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THE PALM BEACH POST SUNDAY, DECEMBER 7, 1997 11A THE CHILDREN'S E.R. ' j0:? ' - . - . V ' ; ; - ) I r: ; " - 1 ? I :-: , -. 5 Jiff i - i f 1 f ' t 1 ... L - - .. 'i..-....fLaUS'.l . I ALISON REDLICHStatf Photographer ANXIOUS MOMENTS: Chevonne Simmons watches and worries as emergency room nurses and Dr. Heidi Cohen care for her 10-month-old son, Clyde Clark III. The babv was stabilized after seizures resulting from pneumonia. TV If 5 i 4 W 'v34a Wilt ' U-T r fx JS i k Like Cohen, Hankinson is both a manager and a hands-on caregiver who treats bloody injuries and debilitating diseases when children's lives are at stake. How can she stand the pressure? "It's fun," she says, and she manages to sound convincing as she explains. Hankinson has been an emergency room nurse since college at Penn State. For more than eight years, that meant long and ugly nights trying to piece together what knives and guns and needles had torn apart. "You see people in crisis, and people in crisis aren't always nice people," Hankinson says. "You see a lot of drunks, a lot of drug abusers. And you get abused." Worst of all were the ones who had tried to kill themselves, or to let themselves be killed. They were always angry about being saved. Hankinson remembers being shouted at, cursed at, pushed away. "It's really interesting, really technical work," she says. "You learn so much about what to do, but once you've learned the procedures, you ask yourself: 'Do I want to do this?' " Hankinson decided she did, if she could work with children. She got her first experience at Texas Children's Hospital in Houston, and was working at Pittsburgh Children's when she was recruited by St. Mary's for the children's emergency room. She discovered that parents and children are different from other emergency room patients in this way: They always want help. And the most stressful life-or-death crises are a minority of cases. Many of the children's E.R. patients at St. Mary's are from poor families who have no doctor or rely on public clinics that are closed at night. They come with coughs or colds or cuts that are quickly treated. Hankinson's job is to teach parents how to deal with such problems. "You help them understand and then you go home and say, 'This was a pretty good day. Nobody called me a name and nobody spit on me.' " ALISON REDLICHStaff Photographer COMMANDING PRESENCE: Dr. Heidi Cohen known as Dr. Barbie to her young patients examines Clyde Clark III. She loves her role as chief of the children's E.R. at St. Mary's. E.R. From 10A Why is Heidi Cohen here, working with children? She holds out her hands. They look like the hands of a 7-year-old. Tiny hands, even for a woman so slight that the top of her head does not reach the shortest nurse's chin. "I was doing cancer research and they'd say, 'Feel this.' I'd say, 'Feel what?' I couldn't feel the tumors because I couldn't get my hands around them." Her hands are perfect for this work, for these patients. She might look like one of them, except that she is pregnant with her third child (the others are 5 and 6V2). Cohen works 12-hour days that include hands-on medical treatment; hourslong meetings with hospital officials; hiring, firing and managing staff; serving on committees. She absolutely loves being in charge, and she loves children. "When I did my OB-GYN rotation in med school, I'd deliver a baby and then I'd leave the mother to be with the baby," she says. That was at Albert Einstein College on New York's Long Island, where she was chief resident and later assistant professor of pediatrics. Cohen worked in New York until she moved to Florida in 1994. She has been at St. Mary's since February 1996 and became chief of the department that May. She has not tried to shed her my-way, right-now New York attitude, which serves her well in a crisis and makes her peculiarly suited for emergency room work. "I don't like problems I can't solve," Cohen says. She works fast and thinks faster. "I have five minutes to develop a doctor-patient relationship," she says. It gets off to a good start when children recognize the doll's name and photo on her ID tag: Barbie. While she's diagnosing the child, she's diagnosing the parents, too. She has to decide whether they can understand follow-up care instructions, or whether they will bother to follow them. She has to consider whether a fall was really accidental, or really a fall. Cohen has great confidence in her ability to make the right judgment quickly, to take command, just as she did last year when she and her husband, radiologist Ross Lieberfarb, stopped at the scene of a motorcycle accident on their way to a tennis game. "I saw a young man on the ground and everyone was standing around, staring at him," Cohen said. "I pushed people out of the way. I pushed a cop out of the way. I started barking orders the way I do in the E.R." She was equally sure-footed when an elderly woman whose heart had stopped was mistakenly brought to the children's E.R., and when the man in a stolen car dropped off his friend, who had been shot. Cohen can think of only one instance when she could not keep her cool. "I had to take my own daughter to the emergency room for stitches," she says. "Clinically, I knew it was no big deal. I cried for two days." cry since the seizure passed, and it is a cry that can be heard all through the halls. 