"Do you hear the children weeping, O my brothers,
Ere the sorrow comes with years?"
The Cry of the Children Elizabeth Barrett Browning (1806-1861)
Arriving to work at a large children's hospital was a totally different experience, everything being child-sized and child-centered. Everything was about children and adolescents! The patients ranged from premature newborns to adolescents, presenting the whole range of ailments and disabilities. The first thing you learn is that a child is not a small adult but a developing and growing human being, hopefully cherished by loving parents, and testing the waters of life and growing into a competent and independent individual. Were that always true. This was to be my "work" for the remainder of my life, whether it was in healing them, listening to them, and, to this day, advocating for them as a trustful partner with parents and families.
I ask you to forgive the seriousness and clinical character of this post but what follows are experiences that were formative for my professional life.
The name "Akron" comes from the Greek, meaning summit or highest point. Located in Summit County, it was in the northeast corner of the state of Ohio, far from the southwest corner of my ancestors down in Cincinnati. It was expected you'd be a Buckeye fan; that is, a supporter of Ohio State athletic teams. However, we had the University of Akron whose teams were known as the Zips, often indicative of their football scores!
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| Akron, Ohio |
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| Akron Children's Hospital Medical Center as it looks today |
Akron Children's Hospital (later to become Akron Children's Medical Center) had its beginnings as a day nursery in 1890 and has steadily grown to be the largest pediatric health care provider in northeast Ohio including it being the pediatric center of Northeast Ohio Medical University. It is presently ranked in the top 50 children's hospital for six specialties. Most of my fellow residents came from medical schools throughout the midwest. Having received a year's credit for my internship, I started as a Junior Resident. Above me were Senior Residents and several Chief Residents. One of my "seniors" was Ralph Wynn who had been a year ahead of me back at St. Joseph's so it was nice to know someone. What was so great about the program was that it was geared at the time to producing well-rounded general pediatricians, although some of my colleagues decided to go into sub-specialties depending on their interests. Ralph, even as a resident was instrumental in starting the hospital's helicopter transport service, and later went on to start the regional newborn transport service in the Greater Buffalo, NY region. My first helicopter transport was with him, as the Ohio Air National Guard would fly us around northeastern Ohio in old surplus Medivacs from the war. We had no radar and had to keep an eye out for small planes wherever we flew. At night, we would often land in a school's playground (in lieu of a heliport) where the townspeople would drive out to the area and light up a circular landing spot for us. While neonatal transport has gotten much more sophisticated, back then, it was difficult hearing a little preemie's heartbeat and breath sound above the roar of the rotors.
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| This is the class of helicopter we flew around Northeast Ohio picking up sick children |
The program offered me the opportunity to experience all sorts of interventions throughout the whole gamut of Pediatrics. We didn't have hospitalists back then...we WERE the hospitalists, often making decisions that, perhaps, we were not ready to make. It was often learning under fire whether under the watchful eye of an attending physician or one of my resident "elders". The mid-70's was a nascent period in our specialty. Many of the vaccines we have today were not yet invented and I had the sad experience of seeing children either die or suffer through diseases that are no longer around. A child with a raging fever often was presumed to have the worst case scenario unless proven otherwise, leading me to become a quick expert in phlebotomy (blood draws) and lumbar punctures (spinal taps). In the neonatal intensive care, it was not unusual to do an exchange transfusion on an infant for Rh incompatibility or polycycthemia. Placing an umbilical artery catheter on premature infants was common as was intubation.
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| Lumbar puncture |
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| Umbilical artery placement |
Being in Ohio, we seemed to be the epicenter for Reyes Syndrome, that mysterious disease involving inflammation of the brain and fatty infiltration of the liver. At first we didn't have a clue what was causing it but we certainly saw a lot of it, often resulting in the worst outcomes. Some bright mind somewhere figured that it had to do with the combination of household aspirin and either influenza or chicken pox. The disease is all but gone now and, if you were to buy a bottle of aspirin at your local pharmacy, you will see the appropriate warning.
Like Reyes Disease, the other entity that struck terror in my heart was infection from Hemophilus Influenzae (a bacteria which has nothing to do with influenza). This could present as meningitis, septic joints, cellulitis, and the worst, epiglottis, often resulting in death. This, too, is another disease that has all but been eradicated, thanks to the Hib vaccine routinely given to children and, incidentally, invented by my first Chairman of Pediatrics here in Rochester, the late, David Smith.
At this point, I'll add a funny anecdote here. My first week as a new (and inexperienced) Attending Physician at Strong Memorial Hospital, I was assigned to be a "rounder" on the wards. One evening on the Adolescent Unit , I saw this young "intern" wearing blue jeans and a flannel shirt, sporting long hair. If I recall it correctly, I asked him to get me the lab results on a patient. He looked at me quizzically as I suddenly realized that he was not a house staff member but our Chairman, David Smith himself! What a start for me! He looked like all the rest of the house staff with his mustache, long hair, and casual dress. I must have been on his "list" for the duration of his chairmanship.
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| Dr. David Smith |
There is a form of childhood leukemia, Acute Lymphoblastic Leukemia (ALL) that we saw a considerable amount of. This, too, often resulted in death but, at that time, protocols were being established by major pediatric centers around the country working on a cure. We started following those protocols and started to have good luck. Today, most of it is curable with a 90% cure rate. My heart went out to the kids with cancer as we worked closely with them. I think it hurt me as much as them to do a bone marrow biopsy on them, or monitoring them as they received their chemotherapy.
My training gave me wonderful preparation for my career but there was one thing I've never gotten used to...child abuse and neglect and their resultant injuries and deaths. It was difficult holding myself back from the perpetrators and required self-control. The sight of seeing a little boy in the emergency room who had been beaten to death has never left me. After having seen severely abused children and becoming knowledgeable about diagnosing it, my experiences sent me on a journey advocating for its prevention throughout my career. Only a few months ago, I addressed our County Legislature, asking for more funding for child protective workers. It's a never-ending battle.
I remember having a guest lecturer at Akron Children's Hospital on child abuse come from Harvard University and I instantly recognized his name as I used to play in the same band with him way back at Mt. Vernon Summer Band School when I was kid. I played the French Horn for many years and Eli Newburger was and still is, a wonderful tuba player, having started our high school's dixieland band that actually appeared on the Ted Mack Amateur Hour. He still is doing gigs all around western Massachusetts as well as advocating for children as a national authority on child abuse. While it was a nice reunion, his lecture was seminal to my education. Much like Sir John Eccles lecture on brain development back in Belgium, this lecture on child abuse has also stuck with me.
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| Eli Newburger |
Being a resident in a children's hospital was not all "sturm und drang". There were many fun moments, particularly seeing sick children smile. One day, as I was walking down one of the hospital floors, there was a hubbub down at the end of the hall and as I approached, I saw a masked man wearing cowboy boots, chaps, and a Stetson. There was no William Tell Overture by Rossini, but, this was the REAL LONE RANGER, the one and only Clayton Moore who had paid a visit to cheer up the kids. I shook his gloved hand as I relived many Saturday mornings in front of a black and white TV. Tonto was nowhere to be found but I think I got as much of a thrill out of it as did the kids! He stayed in character and I never got to see him unmasked.
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| The Lone Ranger (Clayton Moore) and Trigger...he thrilled the sick kids! |
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| A typical Amish child's cross stitch |
I promise the next post will be brighter!
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