A Day in the Many Lives of Phoenix Children’s Hospital – Part II

Last week we introduced our readers to a half day in one of the busiest children’s hospitals in the United States—Phoenix Children’s Hospital (PCH).

In a typical day, 1,090 children pass through these doors to see a doctor, 46 will have surgery, 36 will be admitted to the hospital and 236 will come to the emergency room.

During our visit we followed a handful of the 4,688 people that make Phoenix Children’s so special.

Pediatrics is different from practices which deal primarily with chronic, degenerative diseases—like large joints (osteoarthritis) or spine (degenerative disc disease).

In pediatric orthopedics, doctors tackle injuries and diseases of the immature musculoskeletal system—an ever changing biologic system.

On the second half of the day, we saw how teenagers interact with their physicians and, in a particularly heartwarming experience, we got to know Colton Dunton, a 21-year-old patient who had a five-hour surgery while we were with him and his doctor.

So, welcome to the second half of our day at Phoenix Children’s Hospital.

Teenagers

The teenage years are a march to autonomy. Teens, unlike younger children, have developed the ability to work through complex problems and are very aware of how others perceive them.

For the physicians at Phoenix Children’s Hospital that means that, as Dr. Eric Bowman explained to OTW, “With teens, you’ve got to earn their trust. Building a rapport is really important.”

We met Dr. Bowman in the examining room as he was talking with Angela, age 13 years. She’d broken her wrist and recently had her cast removed. Dr. Bowman was looking at his handiwork when we walked in.

Dr. Bowman has been at Phoenix Children’s for a year and a half. He went to medical school at Ohio University and did his residence at Children’s National hospital in Washington, DC.

Having played sports in high school—golf, soccer, basketball, track and baseball—it was probably pre-ordained that he would specialize in sports medicine.

Dr. Bowman’s bedside manner is so good. Even while he was explaining the dos and don’ts to Angela, he was fun and laid back. “Don’t do any crazy stuff, like cheerleader hand stands.”

“When a patient in comfortable, trusting, then they’ll listen to a recommendation.”

Angela’s wrist is healing well, as Dr. Bowman showed her mother.

“I really enjoy PCH”, Dr. Bowman told us, “The sports medicine department has such a nice atmosphere. And Phoenix is great. There are so many active kids. We see a lot of patients. Also, we have the motion lab, which gives us the opportunity to evaluate our patients in new, state of the art ways.”

Micaela “Kay Kay”, a 15-year-old patient of Dr. William Wood, was in a particularly bad ATV accident 2 months before our visit with her, her family and Dr. Wood. Kay Kay came to Phoenix Children’s by helicopter on the day of her accident.

She endured a number of injuries including severe open ankle fractures and open femur fractures.

Kay Kay has had several surgeries and a fair number of plates and screws are holding her bones together so they will heal correctly. She’s also been to Phoenix Children’s plastic surgery unit to reconstruct her soft tissues.

The first thing we noticed about Dr. Wood was his lanyard—it has all the characters from the movie “Frozen” on it.

“Pediatrics is all about making our young patients comfortable. I try to be friendly and engaging. A good bedside manner goes a long way. So I like to wear bright colored shirts and, yes, my “Frozen” lanyard,” he said with a chuckle.

Dr. Wood came to PCH from the Hospital for Sick Children in Toronto. He went to medical school at the University of Illinois and did his residency at Banner Health in Arizona.

Micaela’s dad and sister joined her for her update appointment with Dr. Wood.

In the examining room Dr. Wood did a lot of listening. “I try to understand the family’s point of view, what’s on their mind. It’s often different or more nuanced than the patient’s.”

Kay Kay and Dr. Wood had a great rapport. She asked him when she could go back to driving. He told her that it was a little early but that she was making very good progress so it wouldn’t be much longer.

After Kay Kay, her dad and sister left, it was back to the “office” where he charted the visit, communicated with the plastic surgery team and made sure Phoenix Children’s resources were marshaled to get Kay Kay back to her pre-accident life.

Spinal deformity surgery, can make any parent anxious. Emily Mackowski who had surgery to correct an abnormal curvature of her spine—otherwise known as idiopathic scoliosis—was back with her parents to visit Dr. Gregory White—her surgeon.

Idiopathic scoliosis is the most common type of spinal deformity and usually occurs in late childhood or adolescence and more often in females than males. Instead of growing straight, a scoliotic spine develops a side-to-side curvature, usually in an elongated “S” or “C” shape.

Correcting that curvature is big surgery.

So Emily’s parents were waiting to hear Dr. White’s assessment of Emily’s progress.

