Heartbeats of Healing

A salute and celebration of people, process, and technology

by Steve Kayser, Editor - Expert Access

Better. Faster. Cheaper. (BFC)

BFC - the mantra of successful business. As well it should be, and needs to be.  But sometimes in pursuit of BFC, whether in the life of business or the business of life, you overlook, take for granted, or are blinded to wondrous achievements happening everywhere around you - achievements that not long ago would have been called miracles, or magic.

Suddenly, out of the blue

You come face-to-face with an unexpected life crisis. It happens to everyone, you (yes I’m talking to you, the reader) are not immune.

No one is.

Not now.

Not ever.

And, when it comes to your health, or a loved one’s health, you’re smacked down hard.  But, then something happens. A special moment in time. Something that force-face-feeds you to look … to see, not through life-hazed, better, faster, cheaper eyes … but really see.

Something wondrous. 

Something magical.

Miracles and miracle-makers in your midst.

Queasy easy? Stop here.

This is a true story. It’s graphic. Reality is rough. Truth is tough. So if you get queasy easy, stop here.

This story describes a complex melding of, and interplay between, some spectacular people, processes and technologies that combine to create a real-life, dynamic human organism. An organism that breathes, reacts, corrects, heals and cures. And, it’s powered by the

Heartbeats of Healing

At the end of this story you’re going to meet some real-life heroes, day-by-day miracle-makers.

Cincinnati Children’s Hospital

6 a.m. – A Friday in March

An 11-year-old little girl arrives with her parents. She looks scared.

She is.

She’s here for major spinal surgery. Two operations. Not one … two.

It’s been a long, but quick, road to this point - the pre-op room in Cincinnati’s Children’s Hospital.  She’d been diagnosed with severe scoliosis, a curvature of the spine, eight months ago. The disease had progressed rapidly. It had been hoped that corrective action could be put off until she was in her early teens.

But it couldn’t.

The little girl doesn’t want to be here. Anywhere but here. You can see it in the way her brilliant green eyes dart back and forth. Before she left her home in the morning, she’d locked herself in the room and wouldn’t come out. Then, after cajoling her out of the room, she bolted outside into the darkness of the morning. Tried to run away. Her father chased her down. Brought her back to the car screaming.

She sobbed the entire trip to the hospital.

What is scoliosis?

This thing “scoliosis” was a monster to her. Why was it chasing her? Why had it now caught her?

Scoliosis is the medical term for curvature of the spine. Spinal deformity is due to a myriad of causes. The etiology (cause or origin) of the most common type of spinal deformity, adolescent idiopathic scoliosis, is unknown, but it’s strongly familial.

Translated … it tends to run in the family.

It affects anywhere from two to five percent of the population, but only 0.6% of people ever need treatment. Females are eight times more likely than males to have the severe type of scoliosis that requires treatment.

Detection

Scoliosis is detected by screenings and x-rays. X-rays are read to determine the degree of curvature in the spine.

The Curve

Typically, angles of curvature (curves) of:

• 0-10% are within normal ranges

• 10-30% require continual observation

• 31-45% require treatment and bracing

• 45% end up usually requiring surgery

• 50% and up is considered severe.

This little girl’s angle of curvature was 60 degrees when discovered, and progressed rapidly to over 75 degrees. For each inch she grew upwards in height, another inch was redirected sideways, causing compression on her trunk.

A noticeable hump had begun protruding from her back.

Some of the effects of severe scoliosis can include:

• Progressive back pain,

• Cardiac and pulmonary compromise,

• Deformity, and

• Dissatisfaction with appearance.

She was here because there were really no good options for her besides surgery. It was the only path of hope to a vibrant, normal, thriving future.

Pre-op

The little girl was ushered into pre-op. She sat on a chair looking incredibly small and vulnerable as a bevy of nurses, doctors, and anesthesiologists spoke with and questioned her. Facts were checked, double-checked and then triple-checked. Many times the same question would be asked.

That’s good.

There was no room for error.

None.

Every possible complication and medical history was explored then re-explored. It had been that way for the previous several months.

The last several weeks had gotten harder and harder on her, as the operation neared. She’d made weekly trips to either donate her own blood for the operation, see her doctors or nurses, and take lung, heart or other tests.  But where had her journey begun? 

Her journey

It turns out that her journey had followed a very well-defined, step-by-step process, hitting points that culminated in her current situation. The steps are:

• Screening and early detection

• Observation of changes in deformity over time with informed judgment regarding prognosis and operative/non-operative interventions

• Surgical planning and operating

Throughout this process the family had a chance to become very comfortable with the hospital, staff and faculty of Cincinnati’s Children Hospital. They were friendly, polite, courteous, and more importantly, internationally recognized innovators in treating this disease.

