CHOC Resident Follows in His Father’s Footsteps

Growing up, Tim Hicks fondly remembers seeing his dad come home from work with a smile. Despite his demanding job as physician, his dad, David, always remained positive and shared countless rewarding stories that he witnessed at the hospital.

It was that unwavering dedication that inspired Tim, now a second-year pediatric resident at CHOC Children’s and UC Irvine, to pursue a career in medicine.

“Seeing how happy my dad has been, I wanted to be part of that,” he says.

As long as he can remember, Tim was interested in medicine. He was a curious child and enjoyed science and studying about the human body.

Similarly, his dad, Dr. David Hicks, a pulmonologist and neonatologist at CHOC for more than 40 years, had always been interested in medicine as well. David wanted to become a veterinarian initially, like his father, but eventually went to medical school.

During his long and successful tenure at CHOC, David has enjoyed seeing the hospital’s growth and working alongside such a compassionate and dedicated team.

“What’s most inspiring at CHOC is the desire of our nurses and doctors to treat their patients as if they were their own. That, and when I see the smiles on the parents’ faces when their kids get better, is what inspires me to continue to do this,” says the 74-year-old physician.

It’s that same drive that motivates Tim to follow in his dad’s footsteps. His goal is to become a pediatrician, and he is also exploring a possible subspecialty.

“I really enjoy treating and hanging out with kids. They manage to smile even in a very difficult time. Their light-heartedness and innocent outlook is refreshing in many ways,” Tim says.

Tim’s relationship with CHOC goes back even further, however. His dad recalls the time when Tim, a teen then, was admitted to CHOC to be treated for a splenic fracture.

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Dr. Hicks with his son Tim at his white coat ceremony, where residents receive their white coats for the first time.

“Little did we know then that he would be back as a pediatric resident one day,” David says. “It was a few scary days in the PICU. Moments like that teach you that life is precious and things can change very quickly.”

Today, as a resident at CHOC, Tim enjoys meeting colleagues who have worked with his dad. He’s even had the privilege of meeting some of his dad’s former patients.

“We’ve definitely had fun, interesting conversations at the dinner table,” Tim says. “He’s given me great advice and taught me to treat the patient as a person; that it’s important to take care of their unique, individual needs with care and compassion.”

Tim also appreciates his dad’s outlook on the importance of a work-life balance, something he witnessed first-hand growing up. Despite his busy schedule, David always made time for things like attending his kids’ sports games, Tim remembers.

“I’ve always told my kids to find what they really love and follow that path,” David says. “And that family is very important. I owe everything to my wife, Gayle, who has taken on 50 percent of the battle, always supporting me and raising our four wonderful children.”

As Father’s Day nears, Tim – or “Hicks 2.0,” as he jokingly refers to himself – couldn’t be prouder to follow his dad’s path.

“My dad is an incredible role model and friend. I’m not only thankful for his guidance in life but also in medicine,” he says.

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Microcephaly and Encephalocele: Michelle’s Story

By Allyson Duran, mother of CHOC patient Michelle

When I was 21 weeks pregnant with our little girl, my fiancé and I received devastating news. Michelle’s head was not measuring large enough for how far along I was in my pregnancy. We were scared and didn’t know what this would mean for our little girl. My OB-GYN referred us to a high-risk maternal-fetal specialist, where we received a shocking diagnosis: our baby had microcephaly, a rare condition where a child’s brain does not fully develop, resulting in an abnormally small head size. They also diagnosed her with another condition called encephalocele, where brain tissue protrudes out to the skin from an abnormal opening in the skull. Although very rare – only 340 babies in the U.S. are born with this each year- this is one of the most common neural tube defects, a birth defect involving incomplete development of the brain and spinal cord.

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During the rest of my pregnancy it was a little emotional because we didn’t know if Michelle would survive the pregnancy or even worse, pass away shortly after birth. We didn’t know if she would come out breathing or what to expect. I had ultrasounds every week to monitor the growth of the encephalocele. When I was six months pregnant, my high-risk OB-GYN sent me to meet with Dr. Michael Muhonen, a pediatric neurosurgeon at CHOC. I didn’t know what to expect, but I couldn’t handle any more bad news. He told me the mass growing outside of her brain could either be tissue or fluid, but they wouldn’t be able to tell for sure until after she was born.

