Sometimes the first step toward saving the world begins in your own backyard.

That’s the hope for Frances Wampler and Blair Williams, two staffers at the Center for Children’s Health led by Cook Children’s, who are part of a team exploring how communities might target youth suicide as a standalone issue.

There are several “ifs” to contend with, but the two women believe it’s worth exploring the steady climb of youth suicide cases in the nation and determine what’s happening on the local and state levels.

“We see it in the headlines, see it on social media—even clinicians are expressing concern over it,” said Williams, who is a community health analyst and member of the community health needs evaluation team at the Center. “So, we’re seeing this as a rising need.”

Wampler and William’s decision to pursue the issue resulted from a culmination of events. In September, Wampler’s nephew, 19, died by suicide, leaving her family reeling from his death. And years earlier, Williams suffered the loss of a close family friend, a 15-year-old who took her own life. Their shared experiences, along with other data—including the Center for Disease Control’s report marking suicide as the nation’s second-leading cause of death among ages 10 to 24 in 2018 and a reported increase of self-harm cases seen at Cook Children’s last year—propelled the two women to pitch the idea of collaborating on exploring whether area communities needed help with this complicated issue.

“I know how hard it was for me and my family to experience the things we did,” said Wampler, program coordinator at the Center who focuses on child abuse. “He was my nephew, but he felt like one of my bonus kids. I felt like I lost one of my children, and I would take that heartache away from any person I could. I don’t want that to be the end of his story. He was not the last decision he made in his life...he was so much more than that.”

“I just want to do something with that—and I don’t know­­—try to save the world,” she said.

While discussing Wampler’s nephew’s death, she and Williams made note of how often youth suicide overlaps with other issues, such as firearm and poison injuries, child abuse and neglect, Adverse Childhood Experiences (ACEs), mental health and so on.

“These are things that the Center already has programming around,” Wampler said. “I was like, ‘We have to do something.’”

The two decided to take it to Center leadership and were given the green light to pursue it and “do some digging on the data,” Williams said.

“They’ve been really supportive of this,” she said. “That, to me, is really powerful because our leaders heard our concerns and supported us in our efforts to keep every child safe from injury.”

Wampler and Williams’s preliminary research efforts could potentially support the 2021 Community Health Needs Assessment. The Community Health Needs Assessment is conducted by Cook Children’s every three years to assess children’s health needs and the board uses the information to develop implementation strategies for addressing these needs.

They’re not sure how COVID-19 may affect this issue, let alone community health needs across the board, but youth suicide was on the rise well before the virus hit, Williams said. In 2012, the number of suicide deaths surpassed the number of cancer and heart disease deaths - causing suicide to be the 2^nd leading cause of all deaths in Americans ages 1-44 every year since.

“Part of it is recognizing there are several community partners and agencies that are well-equipped to handle this,” Williams said. “Part of the assessment is not only looking at the data, but it’s also looking at what resources are in the community that can be used to help.”

As it stands, the Center is in the data collection phase of the 2021 Community Health Needs Assessment process. They’ll sift through all sorts of data, such as what local health departments are seeing, what the CDC says, what the national and statewide numbers on children’s health needs show, and what’s happening inside and outside Cook Children’s walls. They’re currently conducting focus groups, a parent survey, a community leader survey, and key informant interviews, among other things. When finished, the data will be synthesized and a report published as the 2021 Community Health Needs Assessment.

Wampler and Williams are proud that the question they raised about what the Center can do to support youth suicide prevention has been met with a team approach to investigate this important topic further. They acknowledge this task is a huge undertaking. But both are passionate about getting help to children and families who need it.

Recognizing that this is becoming more of a trend is an important step, Williams said.

“There are so many great resources in our community, so many great partners. We have a wonderful health care system, a great employer who recognizes this issue. So, what can we do with these great assets and protective factors to keep kids safe from all types of harm, including harming themselves?”

Regardless of their findings and the various factors that come into play, Wampler and Williams believe ramping up awareness surrounding self-harm and suicide is key to preventing it among young people. But awareness doesn’t equate applying stereotypes, they said.

Even if children do “check off those boxes” for suicide risk factors, it doesn’t mean they’ll try suicide, Williams said. She encouraged all families to have a mental health plan to address any crisis that may arise.

“There are people who have multiple adversities and risk factors who lead very successful, healthy lives, and probably go on to help many other people, too,” she said. “It’s just recognizing that it needs more awareness. It can happen to anyone and to be prepared. If you’re in crisis, it’s going to be harder to seek out help. So, have that help lined up for you.”

Wampler agreed.

Normalizing conversations about thoughts of suicide, even if it’s uncomfortable for families, she said, also might help with prevention. Her nephew had supportive friends and family, played football in high school and had joined the military, she said, adding the family “had no idea he was feeling that way.” No one saw his suicide coming.

“I don’t think it’s talked about enough,” she said. “I don’t know how hard that would be to say, ‘I want to hurt myself.’ But you don’t have to suffer in silence. You can tell somebody that you’re struggling and get help.”

There may not be a simple answer to preventing youth self-harm and suicide, Wampler and Williams said. What leads to it and how to prevent it is often muddied by a multitude of factors, some controllable and others not.

But one aspect of it is clear to both women.

“For me,” Williams said, “if we can save one child, well, that is (saving) the world.”

“Yes. That’s right,” Wampler quickly agreed. “That one child is somebody’s whole world.”

Rebecca Benson had a feeling the weather predictions would be wrong when she woke up Thursday, Feb. 11. As she suspected, no winter storm arrived overnight to cancel school for her two children. Like any other day, she quietly put on her scrubs while her family slept and left her North Fort Worth home in the dark. A diligent nurse at Cook Children’s Medical Center for six years, Rebecca didn’t want to be late for her 7 a.m. shift.

As she traveled down Interstate 35’s expressway, everything seemed normal – until it wasn’t.

“The roads were completely dry. There was not even a mist on my windshield, absolutely nothing,” said Rebecca. “All the bridges I went over were perfectly fine until I came across the big Trinity River bridge.”

Driving down the highway for nearly 20 minutes, she had no reason to suspect what lay ahead – black ice, and a crumpled mess of metal and people. Approaching a curve at the top of a hill, Rebecca’s car began to swerve. As she confidently corrected the wheel, she noticed shining taillights getting closer. It was a pileup that would ultimately involve more than 130 vehicles, killing six people.

“I look in front of me and see all of the carnage from the accident. There's absolutely nothing I can do,” she said. “It’s the expressway. There's barriers on both sides of you. You can’t go to a shoulder. You can't do anything.”

Knowing she was about to crash, she aimed her red SUV in between two semi-trucks.

“I put my foot on the brake, said a prayer, and I literally thought to myself, ‘I could very possibly die in two seconds,” she said.

Rebecca tried to relax her body to avoid broken bones and readied herself for impact. She hit the trucks so hard, her ponytail holder came out of her hair.

“I got through that and thought, ‘Okay, I'm alive. I'm not severely injured. And then I looked in my rearview mirror and see all of these lights coming right at me,” she said.

Rebecca says that’s when she realized she wasn’t out of the woods. The chances of her being injured or worse by the oncoming traffic were high. But thanks to her quick thinking before the crash, she had positioned her vehicle in what she calls “God’s triangle,” because the trucks stuck out past her SUV, protecting her.

“Everything that hit behind me, the trucks took the impact from that. Every time another semi would hit, you would hear and feel the car move. It was so unbelievably terrifying,” she said. “I've seen it on videos, but to actually be there, waiting to see if something even worse is going to happen was awful.”

Rebecca stayed in her SUV until she stopped hearing crashes. All four doors were blocked by the trucks, so she waited until someone opened the back hatch of her vehicle. She crawled out and surveyed the situation in shock.

“I'm like, ‘Okay, I'm a nurse. I got this. Who can I help? What can I do?’” Rebecca explained. “But Fort Worth Fire Department was working a wreck on the non-express side of 35 (when the pileup began) so they were already there. There was a car behind me that they were working on with the Jaws of Life to try to help somebody. Everyone from Fort Worth Fire was amazing.”

After the crash, Rebecca called her husband who was ready to come get her. She also had a text message from her coworker, Ed, warning her not to take I-35 because traffic was backed up. Knowing Ed was stuck nearby, she decided to find him and hitch a ride to work.

“I was like, ‘All right, I'm gonna hop the barrier and I'm walking your way because there's nothing I can do. But I can at least get in your nice warm car and be safe that way,” she said. “I walked up I-35 in the ice. It was the weirdest thing to be walking on a highway.”

When she found Ed and his girlfriend, Kim, she told them to take her to work. Rebecca explained that she could have gone to the reunification center set up by first responders and waited for her husband, but she knew that drive would likely take hours due to the shutdown. She also felt the need to do something other than think about what she had just survived.

“Being able to be at work and helping instead of reliving that,” she explained. “I was like, ‘I need to get to work and just see where I can help.’”

Rebecca acknowledges this is something she will be processing for a very long time. She allowed her husband to come get her a few hours later and take her to a hospital. Thankfully, she only suffered bruises. But she’s already dealing with survivor’s guilt, wondering why she was able to walk away when so many others couldn’t.

“My heart breaks for all the people who lost loved ones, and who have loved ones in serious condition,” she said. “It's horrible, awful, terrifying.”

Rebecca remembers seeing many people in scrubs as she was walking along the interstate and calls the situation a ‘perfect storm’ for health care workers, all trying to get to work at the same time. Asked if she felt like a hero, she adamantly says ‘no.’

“I feel like I'm absolutely blessed and had guardian angels surrounding me,” she said. “I did what any other nurse I know would do. I didn't save anybody. I didn't do anything extraordinary. I just did what I'm supposed to do.”

She says the experience also gives her hope. From the first responders to good Samaritans, she says she saw the good in people. Even when she was safely waiting with Ed and Kim, she remembers a man walking car to car with a box of granola bars for anyone who may have skipped breakfast and needed something to eat.

