Six-year-old Alice lies half reclined on the stretcher struggling against asthma to breathe. Her alveolar sacs are paralyzed and her lungs feel stuffed with cotton. She is slowly suffocating. A plastic mask supplies her with oxygen and medication. When she opens her eyes, she can look straight out the front windows of an Agusta A 109/Mark II helicopter as it speeds east through the night across Puget Sound. Assistant Chief Flight Nurse Sherri Kruzner-Rowe – Sherri K-Rowe to her colleagues – sits at Alice’s left shoulder monitoring her labored respiration, her heart rate, her blood pressure, and her blood oxygenation. Flight Nurse Cincy Katz’s flight station is on Alice’s right, facing aft. To help Alice breathe, Katz injects additional aerosol into her mask, twenty times the dose of her home inhaler. Katz leans over to Alice and asks, “Can you breathe?” Alice’s wheezes OK.
The conversation has two practical purposes; it helps console her and it tells the nurses something about Alice’s condition. Even though both nurses each wear protective helmets and Alice herself sports large, soft hearing protectors, the close confines of the air ambulance and the soft words help relax her as she fights for air. Alice’s parents rushed her to Olympic Medical Center in Port Angeles with a severe asthma attack and when her she failed to improve, her physicians ordered that she be transported as quickly as possible to Seattle Children’s Hospital. “As quickly as possible” meant a helicopter from Airlift Northwest.
“Can you see the lights out front?” Katz asks. “That’s Seattle. We’ll be at the hospital soon.” This time, Alice does not answer. The nurse repeats the question. No response. Alice is still breathing, but now that she cannot talk, her case has attained a new urgency. The nurses quickly replace the light mask with an air bag and mask that seals around Alice’s mouth and breathes for her. Nurse Kruzner-Rowe keys her microphone and instructs the pilot to fly directly to the hospital.
Pilot Steve Lodwig radios Airlift Northwest dispatch with the change in destination. Lodwig sits next to Alice’s feet in a cabin smaller than most compact automobiles. The twenty-four-minute run from Port Angeles at 150 knots is familiar enough that Lodwig almost does not need the Global Positioning Satellite System moving-map display that guides him along the Straits of Juan de Fuca and across Puget Sound directly to the helipad designator at Seattle Children’s. He flies at a comfortable 3,000 feet, high enough to see landmarks and navigate, but beneath the flight path of busy Sea-Tac Airport. Even if Lodwig had not grown up in Seattle, the black void of Green Lake and the twinkling lights of the street grid offer a map that any tourist can follow. Passing Green Lake, Lodwig counts one thousand one, one thousand two, and banks right over the bright ribbon of Interstate 5. With the wind from the south, Lodwig will effect an approach to Children’s from the north. He banks again left at Northeast 50th Street on a strictly prescribed path to minimize disruption by the helicopter’s noise. On the new course, he spots the brightly-lit Children’s complex in Laurelhurst.
Most flights, Lodwig lands at Graves Field in the midst of the University of Washington athletic complex on top of an old garbage dump on the shore of Union Bay. The patient then transfers out of the helicopter and into a regular ambulance to be driven the last mile and a half to Children’s. But Alice’s condition is too delicate to expose her to a second ambulance ride through Seattle traffic, seven stop lights, and ten more minutes away from the emergency room. Kruzner-Rowe will be required to justify to a committee her decision to land at the hospital, but tonight, Alice’s life comes first.
On receiving the message from Lodwig, the dispatcher at Airlift Northwest hits the auto dialer on his phone to alert Children’s. Pagers on the belts of security personnel at the hospital sound off and men and women hurry into the rain along Penny Drive with flashlights and prepare to stop traffic.
Pilot Lodwig pushes the collective in his left hand down slightly and begins his descent. The Agusta’s on-board computer automatically reduces the fuel flow to the twin Rolls Royce turbines and the altimeter winds down through 2,000 then 1,000 feet. As the helicopter drops through 120 knots, the landing gear automatically extend, further slowing forward progress. Ground personnel turn on the landing lights and secure the pad’s fences. Lodwig now can clearly see the two illuminated wind socks and the rotating amber beacon at the Laurelhurst helipad. The Vietnam veteran eases the collective down and at 18 knots, the helicopter shudders through an aeronautical phenomenon called effective translation lift. The wheels settle onto the helipad and take the weight of the aircraft. Lodwig moves the throttle from “Flight” to “Idle.” Because Alice is fighting for air, Lodwig applies the rotor brake so as not to have to wait the two minutes for the blades to stop swinging.
A team from the emergency room rushes through the rain to the left side of the red-and-white helicopter as the flight nurses hoist Alice up and out onto the gurney. Royal blue flight suits glow brilliantly under the intense landing lights. Alice still clutches the stuffed toy the flight nurses had given her just before takeoff. In seconds, Alice’s gurney surrounded by blue scrubs and blue flight suits is through the triple pneumatic doors to the Children’s emergency department. In the resuscitation room, the flight nurses continue working the air bag until the attending physician takes over. In the space of half an hour, Alice has completed a journey that will take her parents four hours by car and once took days.
The resuscitation room in the ER is designed for efficiency and not aesthetics. The walls are crowded with steel shelves and red enameled drawers packed with tools for saving young lives; more like a super-clean garage than a facility to offer solace and care. Large glass-front cabinets that look like vending machines with a key pad hold critical supplies. By pressing in a code, a nurse can access drugs and other life giving miracles. The cabinet’s computer automatically notifies central supply to replenish the used items.
