From hotline to surgery – How CHOC guided a family through an emergency during COVID-19

As the parent of a child with gastrointestinal issues, Kris wasn’t immediately concerned when her son Nolan complained of a stomachache while they were watching TV together. When his pain quickly got worse and Nolan started to vomit, Kris knew it was time to call CHOC.

“With COVID-19 going on, I didn’t know if the pediatrician’s office or emergency room was the best place to bring him. I didn’t want to take a spot in the waiting room from someone who needed it more than us,” Kris said.

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Nolan with his mom Kris

Luckily, Kris had noticed on social media that CHOC had implemented a COVID-19 hotline (1-844-GET-CHOC) staffed by a team of registered nurses. She called the hotline for advice on where to safely seek care for her son during the pandemic.

“As the parent of an immunocompromised child, I knew CHOC could help,” Kris says. “A nurse took our call, and within a few minutes we were on a Zoom video call with a doctor. She gave us very clear parameters of what to watch for and when to call back. Nolan’s symptoms got worse, and when we called back, we were immediately patched through to a video call with a pediatrician.”

Dr. Lori Openshaw, a CHOC Children’s pediatrician, spoke with Kris and Nolan via video chat. After taking a medical history, Dr. Openshaw was able to walk Kris through doing an abdominal examination on Nolan, while the physician closely observed via video. With Kris’ help, Dr. Openshaw better understood the location and intensity of Nolan’s pain, and what might be causing his symptoms.

“Dr. Openshaw told me exactly what to do. She told me where to push on his stomach and where not to push. She paid attention to Nolan’s facial expressions during the exam,” Kris says.

Dr. Openshaw highly suspected that Nolan may have appendicitis and needed an urgent surgical evaluation. She directed Nolan and his mom to get to the Julia and George Argyros Emergency Department at CHOC Children’s Hospital quickly.

“By the time we got to CHOC, they were ready for us,” Kris says. “Dr. Openshaw had called the emergency department and told them we were coming. She gave us instructions to wait in the car at valet, and a staff member would come to the car and ask for our name. It was clear that everyone from valet to security was following protocol implemented to keep people as safe as possible during this pandemic.”

Nolan’s room in the emergency department was ready and waiting for him. He and his mom noted how everyone in the emergency department, and the medical unit to which he was admitted overnight, was calm and collected, which in turn helped them feel calm during a stressful health emergency.

Although Nolan has been a patient at CHOC many times before, he and Kris noticed that a few things were different about this trip to CHOC. To protect the health of patients, families, doctors, nurses and staff during the pandemic, CHOC had implemented a variety of safety measures. Kris and Nolan noticed that everyone underwent a health screening before entering the hospital, people wore masks (and more protective equipment when necessary), social distancing measures were in place with people staying 6 feet apart whenever possible, and additional cleaning measures were carried out on top of CHOC’s already stringent cleaning practices.

“Seeing people go above and beyond to keep patients safe, healthy and comfortable during this time is what makes CHOC so different and so special,” Kris says.

Testing confirmed Nolan did indeed have appendicitis, and his surgery was scheduled for the next morning with  Dr. Mustafa Kabeer, a pediatric general and thoracic surgeon. Surgery was a success.

Nolan_aftersurgery
Nolan was in good spirits while recovering from surgery.

Nolan appreciated that staff made him feel as comfortable as possible during his stay.

“CHOC sees you as a person, not just a patient,” Nolan says. “Everyone explained to me what would happen and what medicine I would get. They made it easy for me to understand what was going on, which made the process feel smooth.”

Having a hospitalized child during a pandemic isn’t something Kris envisioned, but she knew Nolan was in good hands.

“It gave me peace of mind that there was consistency in protocols from each area of the hospital that we interacted with,” Kris says. “Everything was well thought out, and it was clear that everyone had bought into the changes being implemented throughout the hospital.”

Kris noticed that staff were reminding each other of changes in protocol, which further reassured her that the hospital was a safe place.

“Hearing nurses and other staff remind each other of things – whether that be a change in protocol, or where an item had been moved to – reassured me that the decisions CHOC had made to keep people safe were being upheld throughout the hospital.”

Nolan shares in his mom’s appreciation for CHOC.

“You never want to be sick, but if you’re going to be sick, you want to be sick at CHOC,” he says.