“It gave me a lot more faith in humanity.”

“These are a couple of toys for our PICU and TCU families,” she says, donning a plaid scarf and a Cook Children’s mask.

Coffee mug in hand, she speed walks to the door – partly to get out of the cold and partly to check in with the charge nurse as soon as possible before the COVID-19 Command Center call in 30 minutes. By her side is Lori Parrott, a pediatric intensive care unit (PICU) nurse manager, who’s helping carry in Christmas presents for patients.

“It sounds like we may have gotten two more overnight,” Melodie tells her as they briskly cross the sky bridge linking the garage and medical center.

As the director of the PICU and the Transitional Care Unit (TCU) at Cook Children’s Medical Center, Melodie wears a lot of hats. She’s a decision maker. A trusted leader. A master juggler. And she oversees a special wing dedicated to critically-ill COVID-19 patients known as 2North.

She quickly sets the bags down in her small, windowless office and heads to the nurses’ station without pause. Sitting next to a small Christmas tree, the charge nurse fills Melodie in on what happened overnight. A med alert, or medical emergency on the 3P, the stepdown COVID-19 unit, and a DKA, otherwise known as diabetic ketoacidosis. But the big news is the latest patient admitted to 2North. It’s a teenager transported in from another hospital. This patient makes eight on the unit, which has a total of 10 beds. This admission means her team will soon have to find more space to house the patients that are increasingly filling up the COVID-19 unit.

Back in her office, Melodie awaits her turn to speak on the Command Center call, a tri-weekly meeting for leaders entrenched in COVID-19 planning and processes. While sipping coffee, she listens as the director of infectious diseases rattles off the latest number of children who’ve tested positive for the virus. Today, it’s 112 in 24 hours, with 25 currently in the hospital.

Soon, it’s Melodie’s turn to share bad news.

“We may need to think about moving kids over to ‘A’ depending on what the continued census is, and especially if we get down to one bed,” she says as clearly and concisely as possible. “These kids continue to be quite ill and I don’t think any will go out today.”

Moving patients to ‘A’ means opening up a new COVID-19 ICU wing. The hospital is being stretched, but you wouldn’t know it by the positive tone of the call. People are optimistic; there’s hope on the way. They’re waiting on notification from Pfizer that the hospital’s allotment of the COVID-19 vaccine has shipped, which could happen at any moment.

We’re with Melodie this Wednesday morning, the week before Christmas, because she’s offered to show us something we have not seen before. She’s volunteered to take us inside 2North.

Inside the COVID-19 ICU

After the call, we follow Melodie down the hallway, her heeled-boots clicking on the confetti-laden floors. Big, purple double doors are ahead of us with 8-by-11, paper signs. They read, “Doors Must Remain Closed,” and “Isolation Garb for COVID (+) rooms,” with a long list of recommended attire: N95 or PAPR, surgical mask, gown, goggles or face shield, gloves, hair covering, and booties. Immediately upon entering, we see all of this gear in action. To the right, there’s a doctor towering over two nurses. All three are concealed inside in personal protective equipment (PPE) – yellow gowns, white masks and blue headcovers. The physician’s goggles resemble something you’d see on the ski slopes, but he’s not on vacation. He’s just left the room of a child who’s suffering a heart arrhythmia due to the virus.

It feels like we’ve just stepped inside a beehive or an ant bed. Every worker has a job and they’re busy doing it. The energy is fast-paced, but controlled. We watch as a respiratory therapist just a few feet in front of us straps on a PAPR, a small backpack that pumps air through a hose into a sealed helmet. Her speed and skill reveal that she’s done this many times.

To the right, a gloved nurse gives us a thumbs up through a window in a patient’s room. She’s talking to her colleague, who’s sitting at a computer on the other side of the wall. The two are communicating through a mini walkie-talkie type device called a ‘Vocera’ that’s clipped onto their scrubs.

“Can I bring you anything,” said the one sitting near us.

The nurse inside the room can’t leave. She’s halfway through a 12-hour shift, meticulously monitoring the many machines keeping her patient, a 12-year-old girl, alive. This is not a job for the weary. She’s an ECMO specialist, meaning she is precisely trained to take care of children who need extracorporeal membrane oxygenation (ECMO). This treatment is a last resort in which blood is pumped to a heart-lung machine that removes carbon dioxide and sends oxygen-filled blood back into the body.

When a child is on ECMO, two of these specialized nurses or respiratory therapists remain at the bedside at all times. Breaks for food and the restroom are limited. Layers of PPE keep them safe from the virus, but not comfortable. They wear two masks, a surgical mask on top of an N95, plus a face shield, gown, gloves and headcover. If they were soldiers, they’d be ready for war. Their enemy, though, can’t been seen – only the ravages it’s left on their young patient.

Melodie has asked if the girl’s mother would be willing to speak to us. She’s just woken up from the small couch/bed in the room and agrees to step into the hallway. Obviously exhausted, she tells us her name is Florence and that her daughter was diagnosed with COVID 11 days prior.

“She was having a mild temperature, so I brought her to the emergency room just so they could check her out, and we ended up here,” she said in a low, hushed tone. A steady beeping flows in the background.

“That visit was the best decision I made,” she said.

Due to the virus, Florence is the only person allowed to be in the hospital with her daughter. And she can’t leave the room, unless she is leaving the property. All meals are delivered. Anything she needs will be brought to the room for her.

We asked about her time at Cook Children’s, and how things have been.

“I love this place, and I love the staff,” she said.

Florence breaks down. She says everyone she has encountered at the hospital has treated her as if they were the only family there.

“That matters a lot,” she said with tears soaking into her mask.

Ready to return to her room, she shares one last thought: “The ECMO machine is a lifesaver.”

As she walks away, Melodie asks ECMO Manager Jill Pittman to suit up and join the two nurses inside the girl’s room. Shanna Senay and Sara Morgan are the ECMO specialists on duty today. They show us the machine that’s taken the place of the child’s lungs and heart. It’s a bulky contraption with multiple screens, tanks, and tubes, which are red with blood pumping through them.

“ECMO is allowing her lungs to rest and heal from the pneumonia, while we oxygenate her blood and circulate it throughout her body,” Shanna says.

She’s the nurse who gave us the thumbs up from behind the window.

“ECMO is the highest form of medical care that we offer at Cook Children’s, and it requires a lot of training,” said Jill, who’s been a nurse at the hospital for 23 years and now leads the ECMO program. “To be able to facilitate that and have an active role is very meaningful to me.”

ECMO patients are often on the machine for weeks, not just a few days. Because of that, ECMO specialists have to have endurance and the mental fortitude to keep going, even when there is no end in sight.

We’re curious and ask ‘Why do you do this?’

“There’s something special about being able to take care of these kids when they’re so sick and their parents can no longer give them the care they need. Then, it’s up to us,” Sara said with clean air being pumped inside her PAPR helmet. “It’s the last chance these kids have, so we fight every day, every night until they get to the point where they can get better on their own.”

Shanna nods in agreement.

“These kids are warriors. They’re why we push through and why we come out of here sweating bullets and having held our bladders for hours,” she says. “If it were my kid, I would want somebody doing the same thing.”

Back in the hallway, another group of 2North staff members gather to talk to us. One is a young nurse named MyKayla. She has bandages across the ridge of her nose and both ears to protect herself from her N95, which cuts into her skin and leaves sores. Five bandages total, but she’s not complaining. She says she loves taking care of children. It’s her calling.

A respiratory therapist named Joanna is with her, along with another nurse named Megan. They both echo MyKayla, saying they love what they do. We ask if they’ve ever felt scared. There’s a pause.

“Yes, I’ll say it. Especially with it affecting the Hispanic population, it worries me for my family,” says Joanna, who is Hispanic. “But, if God forbid, any of my family members get it and had to be in the hospital, I feel completely comfortable with our doctors, nurses, and respiratory therapists taking care of them.”

Megan jumps in.

“I’m not scared, but I have a healthy respect for it,” she says point blank.

Megan, tall and blonde, moved to Fort Worth a couple of years ago when her husband was sent to work at the Naval Air Station Joint Reserve Base. She was accepted into the competitive nurse residency program at Cook Children’s, and after six months was selected to work full-time in the PICU. She had just a few months under her belt before the pandemic hit. Nearly 10 months on 2North, she now seems like a seasoned nurse.

“I came into this profession knowing anything is game,” she says. “Since COVID, our teamwork as a unit has exponentially increased. It’s been stressful, it’s been frustrating, things are constantly changing, but we keep plugging through, trying to keep our spirits up, and the kids’ spirits up too.”

Off to the side, Jennifer Hayes has just exited a patient’s room. She’s a chaplain on the floor and is accustomed to the tougher moments of an ICU setting.

“The PICU is a hard and heavy place to work, and then you add COVID on top of that, it’s tough,” Jennifer tells us, her appearance failing to match her words.

She’s wearing a bright red shirt with a snowman on it. Her hair is short and brown, pulled up into two spunky knots. She explains her role, how she helps patients and families deal with difficult situations both emotionally and spiritually. She provides the same support to the PICU staff.

“I’m trying to bring joy and fun into the unit,” she says while showing off her fanny pack, creatively decorated to look like a taco for a contest she spearheaded.

She also tells us about the ‘COVID Café,’ a space she established on the unit for worn-out frontline staff to retreat to during their shift. They can watch TV, enjoy the snacks or one of the many word searches, games, or funny memes she’s left at the half-dozen socially distanced tables.

Jennifer is the caretaker of the caretakers, and one of the many moms on the unit. She, like everyone else on this floor, has had to change the way things are done at home. She explains how her 2 year old always wants to hug her as soon as she walks in the door, but can’t for fear that some microscopic particle of COVID-19 has made the trip home with her.

“It has been a big change and has created a delicate balance where we are trying to keep normalcy for our kids, but also we have to be mindful keeping them safe,” she says.