He told us that the prenatal ultrasounds showed a giant encephalocele with severe concerning brain anomalies. I was terrified about what was going to happen to my baby, but I felt reassured that she would be in good hands.

Michelle was born October 10, 2016 at 10:34 a.m. at University of California, Irvine. She thankfully came out breathing on her own, and my fiancé and I were an emotional wreck. I couldn’t hold her or kiss her right away because she was whisked away to the neonatal intensive care unit (NICU). Four long hours later, I was finally able to see her and give her a kiss, but I couldn’t hold her yet.

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Dr. Muhonen came to UCI to see Michelle and review her MRI so they could get a better idea of what was inside her encephalocele. While we waited for the results in the NICU, Michelle stopped breathing right in front of our eyes. The NICU nurses rushed to her aide and resuscitated her. She started breathing again on her own, but I can’t begin to describe how scary those two minutes were. My heart broke and fell into my stomach. At two days old, her condition was declining, but I knew in my heart that she was going to be ok.

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After that, a nurse approached us and handed us a little sack and said, “Someone who heard about your situation wanted to give this to you and remain anonymous.” As we opened the little sack we pulled out a key that said HOPE on it. I broke down in happy tears.

Michelle’s MRI results came back literally seconds later. Dr. Muhonen said that he had never seen an encephalocele this big before, but that it was mostly made up of brain fluid, and he was confident that he could successfully operate on her. Later that day, Michelle was transferred via ambulance to CHOC, where she would be prepped for surgery.

The next day, we put our three-day-old baby in the hands of Dr. Muhonen and prayed that her surgery would go well. Three hours later, he came out of the operating room to where we had been anxiously waiting in the lobby, and told us that the surgery gone well.

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“We were able to successfully put the exposed brain back into the skull and remove the outer sac of the encephalocele. The post-operative results were superb, and Michelle had no difficulties with the complicated surgery,” Dr. Muhonen told us.

Michelle stayed at CHOC in the NICU for three weeks to recover and get strong enough to finally go home. During that time, my fiancé and I stayed just down the street at Ronald McDonald House. When our baby was hospitalized, we were grateful to have an incredible team of nurses caring for her. This was my first baby and I had never been through anything like this before, and Michelle’s nurses were very patient with me and explained everything. They taught me things like how to feed her. They spent so much time with her and knew tiny little nuances about her. They were there to help and support not only their patient, but her parents as well.

Our favorite nurse, Maria, told me that one of her favorite parts of being a NICU nurse is empowering parents so that they can eventually play the role of their baby’s biggest advocate.

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Michelle’s favorite nurse, Maria, feeding her a bottle in the NICU.

For a while, we had weekly appointments with Dr. Muhonen to monitor the shunt (a device that relieves pressure on the brain) he implanted a few months after surgery. During surgery. Michelle was doing so well that our appointments were changed to once every three months!

Dr. Muhonen told us, “While Michelle is still growing, and has challenges ahead, I am optimistic that she will love and enjoy life, bring joy to her family, and will always be an inspiration to others.”

Today, Michelle is a happy baby. We are busy with physical therapy, occupational therapy, and infant stimulation appointments, but Michelle laughs and smiles all the time. She loves when people pretend to sneeze. She loves to jump. She is trying to walk, but she doesn’t like to crawl.

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Earlier this year, we participated in CHOC Walk in the Park in honor of our daughter, and to show our support for the wonderful neurosurgeon and all the other CHOC staff members who helped save her life! We are forever grateful and feel blessed for this wonderful hospital for keeping our family whole.

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Learn more about neurosurgery at CHOC

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The Power of Music Therapy: Darlyn’s Story

On a sunny day in the middle of spring, Darlyn was born at St. Joseph Hospital in Orange. She was immediately transferred across the street to the level IV neonatal intensive care unit at CHOC Children’s. As the spring turned to summer, and summer gave way to fall, the NICU remained Darlyn’s home as she battled with a myriad of health challenges.

