place where the whole team knows them," says charge nurse Jennifer Gentile. "A lot of them get better. It's nice to see them grow up."

    Arnao-Shane moves back to the emergency room, where attending physician Jane Lavelle now has a few minutes to give her a rundown of some the patients being treated: A little boy climbing on a chest had a TV fall on him, and now he's having problems walking. Another child has a collapsed lung. There's a boy with a football injury and another who had a seizure from a fever. "You never know what your shift will bring," Lavelle says.

    NICU Charge Nurse Patty Taylor felt similarly. "The only difference between night and day is it's dark," she said.

    2 a.m. As Arnao-Shane moves through the hospital, cleaning people are everywhere. They're vacuuming the mats by the elevators, mopping the main foyer, buffing the floors in the ER.

    Mercedes Blackstone, another ER attending doctor, has just left a patient who swallowed a penny that had lodged in his esophagus. Before any surgery was needed, the coin loosened on its own and moved into the patient's intestines. For the child's family, it's a happy ending, a story that will become family legend.

    Blackstone also notes that the hospital is relatively quiet this evening, but she says she can never relax until her shift ends at 8 a.m. Dawn can be a particularly wrenching time at the trauma bay because if a baby has died from sudden infant death syndrome overnight, his parents will usually find him then.

    3 a.m. On the ninth floor, Tonja Belo, a nurse on the IV team, is waiting for a call. If a child needs an intravenous catheter at night, the job goes to her. Belo's the expert, able to handle small or collapsed veins and other challenges. "You wouldn't want your baby to be stuck three times, four times," she says.

    On a typical night, Belo's team can tend to between 30 and 40 patients. At 3:45 she answers a call to help with a 2-year-old girl in a room far across the sprawling Children's campus. Belo walks up and down stairwells and down quiet hallways to reach the child's bedside, where she rigs a blanket to cover little Corrina Stadanlick's eyes from the light.

    Corrina starts to cry quietly as Belo and two other nurses remove an old IV. Her mother presses her forehead against her daughter's, their two blond heads motionless as the nurses work around them.

    In one sure move, Belo slides her needle into Corrina's arm, and the child calms down. She asks her mother for some bread.

    4 a.m. In the blood lab, medical technician Carmela Contessa and Supervisor Pam Blair are preparing blood for the morning's surgeries, including four morning open-heart surgeries that will need units of whole blood processed, matched to the patient, and delivered to the OR by 6:30 a.m. The lab is pristine: There's no blood to be seen, not even bagged. Softly whirring machines do the hardest work.

    Meanwhile, in the PICU, Gerard McGrenaghan's mother and father have just toughed out a respiratory scare, solved by an inventive respiratory therapist who jury-rigged their son's sleep-apnea mask to make a tight seal over an awkward appliance that's holding his forehead and jaw in position.

    Sue McGrenaghan has slept, on and off, on a chair that pulls out into a cot. Pat McGrenaghan has stayed up all night sitting sentry at the bottom of his son's bed. They can't know it now, but their son will be discharged just four days later. On May 31, he'll be back in class at Gateway Regional High School.

    5 a.m. Maintenance man John Todaro is back for another day of prepping the operating suites.

    Problem in OR No. 3. Three of the room's lights are out.

    Todaro retrieves a ladder and the appropriate lightbulbs. As he screws them in, he notes that if the new bulbs don't work, that's a sign of a bigger problem in the electrical system.

    He climbs down and flips a switch. The new bulbs work. The hospital can begin the work of the new day.

    Becky Batcha, Molly Eichel, and Natalie Pompilio Daily News Staff Writers
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