Ashley Miller, the charge nurse we saw filling Melodie in early this morning, agrees. She is also a mom and shares how her 14-year-old son watches the news and worries. She oversees the entire 43-bed PICU and is in charge of admitting each patient. She says the now is by far the worst they’ve seen of the pandemic.

“It’s a reality that kids can get COVID and they can become very, very sick,” she says. “It’s definitely a change from March, we’re seeing many more now.”

While we’re talking, Melodie reminds us about an 11:30 a.m. meeting we’re due to attend. It’s with PICU leaders, and they have a lot to discuss.

Leading During a Pandemic

We make our way down to the basement of the hospital where five women have gathered in a classroom. More are on a conference line. Their top concern today is overflow for COVID-19 patients.

“It’s hard to put a target on when we should open a new wing, because we don’t want to turn around and close it if our census lowers,” Melodie tells the group, which is spaced out around the large room. “But once we get to nine patients, that’s it, and that can change in five minutes.”

Until recently, 2North only had two to three patients at one time. Now, it’s pushing capacity. Finding more space and beds is not an issue. The problem is staffing. With a new COVID-19 ICU unit, more staff will be pulled in to take care of the children in the beds. That’s worrisome because burnout is already top of mind for these leaders. They will do anything to prevent losing essential caretakers. That includes Linda Thompson, M.D., medical director of the PICU, who’s sitting in the corner of the room. She is so concerned about burnout, she offers up her vacation home on the Texas coast for fatigued staff to escape to with their families. Everyone here is willing to do whatever they can to prevent from losing people in the pandemic.

“Ding, ding, ding – Ashley Miller.”

This is the sound of a call coming into a Vocera. Ashley, the charge nurse, is alerting the leaders that another COVID-19 patient is being admitted as they speak. Their discussion about overflow may take shape sooner than expected. They hurry to get through their agenda, knowing there is work to be done on 2North.

After the meeting, we part ways with Melodie. She’s off to do what she does best, leading her team during a challenging situation. We’re gathering our cameras and equipment to capture another area we’ve never seen, the step-down COVID-19 unit known as 3Pavilion, or 3P. Until today, 2North and 3P had been restricted to ‘necessary’ personnel only. Somehow, we got lucky, and are being allowed inside both.

Inside 3P – the COVID-19 Step-Down Unit

We take the nearest elevator to the third floor. As soon as we step off, Valerie Badgett, the day nurse manager, is waiting for us. She’s worked on this unit for 17 years and recalls the day this past March when administrators gathered everyone into a break room and told them they were about to be taking care of COVID-19 patients.

“This was a specialty med surge unit prior to COVID. We treated patients with renal disease, from acute kidney failure to children who received kidney transplants, and GI patients,” she explained. “When they told us we were going to become a COVID unit, people were understandably nervous.”

The administrators explained that their floor has a unique airflow system, which allows air to vent directly outside. This prevents airborne viruses from circulating through the ventilation system.

Valerie tells us more about that day in March, and how they had to quickly move their patients to other floors. They thought they had days to prepare for their first suspected COVID-19 patients. In reality, they had just hours before seven children under investigation for COVID-19 were admitted to their floor.

“There were a lot of questions at first because we didn’t know enough about it,” Valerie said. “But Dr. Whitworth came over the very next day and eased a lot of people’s concerns. She has always been there to answer our questions.”

Mary Suzanne Whitworth, M.D. is the medical director of Infectious Diseases at Cook Children’s. Valerie credits her composed leadership for helping the staff on 3P not only accept the challenge ahead of them but take it on as a mission they were called to serve.

Unlike 2North, the atmosphere on 3P is calm. It’s quiet and much larger than the ICU. Patient room doors stretch down two long hallways lined with purple and blue carpet. The only thing that visually sets this floor apart from other non-critical areas of the hospital is the donning and doffing of PPE happening all around us. Doctors and nurses are suiting up in PAPRs, gowns, goggles, and gloves before entering rooms. Knowing this team didn’t necessarily sign up to take care of COVID-19 patients gives us a whole new respect for them.

“It has brought a lot of new diagnoses that we didn’t take care of before, chemo patients, newly diagnosed diabetes, a lot of patients that we’ve gotten have come in the emergency department because they’re sick from something else, and then coincidentally they test positive for COVID,” Valerie said. “Many of our nurses have become certified in chemotherapy so they can take care of the patients we’re now seeing.”

Hearing how this unit has stayed together the past 10 months, even when they had opportunities to abandon ship to work in other areas, is inspiring. They’ve overcome fear, learned how to care for an array of injuries and illnesses, and built an unbreakable bond. They’ve proven resilient, and their strength is needed now more than ever.

“We have 20 beds on this floor, and today we have 17 patients,” says Ashley Kovacev, the night nurse manager who’s volunteered to give us a tour.

She walks us down the hallway, pointing out the negative pressure rooms they never had to use for isolation purposes until this year. We round a corner and an alarm is dinging. A light overhead flashes. Ashely peeks into the room.

“Are you ok?” she asks.

Inside, a mother needs help getting her child to the restroom. Ashley calls for a nurse.

Families on 3P rely on the staff for everything, including food and water. Like 2North, only one parent at a time is allowed per patient and they can’t leave the room unless they are leaving the hospital. Because of COVID-19, the floor’s family lounge and playroom are closed. Patients and parents are stuck in their rooms, but everyone tries to make the best of it.

One small glimmer of hope is the child life specialists and music therapists who don and doff PPE to deliver activities to the children’s rooms. We spot one, a young woman with long blonde hair, sitting alone in the closed playroom. She’s teaching a patient how to play guitar via Zoom, just one of the many creative ways the child life team is engaging isolated patients.

To the left, down a short hallway, a woman in a blue scrub top and black pants is pushing a large cart.

“That’s Rebecca. She’s been absolutely phenomenal since day one,” Ashley says. “We tease her because she literally wipes down the walls non-stop.”

Rebecca is an environmental services worker. She looks uncomfortable as Ashley gushes about how she has kept the team safe throughout the pandemic.

“Not a single person here has contracted COVID from our unit,” says Ashley, crediting Rebecca for their protection.

Reluctant to accept the praise, Rebecca says simply through her mask, “We have to take care of each other.”

As we near the end of the tour, a food services employee in a mask and goggles delivers a plastic bag full of Styrofoam containers to the nurses’ station. It’s just one of the many trips he will make to 3P today, delivering three meals to each of the 17 families on the unit. He, like everyone else we’ve met, smiles as he drops off the food.

It’s no small feat for any of these people – the changes they’ve adapted to. The anxiety of the unknown. The courage they’ve displayed. After spending eight hours behind-the-scenes of Cook Children’s COVID-19 units, we can attest to the following statement:

“Our staff truly honor our ‘Promise’ every single day,” Ashley says holding back tears. “It makes me emotional. These people are so resilient. They care for these kids like they’re their own. It’s truly amazing.”

“I make sure my patients are served breakfast, lunch, and dinner. When they get their trays, I love to see that smile so that’s what I’m there for,” Sandra told the show’s producers for a taped segment that aired during the episode.

Sandra is the lead ambassador in Food and Nutrition Services and logs 30,000 steps a day delivering meals throughout the medical center.

Live on the show, Tamron asked Sandra why she does what she does, especially in the midst of the COVID-19 pandemic.

“It’s just natural. I just love to do it. And joy is always in my heart, so I just love it,” Sandra said with a big smile.

Corey was also featured in a segment on the show. He said he finds joy in uplifting Cook Children’s patients and families and shared the story of a little boy who was unable to walk.

“I walked past him one time, and said ‘Hey buddy, how are you doing?’ and he smiled with a big smile and he showed me his muscles, and I said ‘I’m going to show you my muscles,’ and I showed him my muscles and said ‘You stay strong and you keep on getting strong,” Corey explained. “This kid wound up walking three months later in this hospital. That’s what drives me to keep on coming to work.”

All four Cook Children’s employees were part of the virtual audience received gifts from the show as appreciation for their commitment to serving throughout the pandemic.

Despite a recognized need, the majority of families at Cook Children’s are unable to access legal services. Social workers at the medical center are often contacted by patient families who have been unsuccessful in qualifying for public benefits, obtaining a guardianship for their incapacitated adult child or communicating with their landlord to remediate unsafe housing issues. These social, economic and environmental factors have a direct impact on a child’s health.

“The health and wellbeing of our patients is impacted by so many factors beyond the scope of traditional medical care,” said Vida Amin, M.D., medical director of Cook Children’s Neighborhood Clinics. “Having an accessible, dedicated resource for our families to turn to for assistance in navigating their legal challenges will be an invaluable addition to the family-centered care we strive to provide every day.”

The medical-legal partnership allows law students the opportunity to develop and apply their skills on behalf of clients who cannot afford legal representation.

“We are giving these children and their families a chance of success by increasing their quality of life by decreasing their unresolved legal needs,” said Robert B. Ahdieh, dean of Texas A&M School of Law.

The collaboration, which officially launched in March 2020, has already assisted dozens of patient families. Felicia Carey is one of the program’s first clients. She was referred to the TAMU Law after her sister passed away, leaving her to care for three teenagers, including a niece diagnosed with spina bifida.

“At first it was very difficult because I lost the paperwork that allowed me guardianship so I could take the children to the doctor,” said Carey. “A social worker at Cook Children’s referred me to the program and it’s been phenomenal. They made a process, which was unbearable, extremely easy.”

Since finalizing her guardianship issues, Carey is now working with TAMU Law on an adult adoption, veterans benefits and developing her will. The program also provides patients and families with access to legal services in family law, housing and public benefits.

“Our job is to prepare compassionate lawyers who will advocate tirelessly for their clients. That’s what sets Texas A&M Law a part from other law schools. We embody our core values, especially selfless service,” said Ahdieh.

“It’s an emotional day because we’ve waited so long for this pandemic to end,” said Debbie Boudreaux, Assistant Vice President of Nursing at Cook Children’s. “This has been a team effort from the very beginning, with our COVID-19 Command Center working tirelessly to adapt to all the changes we’ve had to make to keep our employees, patients and families safe.”