8:36 p.m. Stephen's name is called and the Greenhalges are brought to treatment Room 6. At 8:47, Greenhalge is still shaking her head. Stephen is one of triplets, and she has left his two sisters home with her mother. She hates driving in the rain and she hates driving at night, she says. Now it's dark, and it's raining. "Where's the doctor?" she asks. Cohen is s,till in the intense treatment room. The other doctor on duty, Greta Stiebel-Chin, is supposed to relieve the pressure on Cohen by treating the quicker, less-threatening cases. But tonight, the E.R. team is facing an unusual load of patients who will take time and require beds for admission, and Chin cannot easily break away. Hembree, the physician's assistant, is dispatched to examine Stephen but comes back to Cohen with word that the mom wants her instead. Cohen finally gets to Stephen at 9:32. "He's red as a rooster," Cohen says. "He's probably having an allergic reaction." Greenhalge rolls her eyes. Cohen assures her that Stephen is not in danger and will be well-cared for, then quickly steps into the next room, where a month-old baby has a 100.9-degree fever. "That's not supposed to happen," says Ilankinson, who is again dispatched for antibiotics. "Newborns are supposed to have natural immunity. When a newborn has a fever, we react." 10:56 p.m. Stephen's fever was down for a while, but he's bright red again. The child who had the seizure is doing much better. The noise level is much lower: just a few stray coughs. Cohen is standing at the white board, taking stock. Every treatment bed is full; there is none open for the next emergency. The next few minutes are oddly quiet, but no one is pleased. There are at least 10 children in the waiting room and no place to examine them. Hankinson is calling other departments, trying to find rooms for the children who need to be admitted. That will free up treatment beds. "Is 31 clean or dirty?" she asks. "I'm getting two different stories." Cohen tells the nurses to start seating patients in the back hallway, so she and Chin can start examining them. But Chin is still bogged down with admissions. Cohen orders a nurse to call in reinforcements; the nurse shrugs in mid-call. Cohen knows the doctor on the other end is balking, so she gets on the line. really need you in here right noiv so Dr. Chin can start seeing some of these kids. It's only right. He doesn't argue. 11:58 p.m. The cries, the real belly wails, are rising again. The month-old baby's fever is down, but Stephen is still red. He's headed for an overnight bed, but won't get one for hours. (He's released the next day, feeling fine, but without a firm diagnosis. "They need a lot of improvement," his mother says.) 12:04 a.m. Cohen has just completed her sixth spinal tap of the night. Hembree, the extraordinary seamstress, stops her to consult before attempting to reattach a fingertip severed by a folding chair. "I think we can do it," she says. "What's this 'we?' " Cohen jibes. "Two quick sutures," Hembree says. "She'll scream," Cohen says. "You want to sedate her?" "I want to do it quick so these people can go home," Hembree says. "It's up to you," Cohen says, and off Hembree goes. When she's around the corner, Cohen is smiling. "Helen's great. Really great. She could run this place. You know that? She really could run this place." Cohen looks up at the clock. She's supposed to be off at 1, but knows she won't be. "Not if it stays like this," she says. It does. She finally leaves at 3:30 a.m. V 8:25 p.m. Sandy Greenhalge sits in the waiting room hugging her son, Stephen, as she shakes her head slowly from side to side. "They need more staff, or something," she says. Stephen's face and arms and legs are bright red. Greenhalge suspects he's having an allergic reaction to medication he received that morning during an examination at St. Mary's when a doctor inserted a scope into the 5-year-old's bladder. Stephen was fine when she brought him home to Jupiter. Now he's feverish, glowing and miserable. She called the doctor, who told her to take Stephen back to the hospital for tests. They have been waiting for more than an hour. "I should have just gone to the hospital in town," she says. Behind the blacked-out doors, Cohen, Hcm-bree, Hankinson and two other nurses are crowded into the intense treatment room and huddled over Clyde Clark III, 10 months old and motionless after a febrile seizure. Their movements are fast, purposeful, coordinated. Cohen orders three cc's of this and .05 of that. Ilankinson steps quickly to the nurses station to prepare two syringes of antibiotics to attack an infection that is just a suspicion at this point. "We see this sort of thing all the time," Cohen tells the baby's mother, who is staring and crying and flexing her hands at her sides. Cohen explains that she's going to do a spinal tap. The needle's insertion elicits the child's first Marie Ilankinson calls herself the rule keeper. She is the nurse who manages the other nurses, who sees that every shift is staffed" and the medicine cabinets are full and the intense treatment wall is always Braslow-coded and complete.