Before she was born, prenatal ultrasounds showed that Darlyn had a congenital diaphragmatic hernia (CDH), a rare birth defect where a hole in her diaphragm allowed organs from the abdomen to move into the chest. After birth, she was diagnosed with bilateral CDH. Approximately one in every 2,500 babies born are diagnosed with CDH. Of those, only one percent have a bilateral CDH. Darlyn’s parents Mirian and Edgar understood the seriousness of this diagnosis and weren’t sure if their baby would survive the pregnancy, or pass away shortly after birth. In her first week of life, Darlyn underwent her first in a series of surgeries.

“For the first two or three weeks of her life, our main goal was survivorship,” recalls Edgar.

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Darlyn and her father Edgar in the NICU.

Darlyn also has underdeveloped lungs (a condition known as pulmonary hypoplasia), which makes it a struggle to breathe on her own. She lacks a fully formed esophagus, meaning she also can’t swallow or eat on her own either. During Mirian’s pregnancy there was a build-up of amniotic fluid due to Darlyn’s duodenal atresia (a blockage of her small intestine), so the baby was especially active and moved around constantly. The only thing that calmed her down was playing music ― everything from lullabies to classic rock did the trick. Knowing their baby loved music even before she was born, her parents gave her the middle name Melody.

“From day one she has been the melody of our lives,” Mirian says.

Darlyn and her mother in the NICU at CHOC Children's
Darlyn and her mother in the NICU at CHOC Children’s.

Music has continued to play a big role in the now seventh-month-old’s life. Daily music therapy sessions conducted in tandem with occupational therapy sessions have helped her make progress on clinical goals such as developing fine motor skills. Other goals she’s already accomplished include standing for longer periods of time, reaching for and grasping toys tightly, and visual tracking.

A music therapy session conducted in tandem with occupational therapy in the NICU.
A music therapy session conducted in tandem with occupational therapy in the NICU.

“Before starting music therapy, Darlyn wasn’t very active and she often lost oxygen very quickly,” Brie says. “This baby is a new baby since experiencing music therapy.”

Environmental music helps create a soothing space to teach patients to calm themselves in an over-stimulated environment, which can help them heal, even after they go home.

“From the outside, it may look simple, as if I am just serenading a baby in a soothing tone, but I’m working hand in hand with their developmental team to help them reach clinical milestones.”

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A music therapy session conducted in tandem with occupational therapy in the NICU.

Darlyn’s care team is vast. Her medical team at CHOC sees music therapy as a trusted partner in helping Darlyn achieve her clinical goals. Her support system includes: Dr. Irfan Ahmad, a neonatologist; Dr. Peter Yu, a pediatric general and thoracic surgeon; and pediatric specialists from gastroenterology pulmonology, cardiology, infectious disease, the NICU developmental team (made up of occupational, physical and speech therapists), and a dedicated team of NICU nurses.

“We love and appreciate our NICU nurses more than we can even put into words,” Mirian says. “Without them, this journey would be more difficult and more heartbreaking. They take care of Darlyn as if she was their own baby girl.”

Jamie, a NICU nurse, celebrates July 4th with Darlyn.
Jamie, a NICU nurse, celebrates July 4th with Darlyn.

“Music helps calm down infants,” says Dr. Ahmad. “During their fetal life, they are exposed to rhythmic sounds, such as their mother’s heartbeat. They get accustomed to these sounds, and after birth when they hear music with a similar rhythm, they like it. Older neonates become more interactive with rhythmic music, and they look forward to their sessions.”

Darlyn isn’t the only one who has been looking forward to her daily music therapy sessions― her mom does too. After each session, her developmental team calls Mirian to give a full report on her occupational therapy progress and disposition.

Her parent’s high level of engagement is deeply appreciated by her care team.

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Darlyn’s parents chose a Snow White theme for her first Halloween, which she celebrated in CHOC’s NICU.