The vaccine arrived at Cook Children’s Medical Center just before 10 a.m. on Dec. 17 via a UPS truck. The vials were immediately transferred to a special freezer where they will be kept at minus-70 degrees Celsius until they are ready to be thawed and administered.

Today’s vaccination of frontline staff was considered a “soft launch” ahead of the full COVID-19 employee vaccination clinic, which is set to launch at 5 a.m. on Dec. 18. Frontline employees are prioritized and must register for their appointment.

“We’re so grateful to be surrounded by remarkable people who unselfishly come to work every day with the purpose of making a difference in the life of a child,” said Rick W. Merrill, CEO & President of Cook Children’s Health Care System. “By volunteering to receive this vaccine, our employees display great courage and commitment in doing what they can to bring an end to this pandemic.”

After receiving the vaccine, several Cook Children’s employees shared the reason why they took the shot:

“I am getting the COVID vaccine to help keep myself and other people safe from this, and so I can hug my adult children and parents in peace.”- Mary Suzanne Whitworth, M.D., medical director of Infectious Diseases.

“The reason why I’m taking the vaccine today is because my stepdad passed away last week from COVID complications, and it is super important to me, to my family, to the community, to get this vaccine as quick as you possibly can.” - Jason Reese, respiratory therapist

“I trust the science. I have been wearing full PPE since March, and I am truly exhausted mentally and physically. I know this is the only way to beat the virus because it’s been beating us in 2020.” - Deborah English, registered nurse on the COVID-19 unit

“I believe in the safety of our patients, and I want to make sure that we’re safe and they’re safe. I believe in the science, and I believe in Cook Children’s.” - Jill Fallahay, respiratory therapist with Teddy Bear Transport

“Similar to what has happened with adults, Hispanic children have been most affected during the COVID-19 pandemic,” said Ana Maria Rios, M.D., infectious diseases pediatrician at Cook Children’s. “Hispanic people have the highest burden of all the races and ethnicities in the U.S. and they have the highest risk of contracting infection, and becoming severely ill.”

The Centers for Disease Control and Prevention (CDC) reports similar statistics nationwide. According to a report released in August, Hispanic children are eight times as likely to be hospitalized for COVID-19 as white children. For Black children, the risk is five times as high.

In Tarrant County, overall infection rates for COVID-19 have hit the Hispanic community hardest. This group accounts for 27% of all positive tests, which is the largest percentage across all races and ethnicities.

Why are Hispanic families being hit the hardest?

Out of the 181 children hospitalized with COVID-19 at Cook Children’s between March and October, 96 were Hispanic. But how can this be when white (non-Hispanic) people make up the majority of Tarrant County and surrounding areas?

One reason many experts point to is large numbers of Hispanic workers who are on the frontlines and considered essential.

“A lot of people don’t have the luxury of being able to work from home,” said Vida Amin, M.D., medical director of Cook Children’s Neighborhood Clinics. “It’s kind of the worst recipe. You have adults who have to keep working to put food on the table. You have kids who have to go to daycare or school. All of these factors go into play.”

She says another risk is that Hispanic families are more likely to have multiple generations living under one roof.

“We saw this in Italy early in the pandemic. I remember I was curious about why is this happening in Italy and I started to look at the literature. I saw many younger people, in their twenties and teens, were working in the city and they'd come back home where they were living with their grandparents,” said Dr. Amin. “I think it’s a very similar situation here.”

Bianka Soria-Olmos, D.O., a pediatrician at Cook Children’s office in Haslet, has been an outspoken advocate in the Hispanic community throughout the pandemic. After speaking on various Facebook Live events and news interviews targeted toward Spanish-speaking audiences, Dr. Soria-Olmos says getting information out has been critical.

“I think for some people, unless they've known someone who has been personally affected, they may not realize how dangerous and unpredictable the virus is, including the wide range of presentations it can cause from mild symptoms of a cold to life threatening illness that requires intensive care and in some cases even death,” said Dr. Soria-Olmos. “I also feel like the great things about our culture, like the importance of family and celebrations and the act of gathering, have been an Achilles heel for us.”

She says the most important thing for everyone to remember, not just Hispanics, is to be mindful of activities she calls ‘extracurricular.’

“It’s choosing not to do those things where you could potentially become exposed,” said Dr. Soria-Olmos. “The bottom line is leaving your house is a risk when you have transmission rates this high in the community.”

Tarrant County is currently averaging more than 1,000 cases of COVID-19 a day.

Why do Hispanic children end up getting sicker?

It’s important to remember that most children who contract COVID-19 have mild symptoms or are asymptomatic. In fact, overall hospitalizations among children remain low. However, Hispanic children are at the greatest risk of becoming severely ill and needing hospitalization. Experts believe higher rates of underlying health conditions in this population may play a pivotal role.

According to the CDC, obesity, chronic lung disease and prematurity are the most prevalent underlying conditions for children hospitalized with COVID-19. They report nearly 46% of Hispanic children have one or more of these conditions.

“I have to be honest with you that even though I am Hispanic, I didn't realize how much inequities we have in the medical system,” said Dr. Rios. “I think this pandemic is making everyone aware of the public health crisis we’re in. The silver lining is that public health has to be reinvented and we need to work harder in prevention.”

Another issue that can lead to children of any race or ethnicity becoming sicker is delaying medical care.

“I think it's really important that we ask families and schools to remain vigilant about any kind of severe symptoms that they may be noticing in children,” said Dr. Amin. “Don’t just ignore it because children are supposed to be safe from the virus. Some kids do get very sick and we need to be taking these cases seriously and seeking out medical care.”

Symptoms of COVID-19 in children include:

• Fever or chills
• Cough
• Nasal congestion or runny nose
• New loss of taste or smell
• Sore throat
• Shortness of breath or difficulty breathing
• Diarrhea
• Nausea or vomiting
• Stomachache
• Tiredness
• Headache
• Muscle or body aches
• Poor appetite or poor feeding, especially in babies under 1 year old

Dr. Amin adds, “As a clinician, I hope my families will recognize if their child is in a high-risk category, and that they take it seriously when their child becomes ill and seek out care early.”

What can families do to protect their children?

First and foremost, take COVID-19 safety precautions as seriously. This means wearing a mask in public, washing your hands frequently and using hand sanitizer when handwashing is not possible.

“Wash your hands every chance you get and wear a mask,” said Dr. Rios. “We now know masks work both ways. At first, we thought they would only protect others, but we now know masks make a big difference in the amount of virus that can get to us and make us sick.”

It’s also critically important to stay home from work and school when sick. If your child is exhibiting any symptoms of COVID-19, make an appointment with your pediatrician or a Cook Children’s Urgent Care. These visits can be in person or virtual from your phone or computer using a MyCookChildren’s account, which you can easily sign up for here.

“Not everyone is aware that we offer virtual appointments at our urgent care clinics and at our community based (Neighborhood) clinics,” said Dr. Amin. “For families who are working and juggling other things, signing up for MyCookChildren’s is a great way to schedule appointments and to make sure they can see a doctor quickly.”

Dr. Amin also urges parents not to skip well-visits and vaccines.

“These appointments are our chance to discuss their child’s health, prevent serious illnesses through vaccines and help them understand what to do in case their child becomes sick,” she says. “If anyone out there is wondering if they should get their child’s flu shot this year, they should know the influenza vaccine is recommended for all children over 6 months of age, with rare exception. Please discuss it with your primary care physician. As for our clinics, we have safety protocols in place to allow families to wait in their cars until they’re called in and have taken many other safety precautions as well.”

Another thing families can do to protect themselves and their children is to limit gatherings with people outside of their household, which can be increasingly difficult with the holidays in full swing.

“We realize how hard it is to say ‘We’re not going to get together this year,’” said Dr. Soria Olmos. “But we have to do our part to get the community numbers down. To do that, we need to keep our holiday celebrations to our households, and we hope that we will not have to do this ever again.”

As a survivor of the Great Depression, Dr. Dambro’s mom knew doctors were needed in times of economic boom or bust, and she wasn’t about to stand in the way of her daughter’s chosen career path. In those days, a mother encouraging her daughter to pursue the male-dominated field of medicine was a rarity.

“My mom was practical and very reinforcing in her recommendations for my career,” Dr. Dambro said. “In the 1960s, not that many girls had their mothers telling them to go ahead and be a doctor.”

Her mother’s refusal to conform to that norm made all the difference to a little girl with a big dream. After 41 years of practicing medicine, Dr. Dambro will hang up her clinical white coat on Dec. 1.

Born and raised in Reno, Nevada, Dr. Dambro received her undergraduate degree from Occidental College in Los Angeles and completed her medical degree at Tufts University in Boston, Mass. A pediatrics residency, pulmonary fellowship and a short stint on the faculty at the University of Arizona Health Sciences Center in Tucson preceded her move to Fort Worth where she joined the medical staff of Cook Children’s Medical Center in 1987.

Dr. Dambro made her way to Cook Children’s alongside her long-time colleague and friend Jim Cunningham, M.D., chief medical officer at Cook Children’s Health System.

“I first met Dr. Nancy Dambro when we were both pediatric pulmonary fellows at the University of Arizona Health Sciences Center in Tucson,” Dr. Cunningham said. “We quickly became good friends and professional colleagues. A few years later, when I was considering returning to Fort Worth and joining Cook Children’s, I was very fortunate to convince her to join me. And now, 33 years later, I face the rather daunting task of bidding her a professional adieu.”

Their arrival at Cook Children’s was a pivotal turning point for the medical center’s pulmonary specialty. The two of them had to start from scratch setting up policies and departmental procedures. Today, that two-person team now includes six additional physicians and many supporting health-care professionals and employees.

During her tenure at Cook Children’s, Dr. Dambro served as medical director of pulmonology for 20 years, in addition to serving as president of the medical staff. She helped grow the department to include the Cook Children’s Cystic Fibrosis Center and a pediatric sleep center, among many other improvements and additions.

