A day in the life of 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:

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.