“Darlyn’s parents are amazing. They ask good questions, and they trust us to take good care of their little girl. It would be hard to tackle this level of complexity without their trust,” says Dr. Yu. “We still have a long road ahead of us, and maybe more challenges too, but they are resilient, just like their daughter.”

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Darlyn’s parents have decorate her private room in the CHOC Children’s NICU to feel more like home.

A few months into her time in CHOC’s NICU, Darlyn moved into the brand new 36-room unit with all private rooms. Her family has loved having their own private space.

“In the old unit, it could get noisy and we didn’t feel like we had any privacy. Now, we get to decorate her room and make it feel more like a nursery,” says Mirian.

Darlyn's parents have decorate her private room in the CHOC Children's NICU to feel more like home.
Darlyn’s parents have decorate her private room in the CHOC Children’s NICU to feel more like home.

The family has displayed notes of encouragement from loved ones and her favorite nurses- including nurse Jamie, who taught Darlyn how to stick out her tongue. They’ve even hung up the outfit she’ll wear when she finally gets to go home.

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Darlyn’s parents have hung up the outfit she’ll wear when she finally gets to go home from the NICU.
Learn more about music therapy at CHOC

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My Journey to Becoming a NICU Nurse: April’s Story

By April Bell, registered nurse at CHOC Children’s and mother of CHOC NICU graduates Mikayla and Emma

I’ve been a nurse at CHOC for 15 years. I started working here as a nurse aide while I was in nursing school and after graduation, I entered the RN Residency program as a nurse in the medical/surgical unit. I learned a lot about time management and honed my nursing skills starting IVs, inserting feeding tubes and catheters, and giving medications. I enjoyed the time I spent on that unit, but after about five years I was looking for another challenge. The new pediatric intensive care unit (PICU) and new cardiovascular intensive care unit (CVICU) had just opened on the sixth floor, and I was considering a nurse fellowship in the PICU. However, before I could start that process, I found out I was pregnant with twins.

Not only twins, but very high-risk twins called monoamniotic-monochorionic, or “MoMo.” These types of twins share one amniotic sac and the risk is that their umbilical cords could become tangled and/or compressed. These rare twins have a 50 percent survival rate. I knew they would most likely be delivered early; my OB-GYN did not want to deliver past 32 weeks gestation. We ended up making it only to 28 weeks, as their cords were knotted together twice and wrapped around my daughter, Mikayla’s neck, twice.

Mikayla weighed only one pound, 13 ounces when she was born. Emma was two pounds, six ounces.

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April was a registered nurse in the medical/surgical unit at CHOC Children’s when her twins were born premature. Their family’s experience in the neonatal intensive care unit (NICU) inspired her to become a NICU nurse.

From the moment the twins were delivered, the neonatal intensive care unit (NICU) team that was in my delivery room made a huge impression on me including the neonatologist who was present at the delivery, Dr. Daryoush Bassiri. I met Dr. Bassiri the week before my twins were born, when I was admitted to St. Joseph Hospital, next door to CHOC. He told me what I could expect if they were born at 27, 28, 29, 30 weeks, etc. The nurses who were at the delivery were also very supportive and kept me informed about what the plan was for the babies.

Both of my daughters need to be intubated right after delivery, but the nurses made sure I could see them briefly before they left for the NICU. The next few days were quite a roller-coaster, starting when Emma became very sick. Because her lungs were not fully developed, she was placed on a ventilator to help her breathe. The pressure of the ventilator caused her lungs to collapse. She needed two chest tubes to resolve her collapsed lungs. Her lungs also developed pulmonary hypertension (a type of high blood pressure) and pulmonary interstitial emphysema (where air collects outside the normal air space). All of Emma’s lung problems are common conditions in premature babies, but it was still a very scary time. I wasn’t sure if she was going to make it. She was given nitric oxide, a medication to treat breathing problems in premature babies, and finally she started to slowly improve. She took a turn for the better, only to face another setback: she was diagnosed with a heart defect called patent ductus arteriosus (PDA). In some premature babies, the opening between the aorta and the pulmonary artery does not close, as it does in most children.