Dr. White invited Emily’s mom to come up on the table with him as they, together, looked at Emily’s scar.

One thing she was worried about was the inflammation at the tail end of the sutures. As Dr. White explained, that’s very normal. In fact Emily was healing well. The dark color over the suture line was the remains of the surgical glue he used over the sutures to provide a water tight seal—a good thing in the shower!

Dr. White is the Division Chief of Orthopedics at Phoenix Children’s. He earned his undergraduate degree from the University of Arizona, did his residency at Vanderbilt and Rady Children’s Hospital at the University of California, San Diego. Dr. White is coming up on his 20th anniversary at PCH.

In the examining room Dr. White was a calm, confident presence and by the end of the exam, Emily’s mom and dad were feeling almost as good as Emily.

“With families I start pre-operatively, two weeks before surgery, letting them know what to expect, taking them on a tour, show them where everything will happen. Typically, one of our former patients will meet with them too.” Explained Dr. White, “It takes some of the apprehension out of it.”

In the examining room, Dr. White showed everyone Emily’s before and after X-rays. Emily’s dad, especially, was impressed. What a dramatic change. Today, Emily’s spine is as straight it should be. A beautiful picture all around.

Young Adults

Our final patient of the day is 21-year-old Colton Dunton, one of six boys and a huge Toby Keith fan. Colton, who was born with GMFCS level 5 function cerebral palsy (CP), has spastic quadriplegia and is a wheelchair ambulator, will be having surgery soon.

Jim, Colton’s dad is standing by his bed. Christine, his mom, is there too.

Cerebral palsy is a blanket term which describes many types of effects from a non-progressive neurological pre-natal brain injury. About 8,000 infants are diagnosed with CP annually and about 500,000 people live with it in the United States. Every CP patient is unique.

Colton is not a stranger to surgery. Two years earlier he’d had spine surgery. Today, however, he is back to have Dr. Belthur correct one of the side effects of Colton’s CP—overly short hip muscles which could lead to hip dislocation.

Dr. Belthur was going to perform a surgery to keep Colton’s hips in their socket.

Dr. Belthur, who we met earlier in the day with little two-month-old Daniel Zarota, was now about to operate on both hips for tall, lanky, 21-year-old Colton.

His team was preparing when we entered the OR.

Before beginning Dr. Belthur, who stood over Colton on the table, called a “time out.” “I called a time out,” he said “to run through the check list for the surgery. The whole team listens and we ask for two patient identifiers and we describe the operation we are about to perform.”

They will be doing a varus derotational osteotomy on both of Colton’s hips. The surgery will be a 4- to 5-hour operation.

After time out, the team swings into action. As we saw earlier, Dr. Belthur conducts his operating room like a master.

Everyone is in constant, but focused and coordinated motion. Little conversation, lots of concentrated work. It reminds us of a ballet or an orchestra. Only thing missing is the music. Which, for Colton, frankly, can be nothing other than “Should’ve Been a Cowboy”.

Dr. Belthur’s Fellow in this surgery was Dr. Mohammed Waseemuddin.

Varus derotational osteotomy of the femur is a common type of surgery for patients with more severe forms of CP and is not a risky type of surgery.

Its purpose is to correct a deformity of the hip where the angle between the head and neck of the femur and its shaft is greater than is healthy for the patient—usually above 135 degrees.

That causes an inward twisting of the thigh bone (femoral anteversion) and, eventually, hip dislocations.

Dr. Belthur and his team are going to put Colton’s hip back in its socket and shorten his bone to match his shortened muscles.

The first incisions were made along the outside of both hips and were several inches long. They went on to cut the thighbone (femur) and repositioned Colton’s hip ball into the socket.

Drs. Belthur and Waseemuddin added plates and screws to hold the bones together. The plates, which are implanted will not be visible.

When Drs. Belthur and Waseemuddin closed, they did so with sutures below the skin (Colton, therefore, will not need to have the stitches removed) and everything was sealed using skin glue (DERMABOND from Johnson & Johnson) which helps reduce the risk of infection and allows the wounds to be cleaned regularly.

Colton’s mom, Christine, was waiting for him when his surgery was done.

The Dunton family, we could tell when we met them are really special. In the recovery room, Christine was a constant, nurturing presence. On one hand being a family with a child with CP is like any family. The basics are as important as ever. But it is also unlike other families because a CP child is also a special needs child—needs that continue into adulthood.

We could not help but bond with Colton, Tom and Christine when we saw how much love was in that room.

All in all, seeing Colton, his family and Dr. Waseemuddin was a fitting way to end our visit at Phoenix Children’s Hospital.