Bandages, syringes, drugs, splints, respirators, intravenous needles, tubes and solutions, probes, forceps, rubber gloves, and all manner of devices to measure temperature, blood pressure and breathing, and computer screens and electronic readouts compete for space and overwhelm the casual observer. The business of emergency medicine may be all business with little concern and less room for entertainment, but Beenie Babies and Care Bears perch on top of computer monitors and at the edges of shelves, a reminder that these are children’s lives being saved here. The little furry friends peek around corners to comfort the new arrivals.
And there is light, lots and lots of light. Overhead fluorescents, lights on flexible arms, lights to be held, and lights for forehead-mounted magnifiers. The only compromises for comfort are privacy curtains and a simple chair and foot stool to allow a parent to hold and rock a desperately-ill infant. There is still enough space for a DVD player and television set to help ease the anxieties of patients and families.
Passing down the hallway through the ER, the visitor enters the rest of the hospital. More pneumatic doors allow a gurney or wheelchair to pass without delay. Down the hall to the right are the two Intensive Care Units. In the Neonatal ICU, the bright hospital lights give way to a more subdued atmosphere, dimmer, calmer. In the ECMO area, nurses, two at a time, all the time, hover over premature babies whose undeveloped lungs need the help of the Extracorporeal Membrane Oxygenation machines. The ECMO breathes for the baby until she can take in air on her own. Once distinguished by their immaculate white uniforms, distinctive starched caps, and sensible white shoes, modern nurses stand out with gaily patterned smocks and bright slacks or simple blue scrubs.
Almost as crowded with monitoring equipment, the Infant ICU makes a little more accommodation for parents with a sleeping chair so that the infant can enjoy the touch and soft words of Mom and Dad. For an infant, or any child, the trauma of hospital care can slow recovery and loving parents are included in the treatment plan. A simple rocking chair, worn from years of loving use, sits to the side.
In another room, A volunteer “Auntie” rocks a baby girl with more tubes in her tiny body than the sunrises since her birth. Human contact and soft words are as critical to her survival as the medicines. A hand-lettered card is taped to the crib and reads, “Amy, Trust in God.”
Up one flight of stairs is an area specially designed with sleeping rooms, showers, sitting areas, laundry facilities, telephones, and even Internet access. Exhausted parents with blue-and-white stick-on name tags wait and try to rest, and try to share with each other the progress of their little ones downstairs.
Out through the big swinging doors into the public areas, elaborate murals and oversize plastic figures greet patients and visitors. Small children look up amazed at the images and some are hoisted on shoulders so that they can touch the animals and faces which smile from brightly colored locomotives and rocket ships. Great blue and green fish tanks catch little eyes and fascinate growing brains. The vast and confusing hospital is designated not with impersonally lettered wings, but into sectors marked by whales, giraffes, airplanes, rockets, and trains. Parents push hairless children in wheelchairs and teenagers pull intravenous stands that dangle life-giving solutions, but everywhere the visitor sees life and color and caring. Only so much assurance can be offered to a haggard family awaiting the results of a risky surgery or to a child facing months and years of painful rehabilitation, but the happy murals and bright figures help. Two clowns in white makeup, one with a guitar slung across his back, make their way into another unit to tell a joke, sing a song, and bring some cheer.
Visiting families with gifts and balloons make their way to patient rooms, and children, patients and guests, enjoy the toys and games in the public play areas. Blue-coated volunteers distribute gifts, cards and toys, offer companionship, and pitch in to give weary parents a break in supervision of young brothers and sisters. Social workers with their portfolios full of answers offer solutions to the greatest crises in these families lives.
Over in Rehab, patient rooms resemble the bedrooms of all kids with books, clothing, and posters in seeming disorder, but rationally placed in the mind of the adolescent occupants. Rehab patients tend to stay the longest at Children’s while medical staff and therapists seek to repair and rebuild damaged spines and legs. The patients are encouraged to make themselves as much at home as possible, and home can look disorganized to a visitor. Special video game consoles allow a patient to play from bed both for entertainment and for therapy. A Teen Room provides space for older patients to gather and play arcade games, listen to music, and just hang. Some evenings, when things calm down, an old man with white hair stops in to see the patients. He is there as much to learn from their courage as to bring them friendship.
Earlier in the day, the outpatient clinics upstairs bustled with families and staff making their way to appointments. Strollers disguised as brightly colored kiddie cars help take young attentions away from what must be a mystifying and even frightening experience.
In any direction, the visitor sees the mission of Seattle Children’s being delivered with love and with respect, but perhaps unaware that outside and across the community, the state, and the region a complex and comprehensive system of support makes it all possible. As Alice down in the ER gets the help she needs to breathe and to stay alive, she knows nothing of what makes it all possible. She and the other children are fortunate that their parents and neighbors can give them the care that they need, fortunate that their community can boast one of the finest pediatric medical centers in the nation, and fortunate that conditions like infantile paralysis, diphtheria, osteomyelitis,, and tuberculosis that crippled and killed children a generation or two before are now little more than historical trivia.
On another rainy night in 1898, in a fine home with a sweeping view of Seattle, six-year-old Willis Clise was not so lucky.
[Willis died. Nine years later, his mother helped found Children’s Orthopedic Hospital]