Her sister, Mikayla, although smaller, was doing much better. She only needed to be intubated for about a day and a half and was on bubble CPAP (continuous positive airway pressure), non-invasive ventilation support for newborns. Mikayla had the same PDA diagnosis as her sister, and received medication to close her PDA. Emma could not get the medication because the doctors were worried about her kidneys, after how sick she had been. So the doctors decided that a surgical repair know as PDA ligation was the way to go. Once again, we were worried about her. She had an excellent surgeon, Dr. Brian Palafox, who explained everything to me and Emma’s dad. Although he told us what possible complications could come from the surgery, everything went very smoothly.

The next few months were filled with more ups and downs, but nothing quite as scary as the first few days. After they mastered breathing on their own, working on feedings was another struggle. They had an amazing team of developmental therapists, lactation consultants and of course, their bedside nurses. I learned so much from everyone that took care of my twins. As a medical/surgical nurse, I had floated to the NICU before, but I had no idea what each preemie went through.

Emma spent 75 days and Mikayla spent 77 days in the NICU. Towards the end of my twins’ NICU stay, I realized that the NICU was where I wanted to be as a nurse. I spoke with one of the NICU managers and told her I was interested in transferring to the NICU. I was surprised to learn that they were, in fact, just starting a nurse fellowship program. When I started my NICU fellowship, I went with the RN Residents to a special NICU consortium taught by the NICU educator at the University of California Irvine. We were there with nurses from NICUs all over Southern California. I finished the NICU fellowship when my daughters were just about 1 year old. I feel like the classes really helped me understand so much more about the development of the neonate and how to care for them.

During the last seven years in the NICU, I have taken care of a variety of babies, from small micro-preemies to babies who have undergone surgery, and babies with heart defects. I helped open the CHOC Children’s NICU at St. Joseph Hospital. I have also had the privilege to care for babies in our Small Baby Unit.

After having two micro preemies of my own, I feel I can really relate to a lot of the parents. I have been on the other side of it and know how frustrating and worrisome it can feel.

I enjoy sharing my story with my patient’s families. I have seen firsthand how strong and resilient these babies can be.

I was working the night that we opened the new, all private room NICU. At the end of my night shift, I helped transfer my patients upstairs and get them settled into their new rooms. It was amazing to see how smoothly everything went that morning. It was also exciting to see the babies in their own rooms. My twins were always with other babies in a pod, and it would have been so nice to have a private room. I would’ve loved to have been able to stay overnight and sleep right next to my babies when they were in the NICU, like the parents can do now in our new NICU. It was hard to leave the NICU when my daughters were there. The noise in the pods could get loud at times, and occasionally a baby would be sick and need sterile procedures which meant all non-clinical staff had to leave the unit. The patients did not always have privacy. I am excited for the patients and families that will benefit from our new private room NICU.

Looking at my daughters today, you would never know what they have been through. They are almost 8 years old and they are just about to start second grade. They’re very smart and are excelling in school. They started reading in pre-kindergarten and have been reading at an advanced level ever since; they almost read better than their older brother, Joey. The only long-term effect from being born so premature and facing a mountain of health challenges has been with Emma, who has a raspy voice from left vocal cord paralysis, a common complication from the surgery. I am so grateful to have two healthy girls.

I am also very grateful for the way the CHOC NICU cared for my own children, and I am extremely proud to be part of it as a caregiver.

Take a virtual tour of our new NICU

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The Importance of Self-Care for NICU Parents

Having a hospitalized child can be scary and stressful for parents, especially when that child is a newborn. Between raising a family, working and coping with a hospitalized infant, self-care is often not the first thing that comes to mind for a parent.

In this episode of CHOC Radio, we speak with Karina  Ousley, a clinical social worker in CHOC’s  neonatal intensive care unit (NICU), Diana Hurtado, coordinator for the March of Dimes NICU Family Support program at CHOC, and Marla Dorsey, patient- and family-centered care coordinator, about the importance of NICU parents practicing self care.

CHOC Radio theme music by Pat Jacobs.

Learn what to expect when your baby is in the NICU

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