“Under her leadership and dedicated guidance, the pulmonary program has grown to one of the largest and most accomplished programs in the country,” Dr. Cunningham said. “She has been a leader in pediatric pulmonology nationally, a leader within Cook Children’s in many capacities, and a leader in our community. She has been a mentor to countless of our young colleagues and her legacy will continue on through their good works.”

Mentor Mindset

Upon retirement, Dr. Dambro will set her sights on time with her family and fostering her love of gardening, entertaining, reading and travel. She says the time is right for her and those she’s passing the torch to.

“I’ve really had a very happy career,” she said. “I wanted to have a good, long career. I really wanted to work past 65 and to go out of my career when I felt strong. I certainly did not want to, in any way, overstay my welcome. And we have a bunch of young physicians now at Cook Children’s who need to grow in their careers and they need to have space to do that.”

Her advice to those young professionals?

“Probably the first thing is give it your all,” Dr. Dambro said. “Remain committed and don’t hesitate to become involved. The second is practice medicine as it’s meant to be practiced, following the Hippocratic Oath, and do not get involved in pressures from the business.”

Karen Schultz, M.D., is a grateful recipient of Dr. Dambro’s counsel. She began working at Cook Children’s fresh out of her fellowship when Dr. Dambro was the medical director. She said Dr. Dambro helped guide her through those early years of on-the-job education that comes with being a new attending physician. Today, Dr. Schultz holds Dr. Dambro’s former position as medical director of pulmonology and praises her predecessor as a physician, advisor and friend.

“She was a mentor to me from the start,” Dr. Schultz said. “Over the 17 years I’ve been here she has continued to advise and counsel me. When I took over as medical director, for the six months beforehand, she passed on her knowledge to me and continues to help even now. There’s always something I’m learning from her every day.”

Dr. Schultz believes her colleague’s retirement is well deserved.

“I hope that she really enjoys her time because she has worked really hard for a lot of years and impacted physicians, nurses, patients and staff more than anybody could really ever explain to her,” Dr. Schultz said. “This place will not be the same without her.”

Living Legacies

Lindsey Marshall, 33, of Fort Worth, cried when she heard the news of her beloved doctor’s retirement.

“We talked about the wonderful things that meant for Dr. Dambro,” Lindsey’s mom, Kim, said about comforting her daughter. “I know they're moving to a new house and she gets to spend more time with her husband, and she won't have to wake up in the middle of the night. You know, all things that relate to why this was good for Dr. Dambro. So she understood.”

Lindsey was born with Down syndrome and multiple heart defects. She developed asthma as a toddler and suffered from multiple bouts of pneumonia. Kim said Dr. Dambro has been a gift, noting her positive, calm and reassuring bedside manner, and gives her credit for Lindsey being alive today.

“As a parent of a sick kid I will tell you Dr. Dambro has always been a bright light,” Kim said. “She's always been positive. Never unpleasant. She's always looking for the positive and that's just a gift. She is one in a million. So, yeah, we adore her. It's a personal loss for our family just because we treasure good medical help so much but, for Dr. Dambro, we truly are thrilled. You know, she's worked so, so hard for so many years. She deserves a wonderful retirement.”

Lindsey is a living testament to Dr. Dambro’s legacy. Today, she is thriving from both a health and developmental standpoint as she participates in a college program where she is learning job and life skills that will help her live more independently.

Petey Hansen, 31, of Winnsboro, Texas, has been a patient of Dr. Dambro’s since shortly after his birth in 1989. Born at 26 weeks, Petey suffered a number of complications due to his prematurity, including bronchopulmonary dysplasia, or chronic lung disease. It’s going to be hard for the Hansen family to say goodbye to Petey’s beloved physician after 31 years of what they describe as devoted care.

“We are going to miss her tremendously,” Janice Hansen, Petey’s mother, said as she choked back tears. “We so appreciate the excellent level of care that she always gave Pete. And the fact that I always felt like she loved Pete and that he meant something to her. She always cared, and we wish her well.”

Petey, an avid sports enthusiast who will win any game of sports trivia, beat the odds on multiple occasions. He survived prematurity when many said he wouldn’t, and he proved doctors wrong when they doubted he’d ever walk on his own due to clubbed feet or ever live without a ventilator or supplemental oxygen. But, through it all, Dr. Dambro was there. Never giving up. Never failing to fight for what was best for her patient. Never abandoning the oath she took as a physician.

“She’s very protective of her patients,” Janice said. “She is very knowledgeable in her field and very caring, and Petey loves Dr. Dambro. He looks forward to going to see her every year at check ups.”

“Words fail to capture all she has done,” added George Hansen, Petey’s father.

Today, Petey is relatively healthy and only needs the occasional breathing treatment when he’s sick with a cold or respiratory virus. All thanks to his fighting spirit and, in large part, Dr. Dambro’s care.

Family Matters

Dr. Dambro is quick to acknowledge her family—husband Mark, also a physician, and daughter, Mary—when she talks about her career. Looking back, she isn’t sure how she managed 60-hour-work weeks while also raising her daughter.

“The other day my daughter told me that she and her boyfriend thought for some time that I lived in an alternate reality where there was more time,” Dr. Dambro said with a chuckle. “My family, my husband and daughter and my parents when they were alive, have been incredibly supportive and reinforcing to me.”

She’s also grateful for the support of her colleagues.

“I work in the greatest department,” she said. “We have very low turnover and everybody is happy to come to work and, I think, when you can say you start your day happy to come to work, that says a lot.”

Her longest running colleague will, perhaps, miss her the most.

“I struggle to contemplate professional life at Cook Children’s without Nancy Dambro,” Dr. Cunningham said. “But I am thankful that she took a leap of faith and moved across the country with me, so many years ago, and that she dedicated her professional life to caring for the children of our region. They are happier and healthier for all of her good works.”

Dr. Nancy Dambro’s imprint on Cook Children’s Medical Center will be everlasting as her fellow physicians and colleagues carry on with the work of the department she helped lay the foundation for so many years ago. Thanks to her, thousands of children can breathe a little easier—now and for generations to come.

All patients with exposure to COVID-19, regardless of symptoms, will need to quarantine for 14 days. This is required, regardless of test results, because COVID-19 can develop between two and 14 days after an exposure.

At Cook Children’s Urgent Care, a patient may be required to have two negative COVID-19 tests before their doctor or nurse practitioner will sign a form allowing the child to return to school. This will likely be the case if the child's symptoms are high risk for the virus. 

If a child tests positive for COVID-19, they will need to stay home for 10 days after the onset of their own symptoms. This could mean a quarantine longer than 14 days. 

Cook Children's Health Care System follows guidelines from the Centers for Disease Control and Prevention (CDC).

We also follow the Infectious Disease Society of America which has issued the following COVID-19 guidelines: 

• Intermediate to high clinical suspicion of COVID-19: A COVID-19 test should be repeated in 24 to 48 hours (different samples if indicated)
• Low clinical suspicion: No re-testing

All patients with high-risk symptoms should be tested for COVID-19 before returning to school based on physician or nurse practitioner discretion.

These symptoms include:

• Fever
• Cough
• Shortness of breath
• Body aches
• Loss of taste/smell
• Headache
• Sore throat
• Sustained vomiting or diarrhea (and usually a combination of the these symptoms)

“Our goal is to make sure we limit the spread of COVID-19 as much as we possibly can to keep everyone healthy,” said Suzanne Whitworth, M.D., medical director of Infectious Diseases at Cook Children’s. “If the first test gives a false negative result, we could potentially be sending a contagious child back into the classroom. That is why a second test is needed in cases of high suspicion.” 

All patients with low-risk symptoms and NO known exposure to COVID-19 can be tested before returning to school based on physician discretion. Low-risk symptoms include congestion or runny nose, rash or a single episodes of vomiting or diarrhea.

Click here to read more about COVID-19 testing.

“September of 2020 has been the highest month ever that we've seen suicidal patients admitted to our medical center,” said Kia Carter, M.D., medical director of Psychiatry at Cook Children’s. “We've seen this number rising year after year, so it's not surprising that it's this high. Suicide has become the second leading cause of death for kids and adolescents in the last year, versus two years ago when it was the third leading cause of death.”

This news comes after a near-record month in August when 29 patients were admitted for intentional suicide attempts. The patients admitted to Cook Children’s in September were between the ages of 6 and 18 years old. Dr. Carter says she feels the pandemic has played a moderate role in the increase, but that we typically see higher numbers in the fall months when kids return to school. In September of 2019, for example, Cook Children’s admitted 32 patients for suicide attempts.

“We've definitely seen this number rising in the last five years, but I do think that the amount of stress that we as a society have experienced in the last six months has caused some of our kids and adults to struggle more,” said Dr. Carter.

Virtual school may also be playing a role in mental health of kids. The Rees-Jones Behavioral Health Center at Cook Children’s has become a resource for children and teens who report feeling hopeless and not knowing how to cope with the isolation the pandemic has caused.

“I think everything in proportion is good, but when something is to this extent where some kids have had to do 100% virtual since March, it’s been very difficult,” Dr. Carter explained. “When kids have school, they have an outlet. They have other people to talk to. They have friends and social activities. Now, it’s just them, their parents and siblings.”

She says it’s important to know that some kids do very well with virtual learning, but it’s up to parents to know what works best for their child. Also, some families may have to choose virtual learning if the child or another family member falls into the high-risk category for COVID-19. In that case, parents should remember to ask for help when they need it. School counselors, nurses, teachers and their pediatrician are all great resources.

Warning Signs

Dr. Carter says the biggest thing to look for is a change in your child’s behavior, which she acknowledges can be difficult during the pandemic. She says little things like sleeping more than usual or not wanting to engage or interact in activities they used to enjoy can be signs of depression.

“Start engaging a little more and check in, like ‘Hey, are you feeling okay? I noticed you were getting a little angry at us for no reason,'” she said.