It also helped to know that Cincinnati Children's Hospital Medical Center had been named one of the 10 best pediatric hospitals in the United States, according to

U.S. News & World Report's annual "America's Best Hospitals.”

The pain scale

An anesthesiologist explains a pain scale of 0-10 to her. After the operation, she is to give them a number that describes what her pain feels like. 0=none, 10=worst imaginable. The anesthesiologist then asks her what parent she’d like to accompany her to the operating room to watch her “go to sleep.”

“None, I am 11 years old.”

Yes.

She was an 11-year-old after all. Tough and stubborn (in public anyway). Qualities that will serve her well in the next year. But especially in the next two months.

She’s wheeled off to surgery by her own little 11-year-old, stubborn self. She leaves looking up at the ceiling with a blank vacant stare – brilliant green eyes. You have to wonder what an 11-year-old girl thinks at a moment like that.

The waiting room – 7:30 a.m.

The parents and family sit in the waiting room at the hospital. It’s packed. Loud. perpetual motion. But the chairs are comfortable … sorta.

10:00 a.m. The phone rings at the front desk. A grandmotherly receptionist motions the parents over.

It’s part of the process. To let family members know how things are going. Seems simple doesn’t it? It is. But it’s incredibly effective.

The first phase of the two-part operation is progressing smoothly. The objective is to enter through her right rib cage with video-assisted, image-guided surgery (incisional endoscopy).

Innovative technique

This method goes in through the rib cage using three or four small incisions to reach the front of the spine.

Looks something like this

Once inside the chest, the spine is clearly visible and "soft" tissues can be cleaned off exposing the spine. Among other things that I am totally unqualified to write about, I understood, nonetheless, that the connective tissues were released to the spine so that it could be could be manipulated and made flexible for phase two of the operation which was to take place 7 to10 days later.

Sound scary?

Probably not.

Unless it was you or one of your family members. Then I suspect it might be.

The minimally invasive approach

This is called a “minimally invasive” approach.  Minimally invasive surgery utilizes small skin incisions, minimizes the damaging effects of large muscle retraction, and attempts to leave the body as naturally intact as it was prior to surgery. 

Translated … feels better, heals better, looks better

Or for you business folks out there, better, faster, cheaper.

The goal is to achieve:

• rapid recovery,

• lessen post-operative pain, and

• leave cosmetically satisfying incisional scars.

Translated … feels better, heals better, looks better

If enough flexibility of the spine can’t be achieved this way, they’ll have to resort to the old-fashioned body-opening. They’d peel her back like a can of tuna from the front to the back of her rib cage, afterwards and forever leaving a big scar.

Time’s Arrow

Moves On

12:00 p.m. – nothing.

1:00 p.m. – nothing.

Overheard conversations. Salutes. Testimonials.

The waiting room begins to empty. Few people are left. The people that remain, begin to bond, open up, and explain why they’re there. And their stories, bar none, are a salute and a testimonial to the skill and reputation of Cincinnati’s Children’s Hospital. The majority of people left, on this Friday in March 2004, are all from out of state.

Not from Cincinnati or Ohio. They’ve flown in from all over the United States to have their children cared for, healed.

Hope of healing

Distance is not a deterrent to the hope of healing.

2:00 p.m. – nothing.

Worry sets in.

3:00 p.m. – nothing.

No matter how comfortable the chairs are, sitting in a waiting room for that long, seeds discomfort - mental and physical. Pacing starts.

3:30 p.m. - finally. The call they’ve been waiting for. Finishing up phase one. All went well.

4:30 p.m. – Family gets to see their young daughter for the first time in the

Intensive Care Unit (ICU)

Did I forget to mention that the operation entailed the little girl being in traction for 10 or more days?

If you ever get a chance to see someone in traction …

Don’t.

If you ever get a chance to see a little child, a little girl, in traction …

Run.

The family’s first sight of their daughter is heart-rending.  A great vacuum sucked all the air out of the room. Like being shot in the stomach by a Hellfire Missile.

“The operation went great,” explains the doctor.

But the family, particularly the father, could only stare at the little girl.

What is traction?

Well, there’s the medical definition, then there’s mine. I’ll give you both.

The medical definition of traction

Spinal traction is based on the application of a longitudinal force to the axis of the spinal column. Parts of the spinal column are “pulled” in opposite directions in order to stabilize or change the position of damaged aspects of the spine. The force is usually applied to the skull through a series of weights or a fixation device and requires that the patient is either kept in bed or placed in a halo vest.

Certainly is distractive

Spinal traction relies on the application of a distractive (“upward”) force being applied to the skull while the rest of the body is held in place. The use of a device that is firmly attached to the skull is required for the successful application of this force - a device which is basically a ring that is attached to the head through a series of  pins. The traction force is initially applied through both of these devices by fixing the patient’s torso in bed while a series of weights are gradually added.

Got that?