The Palm Beach Post from West Palm Beach, Florida on December 7, 1997 · Page 10
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December 7, 1997

A Publisher Extra Newspaper

The Palm Beach Post from West Palm Beach, Florida · Page 10

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West Palm Beach, Florida
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Sunday, December 7, 1997
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Page 10
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10 A THE PALM BEACH POST SUNDAY, DECEMBER 7. 1997 THE CHILDREN'S E.R. A MOTHER'S TOUCH: Tricia Taylor's mother comforts her daughter after the 14-year-old broke her ankle in two places during a powderpuff football game. The Taylors spent more than 5 hours in the E.R. ALISON REDLICH Staff Photographer Tammy acme,. LIU sees ft aDD j jj j r 1 ; -i" I' fa N I L. , v:-r v I (i$ - - i : I ALISON REDLICH Staff Photographer i WHEN A MOM CAN ONLY WATCH: Myra Leggett (right) watches anxiously as her 1-month-old son, Ricky Bannister, has blood drawn by medical student Brian Perri (center) and nurse practitioner Richard Close. Leggett brought the baby to the E.R. with pneumonia and a high fever. E.R. From 1A jump up, when siblings and blankets and toys are bundled in a hurried heap and the family is asked to explain once again when the coughing began or how high the branch was or what the bottle looked like. About 25,000 children last year passed through those doors into the only 24-hour pediatric emergency room between Broward County and Orlando. That's only about 10,000 fewer patients than the hospital's adult emergency room, and the gap has been narrowing since the children's E.R opened in March of 1995 as a key step in the development of a children's hospital at St. Mary's. ' Half are younger than 6. Nine out of 10 are treated and sent home without a longer stay. About 200 child trauma cases, such as kids whose skulls are crushed in car crashes, go straight to the hospital's trauma center next door each year. About 6 percent of the children's emergency cases involve life-threatening conditions, such as severe asthma attacks or raging infections. Those are dealt with here, along with broken bones and aching bellies. Even when the treatment is successful and short, the pace is frantic, the stress intense, the stakes precious. One Friday evening, the best-ordered priorities of the triage nurses are scrambled over and over by the arrival of feverish newborns, wheezing teens, a toddler left languid by seizures, a 6-year-old whose right eyebrow is underscored by a deep and bleeding gash. ! Two doctors, a physician's assistant and 10 nurses rearrange themselves along with the waiting list. Each of the 12 treatment beds, most in separate rooms, is assigned to a nurse, and each nurse updates the white board in the hallway with the name, age, condition and treatment of the patient. Help goes where it's needed most. This sets fingers curling and palms slapping and teeth drumming all over again in the rooms where parents have been left to wait a little longer with their crying children. Each parent says the same thing to each child: It won't be long now. Sometimes, it's true. Outside Room 11, the orthopedic treatment room where one wall is lined with dozens of steel-gray crutches, child-size to adult, Dr. Bret Baynham is weighing sedation and treatment options for Tricia Taylor. Tricia is a holdover 1 from early afternoon, but she has not lacked attention since snapping two ankle bones during a powder-puff football game at school. "They got her right in here," says her father, Dick Taylor. The children's E.R. has its own X-ray equipment and gets hurry-up results on all sorts of tests. The diagnosis in Tricia's case was easy, and the solution was to call in Baynham, one of two pediatric orthopedists in Palm Beach County. The doctor explains that there is a good chance he can set Tricia's bones right away, without a trip to the operating room. Everyone seems encouraged to hear this, plus the added good news that, at age 14, Tricia's "growth plate" should not be affected. ("You always try to find something encouraging to say," Baynham confides.) Within minutes, Tricia is gliding into a morphine haze and Baynham is at work. In the hallway, Cohen and several nurses are making friendly wagers on the white-cell count from the day's second spinal tap. The white board shows seven patients, ranging from a 3-month-old with sepsis to a 15-year-old with a broken arm. At 6:50 p.m., the noise level is high and rising: cries everywhere. Gurgling screams, rising and falling in pitch. Coughs, beeps. The doctors and nurses have to make themselves heard above it all. Cohen stands at the board and takes inventory. Among her many jobs, she must maintain the flow, see that children are treated as quickly as possible and either released or admitted to the hospital. One way or the other, at least one emergency treatment bed must be kept free for the next urgent case. She sees at least two cases on the board that will require admission. One is the baby with sepsis, a blood infection that has probably been lurking since birth. The other is Vivian, the girl whose spine Cohen decided to tap. Cohen's instincts were correct: The tap results show Vivian has meningitis. It will be days before other results show whether it is bacterial, but powerful antibiotics are already at work just in case. "This is the patient we're