While it’s easy to write off irritation as a side effect of being a teenager, it is one of the primary symptoms of depression in children and adolescents.

Other signs to watch for include:

• Declining grades
• Lack of concern about appearance and hygiene
• Changes in eating and/or sleep
• Self-injury such as cutting
• Less motivation
• Alcohol/drug use
• Acting highly anxious or agitated
• Recklessness

Dr. Carter says girls are more likely to be hospitalized for attempting suicide, but boys tend to make more lethal attempts. As for age, Cook Children’s data shows 14 to 15 years old is the average for suicide attempt admissions, but more recently, the majority of patients have been around 12 to 13 years of age.

With many kids at home alone due to COVID-19, increased access to things like medication, firearms and the internet may also be contributing to the increase in patients. Dr. Carter says her team has also seen more patients participating in social media challenges where kids are hurting themselves.

“We have seen a rise in cutting behaviors, which are a form of self-injury. This is not always considered a suicide attempt but more of a maladaptive behavioral response to stress.”

She says these are things often picked up on social media, reinforcing the importance of knowing what your child is looking at and who they are talking to on the internet.

What Can Parents Do?

Get help.

If you’re concerned for the immediate safety of your child, take them to an emergency room. Trained professionals will evaluate your child to see what next steps need to be taken.

If you’re concerned about your child’s mental health (but not that they will harm themselves), you can contact your pediatrician, school nurse or counselor for a list of outpatient resources in your area.

If you feel your child may need a higher level of care (but it’s not an emergency), you can call Cook Children’s Behavioral Health Intake Department at 682-885-3917. Our team will help arrange referral for outpatient therapy and medication management, partial hospitalization day treatment options or inpatient treatment if needed.

Partial hospitalization allows children to receive treatment including medication management, family and group therapy at the Rees-Jones Behavioral Health Center during the day, while allowing them to go home at night. Children who are deemed an immediate danger to themselves may be admitted to the inpatient unit for 24/7 monitoring and treatment. The Rees-Jones Behavioral Health Center, is one of the few places in North Texas that offers inpatient psychiatric care for children between the ages of 2 and 12.

“Our biggest hope is that we can help families find the support and resources they need, and that we can educate our school systems about warning signs and screenings because they are hopefully going to come in contact with those kids before we do,” said Dr. Carter. “We don't want the numbers to continue to rise and we continue to lose our children. Remember that suicide is preventable.”

“Congratulations. You’ve been chosen to be the mother of a beautiful baby girl.”

Excited. Shocked. Joyful. Overwhelmed. I imagine most people would have similar feelings upon hearing those words, especially when just 48 hours earlier neither my husband nor I knew that our daughter was preparing to enter the world.

I remember that day vividly--the day of her birth. I lived three states away from her birthplace and spent morning entirely unaware how much our lives were about to change. I’d taken our two- year-old daughter, Gracie (who is also adopted), to the splash pad park. I was watching her with soaked hair in a neon floral swimsuit as she tried to scoot her way down a blue slide when I received an email notification. It was from our adoption agency and was marked urgent.

Four months earlier the adoption of Gracie’s half-brother fell through on the day he was born. Needless to say, our hearts were broken and it took us months to feel ready to begin the matching process with an agency. We had been approved to start again just two weeks earlier. I opened the email to see that a birth mom was on her way to the hospital at that moment and when she arrived she wanted to view profiles of prospective adoptive families. If we wanted to be considered we needed to let our agency know immediately.

As I stared at the words, a half dozen fears came pouring into my head. We weren’t ready. We hadn’t made arrangements. There was so little information available about the situation, etc., etc.—on and on my head went. Yet my heart was strangely warm and still. It was telling me the answer. I quickly called my husband and asked him to read the email. After asking how he felt, he said, “I don’t know if this will be our baby but I feel we need to try.”

She was born that June 5th day. After being told we’d been in the birth mom’s top two, it was radio silence. We’d had situations fall through when trying to adopt our older daughter and, of course, the failed adoption four months earlier. We weren’t strangers to disappointment. Still, we couldn’t help feeling disheartened after jumping at every text, email or phone call for the last 36 hours. My husband and I had determined the lack of news was not good news.

This is likely the reason for my amplified shock when I answered my phone driving home from work that day. I could barely comprehend as I replied in broken sentences (fairly certain I squealed), tearing up as I replied, “Wait, wha... Are you serious? What does that mean?” The social worker chuckled and said, “It means you need to get on an airplane real fast. We need you at the hospital at 9 tomorrow morning.”

Lots of packing, little sleep and a 5 a.m. flight later, we landed in another state, anxiously raced toward the hospital and, with excitement bouncing in our bellies, met the social worker at the nurse’s station of the birth hospital’s newborn unit. Our two-year-old daughter was not allowed back so my husband stayed with her as I was led into the nursery. It’s possibly best described as a slightly humorous reversed telling of the children’s book “Are You My Mother?” as I walked past tiny bundles in clear bassinets thinking as we neared each one, “Are you my baby? Are you my baby? Are you my baby?”

As we approached a far corner I spotted two nurses standing beside a pediatrician carefully examining a small baby with big eyes, a perfectly round head, smooth skin and a slightly upturned nose laying on a fuzzy blanket decorated in pink and blue footprints. She was my baby. Our Everly.

It’s impossible to recount that moment without emotion. Picking up my daughter for the first time. Cradling her to my chest in the dim corner of the nursery. Whispering in her ear as those chocolate-colored eyes absorbed me. Feeling her incredible warmth when we first did skin-to-skin. The absolute unparalleled joy of wheeling her into a room to meet her impatiently waiting daddy and sister. Tears poured from my husband’s eyes as he held her in his big arms. Protecting her, as he has every day since. We both smiled as Gracie kept asking to see Everly’s toes and saying, “Put her in car seat. We take her home now.” Everly patiently tolerated her countless kisses, toe tickles and lots of head patting. They’ve been each other’s biggest fan ever since.

Adoption is a journey. One filled with foreign paths, fear, disappointments and doubts. But watching my two girls, one dark and the other fair, bent over in belly-rocking giggles at the simple bliss of splashing together in a bathtub full of bubbles, I say with ardent assurance that the road they came by holds no regrets. The doors that didn’t open, the opportunities we couldn’t take, they led us all to their loving arms and slobbery kisses. If I lived two lifetimes I would never find adequate words to describe the debt. The small moments I’ve shared with their birth mothers are sacred. They gave our girls life. Then gave us the supreme gift to raise them in it.

Yes, adoption is a journey. Our journey. And the destination is so much better than we ever could have imagined.

Deann Kenaly’s Adoption Story

My husband and I started our domestic infant adoption journey with Gladney Center for Adoption in 2015. We attended classes in person and online, became CPR certified and had our lives and home dug deep into before becoming “ready to adopt.” The waiting was long and hard, until August 2016, when we got a call from CPS asking us to foster our nephews.

This changed everything for us. We were in line to have an infant, not 4 and 6-year-old boys. We soon became foster-certified and were willing to do anything we needed to do for these two boys to come live with us. We put our domestic adoption with Gladney on hold at this time. On November 16, 2017, we welcomed Joseph and Jesse into our lives forever and officially adopted them.

In March 2018, we were ready to continue our journey with Gladney. We had a few more bumps in the road along the way. On December 31, 2019, we got a call from our Gladney caseworker presenting us with a potential birth mom, which is something she commonly did, so not out of the ordinary. She told me the history and background of this little baby girl. She was already born on December 10, 2019, and she is healthy and beautiful. I immediately said, “Yes, please show this birth mom our profile book.” Our caseworker then said, “Deann, she is yours. The birth mom has already given up her rights and this perfect little girl is yours!”

I didn’t know what to do but cry tears of joy and repeatedly say, “Really, are you serious?” I was then able to call and share the news with my husband. That night we shared our happy news with the boys. With the New Year’s holiday and some paperwork that had to be completed we were able to pick up our little girl on Monday, January 13, 2020. We waited to tell our immediate family until the night before we picked up our little girl.

Monday morning came and we all got dressed up to go to Gladney to meet baby Stella and bring her home. We were ecstatic to finally meet and bring home our sweet baby girl. On July 10, 2020, Stella finally became an “official” part of our family. Although it was the longest journey ever, it was well worth it. Within 5 years we became parents to three wonderful children--Joseph, 10, Jesse, 8, and Stella, 9 months.

Claire Cartmel’s Adoption Story

We’ve always wanted to adopt. It’s been part of our conversations for years. My background of volunteering and working social services, combined with our love for children, made this desire a no-brainer. We struggled with knowing when the time would be right to grow our family through adoption. It’s hard to know when to hit the ground running toward a journey well known for its ups and downs.

After wading through mounds of paperwork, we became active in February of 2020 and matched with a mother due six months later. For reasons that are not my story to tell, that match failed, and we found ourselves back at the drawing board sad but hopeful.

The morning after we got this news, our social worker set up a phone call for us to talk with another expectant mother. Instead of a phone call at our agreed upon time, we got a text telling us to hang tight. We soon learned that the mother was on her way to the hospital, unsure if she was in labor. When it was clear that she was, we spent the next couple of hours packing, buying last minute things and trying to enjoy the unfolding journey. Our daughter was born the next morning as we traveled to meet her—22 minutes into our 8-hour drive, and just four days after the news of our failed match.

While 2020 hasn’t been the poster year for many things, it has been a particularly memorable one for us. Stay-at-home orders have afforded us more time with our family than we could have ever imagined. We finalized our adoption this summer and marvel daily at the precious gift that she is to our family.

“We've definitely seen a high number of adolescent suicide attempts over the past couple of months, especially during COVID-19,” said Kia Carter, M.D., medical director of psychiatry at Cook Children’s Medical Center. “We've also seen younger kids endorse suicidal ideation.”

At Cook Children’s, the vast majority of patients treated for self-harming are girls, typically between the ages of 13 and 15. But Dr. Carter says she’s had patients in her unit as young as 4 years old talking about wanting to die.

