Kid╒s Day

March 3, 2014

Children's Hospital's intensive care unit handles Valley's sickest kids

Derrickke Brown came into this world on Dec. 13, but the tiny infant has not been home yet.

As soon as Derrickke was born at St. Agnes Medical Center, he was rushed to Children's Hospital Central California for cardiac surgery to close two holes and fix a valve in his heart.

Since the surgery, Derrickke has been in the new addition to the hospital's Pediatric Intensive Care Unit — better known as the PICU — where he is hooked to a bunch of machines that will help him get better. His mother, Barbara Brown of Fresno, says having a son at Children's Hospital has been a comfort to her as she splits her time between visiting the hospital, work and the other members of her family.

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"I feel like it is OK to be away because Derrickke is in such good hands," Brown says.

Hospital workers offer comforting care for parents despite the PICU being one of the busiest — and most critical — departments in the building.

Any patient who requires life support — whether it be a Lupus patient dealing with the medical problems associated with the condition or a critically injured child — goes to the PICU until they can be moved to another part of the hospital or sent home. In 2013, 1,150 patients used the PICU for a total of 8,881 days.

Until 18 months ago, Children's Hospital had the only PICU in the Valley. A small unit has been opened at Bakersfield Memorial Hospital. Doctors from Children's work closely with the doctors at that facility.

Dr. Sam Lehman, associate medical director of the PICU, explains that since the eight-bed addition, which brings the total beds in the unit to 42, has only been open for a few months, it's primarily being used for cardiac patients.

"We don't want to overwhelm the unit from the start," Lehman says.

Additional PICU beds have become a necessity as the unit gets more patients each year. Lehman points out that while most children's hospitals of this size are located in major metropolitan areas, the large facility here — one of the 10 largest hospitals of its type in the nation — is needed because patients come from such a large area. There are potentially 1.2 million young patients in the area serviced by the hospital.

"Having the additional beds has facilitated our ability to take care of more kids in the way that works best for families and patients," Lehman says. "It allows us to group a set of patients with similar disease diagnoses together to help facilitate their care."

That's why Fresno newborn Adelina Luna Martinez is only a few doors away from Derrickke. All of the medical reports during her mother Kristen Martinez's pregnancy were very positive and when Adelina came into the world Oct. 25, she appeared to be a perfectly healthy girl.

Then a day later, the doctors heard a "swooshing" sound in her heart, which was caused by a Ventricular Septal Defect.

In simple terms, Adelina — like Derrickke — was born with a hole in her heart. Because her case wasn't so severe that her body was being deprived of the proper oxygenated blood, the decision was made to wait a few months before doing surgery to close the hole.

In early February, Adelina had cardiac surgery to close the hole and remove some marrow that was in the pulmonary artery. As soon as the surgery was completed, Adelina was placed in PICU.

Martinez and her husband, Andrew Martinez, already were facing the fears of being new parents. Then they had to deal with the additional concerns surrounding the heart surgery and they were happy that Children's Hospital was so near.

"Everyone has been absolutely incredible," Martinez says. "They are very good at making you feel confident that they know what they are doing. Her cardiac surgeon spent two hours with us the day before Adelina's surgery explaining every single detail."

The tiny heart patients go to the PICU rather than the Neonatal Intensive Care Unit because the NICU tends to deal with infants who are born prematurely or have a congenital birth condition. A patient — from birth to 21 years — who is admitted to PICU is facing a serious health issue and that means family members need to be close. There are a lot of families who use the local hospital who could not afford to travel to Los Angeles or San Francisco, but they can spend time with their child in the PICU because it's close to home.

Lehman, who has been at the local hospital for 11 years, says that the PICU staff — just like all of the departments in the hospital — have a special ability to give the best medical attention while making families feel comfortable during what could end up being a long stay.

Children's Hospital's PICU deals with such a large sampling of patients, the doctors often deal with medical issues — such as Valley Fever or certain types of infections — that doctors in other hospitals never face.

They also take care of patients who normally would see doctors in other parts of the sprawling complex.

Heavyn Son, a 4-year-old from Visalia, has Stage 4 tumors throughout her body. She is spending a few days in the PICU while undergoing infusion chemotherapy that is so aggressive she needs to be near the kind of intensive care offered in the PICU.

Although Heavyn is not feeling well after treatment, she sits with her nana, Sharon Riley, who reads her a story. Riley — like all of Heavyn's family members — sports a shaven head to show support for the little girl.

The difference between dealing with children rather than adults, for Lehman, is the potential outcome.

"Children get better," Lehman says. "And that's a child who could have another 80 years of life left. That's an incredible feeling. That's a great thing that we do. It's an impact we have on families and children.

"Someone who takes care of adults in an ICU does an incredible job, but the best they can do with a 75-year-old is give them another five years of life. The majority of time an adult ICU doctor cares for a patient who is in their last six months of life."

The reality of working in any ICU is that some outcomes aren't happy. In the case of the PICU, the team looks at those situations as having done as much as they can for the patient. They have often created bonds with the family and try to make those situations as easy as possible for the families.

That's why Lehman says it takes a special kind of person to work in the PICU.

"It's not for everybody. I think people who are successful are very emotionally attached to the work they are doing but are able to do that here with those families and patients and not let it overly consume the rest of their lives. There are people who are able to distance themselves, but they become cold. The people who can't separate it get consumed by it. It has to be that middle ground of being emotionally invested in the children we take care of and be able to offer compassion to families without it overly consuming them," Lehman says.

The connections are made quickly and often last for years.

The average time in the PICU is just over a week. But some patients, such as Kieren, a 15-year-old from Tulare, have to stay in the unit for months. Her recent visit is into its second week of what is expected to be a long stay as she battles with Stage 4 Lupus. She was in the PICU last year for three months during her last visit to Children's Hospital.

Because Lupus causes the immune system to attack all parts of the body, Kieren needs intense monitoring. With all of the intensive medical concerns, the staff continues to work to make patients, parents and guardians as comfortable and as informed as possible.

"I've done a lot of traveling and been a lot of places and you couldn't ask for a staff to be any better than what they are here," says Jackson Mainger, Kieren's grandfather and legal guardian. "And Kieren feels very comfortable because she knows everybody and they know her.

"I think it's very personal with them. I've been stopped many times down in the lunchroom by doctors and nurses who ask me how Kieren is doing. From the doctors to housekeepers, they all care. And that's something to be said."

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