Nolan only had to stay at CHOC one night after surgery for observation and went home the next day. Dr. Openshaw, although not Nolan’s primary pediatrician, called several times to check up on him after surgery.

“Dr. Openshaw’s care and follow-up made us feel comfortable and assured,” Kris says.

Today, Nolan is back at home, getting reacclimated to distance learning while his school is closed – he’s also learning how to cook and do laundry before he heads off to college in the fall.

Kris is happy to have this health scare behind them, but grateful she knew who to call when her son was sick.

“CHOC has always known what is best for my child. No matter what is going on around us – even a pandemic – doing what’s best for my child will always be CHOC’s priority,” Kris says. “I knew the only place I would trust information from during this time was CHOC. The fact that they had set up a COVID-19 hotline for parents was just another sign that they are always three steps ahead in every situation.”

Get more information on Coronavirus (COVID-19)

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Patients Say the Darndest Things

In celebration of Doctor’s Day, we asked a few of our physicians what’s the funniest thing a patient has ever told you?

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Left: Dr. Mary Jane Piroutek. Right: Snow White, her doppelgänger.

Dr. Mary Jane Piroutek, emergency medicine specialist

Q: What’s the funniest thing a patient has ever told you?

A:  Kids say funny things all the time. One of my favorites was a little 4 year old girl that had ingested coins and they were stuck in her esophagus. When I asked her what happened she shrugged her shoulder and with a mischievous look in her eyes said, “I ate the money, I’m not supposed to eat the money.”  Also recently a patient told me I looked like Snow White (which I don’t) and she called me Dr. Snow White the whole time I took care of her.

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Dr. Gary Goodman, medical director, pediatric intensive care unit, CHOC Children’s at Mission Hospital

Q: What’s the funniest thing a patient has ever told you?

A: Just recently, I had a patient, who has a mild developmental delay, call me “the boy.”  I would stop in the patient’s room each morning, at which point I’d get asked, “What do YOU want?”

doctor's day

Dr. Kenneth Kwon, emergency medicine specialist

Q: What’s the funniest thing a patient has ever told you?

A: An adage in pediatric emergency care is when a child comes in with a nosebleed, you don’t ask if he picks his nose, you ask him which finger he uses. When I asked this question to one of my pint-sized patients, he answered that he used all of them, and then proceeded to demonstrate by sticking each of his 10 fingers in his nose individually. It was priceless.

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Dr. Maryam Gholizadeh, general and thoracic surgeon

Q: What’s the funniest thing a patient has ever told you?

A: There was a young child around 8-9 years old and we were going to remove his appendix with laparoscopy. I was standing on his left side because with laparoscopy we make our incision on the left side. Just before he went to sleep he looked up at me and said, “Why are you standing on my left? My appendix is on the right.” I was amazed at how knowledgeable this kid was!

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Dr. Jennifer Ho, hospitalist

Q: What’s the funniest thing a patient has ever told you?

A: From a 3-year-old girl: “I want to be a doctor like you … but only for unicorns and fairies.”

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Dr. Andrew Mower, neurologist

Q: What’s the funniest thing a patient has ever told you?

A: “I don’t eat apples, doctor.”

“Why?”

“Because they keep the doctor away, and I like you, Dr. Mower.”

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Dr. Laura Totaro, hospitalist

Q: What’s the funniest thing a patient has ever told you?

A: I was examining the mouth of my patient when he proudly showed me his loose tooth and whispered to me that his family had a secret. He then excitedly admitted that his mom was the tooth fairy!  His mother looked at me quizzically and then burst out laughing when she realized what had taken place. Earlier she had admitted to him that she played the role of tooth fairy at home but her son took this quite literally and believed it to actually be her secret full time job for all children.

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Dr. Mustafa Kabeer, general and thoracic surgeon

Q: What’s the funniest thing a patient has ever told you?

A: A patient asked me what my first name was, and I told him it was Mustafa. He then promptly told me that was the name of his pet lizard!

doctor's day
Dr. Taraman, pictured with his apparent doppelgängers, Linguini from “Ratatouille” and Flint Lockwood from “Cloudy with a Chance of Meatballs.”

Dr. Sharief Taraman, neurology

Q: What’s the funniest thing a patient has ever told you?

A: One of my patients told me that I look like the character Flint Lockwood from Cloudy With A Chance of Meatballs and another one thinks I look like the character Linguini from the movie Ratatouille, both of which I found very funny.  Apparently, I give off the nerdy guy vibe.