“We've seen a huge increase with younger kids knowing what death is because of video games,” said Dr. Carter. “We have to assess their cognitive level and find out if they know what death means or do they think it’s like the video game where they die, but get a backup player.”

So far in 2020, 192 kids have been admitted to Cook Children’s for attempting suicide. Compare that to the same time period in 2015 when the hospital saw 88 patients - less than half of the current statistics.

Unfortunately, the data from Cook Children’s Behavioral Health Center is in line with a new study from the Centers for Disease Control and Prevention (CDC). The article, released Sept. 11, shows suicide rates among 10 to 24 year olds have increased 57.4% from 2007 to 2018.

"It's a real trend that has been demanding, for a while, a serious public health and research effort to understand what is happening and why," said Anna Mueller, an associate professor of sociology at Indiana University Bloomington. In an interview with USA Today, Mueller said she doesn’t buy that it’s just social media, though we do know many children express anxiety and depression linked to social media.

“Social media plays a big role in the mental health of children and teens,” said Dr. Carter. “They experience bullying online, they may not feel self-worth because they’re comparing themselves to what they see on Instagram. They’re also getting ideas on the internet about how to harm themselves.”

Dr. Carter says social media and sites like YouTube have made self-harm almost acceptable. She says children are looking to those avenues to find out how many pills to take or other ways they can attempt suicide.

“A lot of kids will research how much medication to take to not wake up,” said Dr. Carter. “I would say 99% of the overdoses we see have some over-the-counter component.”

Since January, 31 children have been admitted to Cook Children’s for ingesting too much Benadryl. At least three of the Benadryl overdoses are linked to a TikTok challenge, but the majority of cases were among patients intending to harm themselves. Other drugs commonly found in medicine cabinets such as Tylenol, aspirin and ibuprofen are also frequently used.

So why do children and teens take these drastic measures?

“When people feel like they're not going to get better and there's no way out, they tend to go to these levels,” Dr. Carter explained. “I think the biggest thing is hopelessness. When kids feel like they don't have anyone to talk to, they don’t feel like they can communicate with their parents or they’re getting bullied and they don’t have a social circle. Some kids also are struggling with gender and sexual identity.”

About 30% of the children assessed by Cook Children’s Behavioral Health Center report issues with gender or sexual orientation. Among those are patients diagnosed with gender dysphoria, a feeling of discomfort or distress that can occur when someone feels their gender identity differs from their sex.

“There are some kids who physically don't feel comfortable in the body they're in and they don't feel that they relate to the other girls or the other boys. We see this occur a lot around age 10,” said Dr. Carter. “A lot of times parents feel like it's a phase, and that might be true, but I would encourage parents to not minimize it because kids can begin to feel hopeless.”

She suggests parents keep an open mind, listen to their children and get them in to see a licensed professional counselor. And she says it’s ok to not agree with their feelings, but to share those thoughts with your spouse or a friend instead of the child.

“If you're resistant to it, your child's going to shut down and that can cause a whole realm of depression, hopelessness and not wanting to be alive anymore,” she said.

With COVID-19 and social distancing, spotting signs of depression and hopelessness can be challenging. Things that may have seemed out of the norm in the past, like avoiding social activities, may not be so odd now. But Dr. Carter says watching for changes in behavior is still key.

“Most kids still want to play video games and have their cell phones, so if they don’t want a new video game and all they want to do is sleep, you’re going to want to assess where that change is coming from,” she said.

Other signs of depression to look out for include:

• Declining grades
• Lack of concern about appearance and hygiene
• Changes in eating and/or sleep
• Self-injury such as cutting
• Less motivation
• Alcohol/drug use
• Acting highly anxious or agitated
• Recklessness

If you feel your child needs help, please talk to your pediatrician or call 682-885-3917 for a referral to Cook Children's Behavioral Health Center.

“We’ve seen gun sales increase significantly nationwide over the past several months,” said Dan Guzman, M.D., a Cook Children’s emergency physician. “Now, with many children being in the home for longer periods of time, curiosity and boredom are something we need to expect. We have to stay vigilant and make sure we’re doing everything we can to prevent a tragic accident.”

According to Small Arms Analytics and Forecasting, this year’s gun sales have already eclipsed 2019 by more than one million firearms.

“With the hunting season about to begin in earnest and the presidential election season about to start in earnest as well, 2020 will without doubt exceed the previous high of 16.6 million units sold in 2016,” SAAF chief economist Jurgen Brauer wrote in an emailed statement provided to FOX Business.

Last year, 41 children were admitted to Cook Children’s for injuries related to guns (including handguns, rifles, shotguns and other firearms such as BB guns.) With 23 children already injured in 2020, Dr. Guzman fears he could see more of these patients this year than last.

“I think most people think this ‘won’t happen to us’ because we’ve taught our kids to never touch guns,” Dr. Guzman said. “But if you aren’t taking the proper precautions as the adult and parent, it’s probably only a matter of when, not if, your life may be affected by an unintentional discharge involving someone you know, and maybe even your child.”

Building awareness for gun safety is a passion for Dr. Guzman. He’s the medical director of the Aim for Safety program at Cook Children’s, which promotes firearm safety for children. The program, which has been featured in several news stories, is a multi-step interactive experience that provides parental awareness and teaches children the steps they should take when they encounter a firearm.

“As parents need to feel comfortable having open-ended conversations with others where our children may play and stay,” he said. “That includes family members and close friends. Don’t be afraid to ask if there’s a gun in the home and if so, how it is stored. Keep the conversation focused on safety and not politics.”

Dr. Guzman offers these safety tips:

The 3 Ts of firearm safety and children

Talk – This includes your family, neighbors and friends. When your child visits other homes, ask the owners if there are guns in their homes and how they are stored. Dr. Guzman said this question is not to be insulting, but to keep your children safe from unsecured firearms.

Teach – Have a conversation with your kids about what to do if they see a gun:

• Stop
• Don’t touch the gun
• Run away
• Tell someone

Take – Dr. Guzman is asking gun owners to take action and store their firearms properly. And, to take personal responsibility for our children’s safety.

Their journeys differ in many ways. Emily is a two-time cancer survivor who says she essentially ‘grew up’ at Cook Children’s, while Jason was diagnosed as a young adult. But both say they were so inspired by their experiences at Cook Children’s, they decided to return to care for patients and families who resemble their own stories.

For Jason, becoming a nurse was not even on his radar. At 20 years old, he was studying to become an opera singer at Oklahoma City University. At first, he thought the shoulder pain he was experiencing was the result of a boxing class he was in. Then the pain moved to his hips. After several visits to different doctors, Jason finally had bloodwork done.

“They discovered that my white blood cell count was crazy high,” he said. “They’re supposed to be about 6,000 and I think mine was 68,000 at the time of diagnosis.”

He was advised to go to Cook Children’s to see Karen Albritton, M.D., who specializes in teenage and young adult cancer. Luckily, Jason was already familiar with Cook Children’s since he grew up in Fort Worth.

“Finding out that the best place you can go is in your hometown was just serendipitous,” he said.

It was at Cook Children’s that Jason received the diagnosis of biphenotypic leukemia, a mixture of both acute myeloid leukemia (AML) and acute lymphoblastic leukemia (ALL). He spent a total of three months receiving chemotherapy and radiation for his cancer. During that time, genetic testing revealed he was highly likely to relapse if he didn’t receive a bone marrow transplant. In another twist of fate, he learned his only brother was a perfect match. Thanks to his sibling’s willingness to become a donor, Jason received the bone marrow transplant that would ultimately make him cancer-free on May 8, 2012.

“I ended up having my transplant on my 21^st birthday,” said Jason. “It's something I always joke about because whatever day you get your transplant is supposed to be celebrated as your second birthday, but I still only get one.”

To make his 21^st birthday even sweeter, Dr. Albritton arranged for three singers from the Fort Worth Opera to come visit him in the hospital.

“She really went above and beyond, and really, it was a very, very special day,” he said.

With the intense treatments Jason had to endure to fight the cancer, he wasn’t sure he’d ever be able to sing again. It had been a dream of his to become a professional performer since early childhood, but he feared his vocal chords had been permanently affected by the medication. But after beating cancer, Jason went on to finish his degree and even received a master’s degree in opera at the San Francisco Conservatory of Music.

“While I was doing all of that, it just felt like something was missing. I had thought about becoming a nurse when I was in the hospital,” Jason explained. “So I went back to my other love and honestly, I've never been happier than I am right now as a nurse. And especially at Cook Children’s, being able to work at the hospital with some of the people who treated me, and being there for these kids the way the nurses were there for me. I've gone home crying happy tears multiple days because I just feel so lucky.”

He says he loved his doctors, but the nurses held a special place in his heart.

“The nurses are the ones who are with the patients most of the time, and it was the nurses who really took care of me when I was at my sickest,” said Jason, his voice cracking as he spoke. “When I was in the most pain, when I couldn't stand or sit, they made my treatments bearable. I actually got to tell one of them that she specifically was the reason I wanted to become a nurse, because of all the ways that she helped me when I was a patient.”

Much like Jason, Emily says the nurses left a big impact on her, though she was much younger when she was diagnosed.

“I spent the majority of my childhood fighting cancer at Cook Children's,” said Emily. “In November of 2001, when I was almost 4 years old, I was diagnosed with Wilms' tumor. I had my kidney removed with my tumor. That was the size of a youth football.”

For Emily, the treatments lasted many years. She relapsed twice and had to have additional surgeries on her lungs and diaphragm, all followed by chemotherapy and radiation.

“Cook Children's quickly became my second home and somewhere that I felt safe,” she said. “I thought this was normal. Cook Children's made it feel fun, like something that I didn't have to do, but it was just part of life.”

She has especially fond memories of the Hematology/Oncology infusion center where she would receive treatments as an outpatient.

“The clinic was like a sanctuary for me. It was somewhere that I felt safe and where there was other kids like me who were bald and had ports and IV poles. That's where I would make most of my friends,” said Emily. “The clinic nurses always were a blast, playing music and giving out prizes. And Child Life made sure that even though we were there for hours, that it was always fun.”