here for," Cohen says, as she walks back down the hallway to stop in each room. that distinguish this from an adult emergency room: cartoon figures painted on the treatment-room windows, a scattering of toys in the waiting areas, a collection of children's videos. "It looks like someone had some time this afternoon," Cohen says with a mock-jealous grin. The nurses nod. There are just three patients in treatment and none waiting. One nurse makes the mistake of saying, "It's been quiet." She recognizes the curse before the others have a chance to attack with their eyes, but it's too late. Now it can't stay quiet for long. Cohen, 36, medical director of the children's emergency medicine department,, just shrugs. She thrives under siege, which is good, because she has always had a black cloud over her head. When Cohen works, the E.R. is always busy. She looks in on the patients, reviews their medical histories and symptoms, and decides that two of the three are on course: The fever in Room 1 is lower, and an orthopedist is on the way to treat the fractured ankle in Room 11. But Room 6 is troubling: 12-year-old Vivian Jimenez. Fever, headaches, vomiting, extreme sensitivity to light. A doctor has already examined her, concluded that the problem is probably viral and decided not to do a spinal tap. Cohen reverses that decision. It helps in explaining her caution to Vivian's family that Cohen is fluent and comfortable in Spanish. Already, the waiting room is filling. Triage nurse Bonnie Samter is taking blood pressure and weights and histories when paramedics wheel in a 7-year-old girl who has fallen off an outdoor staircase. Perhaps 15 feet, perhaps 20. She goes to the head of the line, straight into intense treatment, the department's central room. The room is just big enough for two patients and enough doctors and nurses to give them life-sustaining attention. The wall decor is dictated by the Braslow technique: a universal color code that arranges tubes and splints and other equipment by patient age and weight. If there is real drama occurring in the emergency department, it is occurring here, on view through a glass wall to anyone walking down the hall. The fallen girl, her head immobilized by a brace, is surrounded by family, nurses, a police officer, a paramedic and Cohen. The crowd spills into the hall. The girl's only complaint is abdominal pain. She winces as Cohen feels for the source. "I think she's lucky," Cohen says as she steps out of the room and leaves her team to complete the examination. Cohen stops at the white board, which now shows seven patients in treatment, and decides where to go next. In the waiting room, Bailee Stack has just reordered the triage list. Bailee is a 6-year-old with ataxic cerebral palsy. She has little motor control and is subject to seizures, which means she can fall at any time. This time, she fell against a countertop and opened a gap between her right eyelid and brow. At least this time is better than last time, when she fell backward into a door jamb and bled for hours. "Sometimes we put a helmet on her, but it wouldn't have helped because it doesn't cover the eye," said her father, Kevin. "You'd have to put her in a suit of armor to protect her." Kevin Stack and his wife, Barbara LeBeau, are the calmest parents in the waiting room. Both nurses, they are conditioned to life on the edge of disaster. Bailee has already put the countertop debacle behind her. Here in the waiting room, she is a 200-mile-an-hour girl with no steering or brakes. She roars through piles of blocks, around tables and across the room, tilting this way and that, up and down and up again in a flash. Bailee is still in motion as her parents and brother, Dylan, gather around treatment bed 9. It is their good fortune that Helen Hembree is on duty and ready to sew Bailee back together. Hembree, a physician's assistant, is the department's suture ace. She is also a warm, reassuring presence with a self-deprecating sense of humor about her first name ("An old lady's name.") and the unmistakable accent of her native Taiwan. Bailee's seizures make sedation tricky and her constant motion makes examination a challenge; stitching the wound is almost unthinkable, except to Hembree. Even with Bailee's arms wrapped tight to her body and four adults holding her down, she is a blur, a loud blur. The cry "mommy, mommy, mommy, mommy" rises into one gurgling, guttural shriek. Hembree just smiles and draws Bailee's face back in place with nine sutures of 6-0 Prolene, thinner than a human hair. "It's funny," Hembree says, "but at home, I don't sew at all." 5:30 p.m. and the treatment beds are filling; so is the waiting room. It's typical of a Friday night, one of the week's busiest. "This is busy but manageable," says Samter at the triage window. "Sometimes it's busy but nuts." In bed 7, a girl waits to have a bug extracted from her left ear. (It turns out to be a dead cockroach.) The girl who fell down the stairs is still in the intense treatment room, but the pain has stopped and there are no other signs of injury. Down the hall, the parents of another child are shouting at each other: How did this happen? ' Dr. Heidi Cohen takes a few moments to inspect the Tootsie Pop-and-napkin Halloween ghosts at the nurses station before she begins inspecting patient charts. The ghosts are among the handful of touches Please see I.RJ11A

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