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Alicia’s Story: Repairing a Right-Sided Congenital Diaphragmatic Hernia

CHOC Surgical NICUAlicia was born at full term, beautiful with 10 fingers, 10 toes and a life-threatening defect buried inside her tiny chest.

She had a congenital diaphragmatic hernia (CDH), a condition where a hole in the diaphragm allows abdominal organs to move into the chest. And this case was especially serious.

Though less common, hernias on the body’s right side are more dangerous because the liver, a larger organ, can move into the chest cavity, impairing lung development, impeding blood vessel functionality and ultimately causing pulmonary hypertension, says Dr. Mustafa Kabeer, Alicia’s surgeon at CHOC Children’s.

Just 20 percent of CDH cases are right-sided, and about 40-50 percent of babies nationwide survive their treatment; conversely, more common left-sided hernias yield about an 80-90 percent survival rate, Dr. Kabeer says.

Prenatal meetings remain key

After the diagnosis, Alicia’s mother Marlen began meeting with Dr. Kabeer and other specialists to prepare for her baby’s birth and treatment afterward.

“It helped because we had the prenatal meeting,” Dr. Kabeer says. “That way, parents can connect a face to a particular job in the care of their baby. They are educated and know what to expect during treatment.”

Just hours after her birth, Alicia’s condition began dramatically deteriorating. A transfer to CHOC was necessary, and Marlen and her husband were warned that Alicia would not likely survive the 2-mile ambulance ride.

But she made it, and quickly began treatment under a life-saving device called extracorporeal membrane oxygenation (ECMO) to help her compromised lungs. First pioneered at CHOC about 40 years ago, ECMO is a heart and lung bypass machine that can be used to rest a failing heart or lungs, providing complete support until the organs recover.

About a week later, Dr. Kabeer performed the procedure to repair the diaphragmatic hernia, all while Alicia remained on ECMO with substantially high risks of uncontrollable bleeding due to the blood thinners needed while on the treatment.

Alicia sailed through the surgery with little bleeding, but within the next day or so, Dr. Kabeer needed to perform two separate procedures to relieve pressure building inside her abdomen that compromised blood flow to the lower half of her body.

Two weeks old and five surgeries

Shortly after this surgery, Alicia began to bleed. During the next four days, she had ongoing bleeding and during the fourth day, lost about 1,500 mL of blood, or about six times her normal blood volume. Hospital staff kept her stable, and Alicia was taken off of ECMO. Two days later, Dr. Kabeer performed a final surgery to close her abdomen, which had been left open all of this time to decrease pressure.

“All of those surgeries were very high-risk surgeries,” Marlen says. “There was a very high chance she wouldn’t make it, but she did perfectly.”

Throughout the entire process, Dr. Kabeer communicated with Marlen and Omar about the risks of the surgeries. And like every other time Alicia’s parents were cautioned about her survival, the tiny infant fought back.

Baby Alicia today.
Baby Alicia a few months after her surgeries.

“Even though it’s a difficult subject, and a complicated, emotional and anxiety-provoking issue, we want parents to understand the problem their child is facing and that we’re trying to help them and their baby overcome it,” Dr. Kabeer says. “That connection and rapport are very important and it all stems from honesty.”

“It involved a very transparent discussion,” Dr. Kabeer said. “I laid out for them all of the issues and all of my concerns, and made them see that we’re going to do our best and face these challenges together. I want to give parents reassurance and security to know that not only are they in a good place, but they’re with staff who are well trained.”

Coordinated care in the Surgical NICU

Between her five surgeries and afterward, Alicia was closely monitored inside CHOC’s Surgical Neonatal Intensive Care Unit, a special part of the hospital’s main NICU dedicated to the care of babies who need surgery.

In the unit, the team cares for patients jointly, discussing the cases of children like Alicia as a group and forming a treatment plan that often calls for the expertise of other specialties at CHOC.

After several months in the Surgical NICU, Alicia went home with her family. Today, she is a happy, charismatic four-year-old.

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Today, Alicia is a thriving four-year-old.

“Alicia’s case reinforces the fact that babies are extremely resilient,” Dr. Kabeer says. “It’s amazing that she tolerated all of this. Every patient is unique and this is a perfect example of why we should give them every chance possible.”

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