In 2004, Emily received an autologous stem cell transplant and was deemed cancer free. She was on the mend until middle school when she developed a second cancer in her thyroid, likely due to heavy treatments from her first cancer. She had her thyroid removed and she was once again cancer free. She says even then, she knew she wanted to take care of children. When Emily went to college, she considered going to medical school to become a doctor, but quickly realized nursing was her calling.

“I love interacting with people. I love having relationships with people. I love being very hands on,” she said. “I felt like a doctor does all of those things wonderfully, but I felt like as a nurse, I could do all of those things more prevalently.”

She applied to Cook Children’s nurse residency program, but knew the competition would be strong. Out around 600 applicants, only about 5% would be accepted into the 12-month program.

“I knew that working at Cook Children's was a privilege and an honor, and I just had to tell myself that it may not happen right away, but I'll get there someday,” Emily said. “When I got the phone call from the manager of the nurse residency program, I think I cried as soon as she told me who she was. I didn't know if it was going to be a yes or no, but I still cried. As soon as she gave me the offer, I accepted it right on the spot. I think I said yes a hundred times. My mom was in the car with me and we both bawled after I hung up because it just came full circle.”

Both Emily and Jason say they want to work on the Hematology/Oncology floor where they were patients, but also understand the need to keep an open mind since placements for nurses at Cook Children’s are never guaranteed. After rotating through several departments for six months, Emily recently received her permanent placement. She’s officially a nurse in Hematology/Oncology.

“That kind of sealed the deal and it all made sense to me. The plan that God has for my life… all that I went through wasn't just something to go through. It had meaning,” Emily explained. “I always say that I wouldn't go back and change it, because it's allowed me so many opportunities to help other people and, now, children like me.”

Jason, who just began the program in July, is currently rotating through the Hematology/Oncology (H/O) floor. He hopes at the end of his six month rotation, he’ll be joining Emily.

“It's a very special population,” said Jason. “And the nurses just all care so much. I mean the whole staff, everyone cares so much about these kids and just work so hard for them and work so well together because of that common passion. And it's just really special to be here.”

“All of these children presented to the hospital with symptoms that resembled a severe case of Kawasaki disease,” said Nicholas Rister, M.D., an infectious diseases physician at Cook Children’s.

Kawasaki disease is an illness that creates inflammation in blood vessels with no proven cause, but is generally thought to follow various infections after they have otherwise resolved. Dr. Rister said the patients with MIS-C arrived at Cook Children’s following exposure to COVID-19 and had symptoms including fever, abdominal pain and outward evidence of inflammation including diffuse rashes, conjunctivitis and swelling. In the more severe cases, evidence of multi-organ dysfunction including respiratory distress, low blood pressures, liver and kidney damage and altered mental status were also seen.

“Of particular concern to us is inflammation of the heart and surrounding major blood vessels which is also seen in Kawasaki’s disease. We have seen this same thing in several of these COVID inflammatory disease patients,” explained Dr. Rister. “Minimizing the degree of inflammation in these children, while providing supportive care for any organ damage, has been a key component of treatment.”

All four patients were tested for COVID-19. Three tests came back negative and one was positive.

“We believe all of these cases are related to COVID-19,” said Dr. Rister. “The three negative results are evidence of how far the infection had progressed, resulting in the inflammatory syndrome.”

Three of the patients have been released from the hospital. One remains in the pediatric intensive care unit.

In addition to the recent appearance of MIS-C cases, the infectious diseases team at Cook Children’s is also looking closely at increased reports of unexplained fevers in our area.

“We want parents to be aware of these cases as COVID-19 continues to spread in our community,” said Dr. Rister. “Unexplained fevers for several days and evidence of generalized inflammation may be signs of this illness.”

Symptoms of more severe MIS-C cases include severe abdominal pain, shock from low blood pressure, respiratory distress and lethargy. If your child exhibits any of these symptoms, seek emergency medical care immediately.

Less severe symptoms include fever, abdominal pain and rash. Caregivers should call their pediatrician if these symptoms appear, as they overlap with many other common infections and medical conditions. It is important for these children to be fully evaluated.

Lauren, who was diagnosed with leukemia in 2017, said Poehler was funny, encouraging and relatable. For about 40 minutes, the two talked about their families, favorite TikTok videos and staying at home during quarantine.

Since being diagnosed with cancer, avoiding germs and public places has become a part of life for Lauren. Poehler asked the teen if she had any advice for those of us who are struggling with the new changes in the world.

“You find the things that calm you down and relax you,” explained Lauren. “Spend time with your family, that’s what I do and it’s got me through some bad times.”

The teen also told Poehler about her dreams of becoming an anesthesiologist, which she attributes to her experience as a surgery patient at Cook Children’s.

“Medicine is so cool,” Poehler told Lauren during the chat. “I’ve talked to a lot of kids who have to go through a lot of procedures and they get interested in medicine because they have experience with it that a lot of young people don't, and they see how they could make a difference. It's really cool.”

Lauren asked Poehler questions about everything from her career path to what it’s like being an actress and comedian. She also asked Poehler what inspires her. Her answer: working mothers.

“Moms who have to work and raise kids, especially during these times. There’s a lot of mothers who are working hard,” Poehler said. “I’m also very inspired by health care workers who are in the trenches and can’t see their own families because they have to be safe. I’m very inspired by people who put their lives on the line, risk their lives for people.”

Last month, Children’s Miracle Network Hospitals named Poehler a CHANGEMAKER, which is an exclusive list of celebrities, influencers, corporate leaders and advocates who have positively impacted children’s health. According to the organization, the individuals and groups named have made a difference in the health and well-being of children, specifically sick and injured children treated at children’s hospitals across North America. 

This is the daunting statistic looming over the heads of the team at the National Marrow Donor Program at Cook Children’s. Each day, this dedicated group of six sets out to see how many people they can enroll in the National Marrow Donor Program, also known as the Be the Match registry. Equally as important, they’re also tasked with contacting, scheduling and counseling donors who have been identified as a likely match.

“We have the potential to save anyone’s life,” said Jamie Kayser, the program’s director. “It’s not just blood cancers, the donors we identify also save the lives of patients with diseases like sickle cell anemia. We find donors for both adults and children.”

For Kayser, her work is more than a job. She’s one of the millions of people who have been deeply affected by cancer.

“When I was 27 years old, my first husband died of leukemia,” she explained. “He underwent two bone marrow transplants over the course of his treatment. I was not a nurse at the time, but going through it with him, I realized how important nursing was and I decided I was going to become a nurse.”

At the time, Kayser vowed to never work in oncology or in a bone marrow transplant unit. She ended up doing both. Her first role was as an oncology bone marrow transplant nurse at Cook Children’s, which she accepted in 1994. Seven years later she took over her current position as the director of the National Marrow Donor Program at the hospital.

“I say I’m doing the other side of transplant,” Kayser said. “There’s the side where the patients receive the bone marrow transplant and then there’s this side where we register donors, find matches for patients and get them ready to give.”

The National Marrow Donor Program is a nationwide registry. For those enrolled, the chance of being identified as the best possible donor for a patient is one in 300.

“There are two ways to donate depending on what the patient’s doctor requests,” explained Kayser. “The most common way is very similar to giving blood.”

Seventy-five percent of donors are asked to provide blood stem cells through a peripheral blood stem cell donation (PBSC) donation. This was the case for 21-year-old Andrew Kozman of North Richland Hills, Texas. He knew the chances of being identified as a match were rare when he signed up for the donor registry in late 2018. During his PBSC donation, he said he was shocked to receive a call just three months after he submitted his cheek swab in the mail.

“You always hear about the people who have been on the list for years and have never received a call,” said Kozman. “I was fortunate to get a call just months later. Everything has moved pretty quickly since then.”

To prepare for his donation, a nurse visited Kozman’s home for five days ahead of the appointment and injected him with a drug called filgrastim. The medication increases the number of blood-forming stem cells in the bloodstream. On the fifth day, blood is drawn and circulated through a machine that filters out the stem cells. The remaining blood is returned to the donor.

“It was just like getting a normal flu shot. I felt a little sore afterwards, but that’s it,” said Kozman. “I never really gave it a second thought. I signed up and found out that someone needed my help. I thought ‘I could sit in a chair for a few hours if it’s going to save someone’s life.’”

The second way to give is through a surgical procedure called a marrow donation or harvest. Only 25% of donors are asked to provide blood stem cells in this manner. This procedure is done at a hospital while donors are under anesthesia.

“Unfortunately, there is a lot of misconception about bone marrow harvests,” said Gretchen Eames, M.D., medical director of Hematology/Oncology and Stem Cell Transplant Program at Cook Children’s. “It is considered a minor surgery. There is no incision; no stitches or sutures are needed.”

During a marrow donation, blood stem cells are withdrawn through two small punctures in the back of the donor’s pelvic bone. Discomfort during recovery varies from person to person, but Dr. Eames says donors are usually able to manage any pain with Tylenol or hydrocodone. Most people will make a full recovery within a week.

Rebecca Proctor joined the National Marrow Donor Program registry in 2014 when she was a college student. Now a Neonatal Intensive Care Unit nurse at a Fort Worth hospital, she was also surprised to receive a call informing her that she was a match for a patient in need of a bone marrow transplant.

“I was definitely a little nervous when I first got the call,” said Proctor. “After agreeing to a marrow donation, I would have days here and there where I would panic. But I knew if this was going to save someone’s life then I could do it.”

Dr. Eames performed the procedure on Proctor at Cook Children’s, which is one of two bone marrow collection centers in Texas and the second busiest center in the U.S.

“We do approximately four to six bone marrow harvests a month,” said Dr. Eames. “Our donors come from all over the place. Many of them live here in the Dallas/Fort Worth area, but we have people who travel here from California, the east coast and the Midwest because they do not have a national marrow donor collection center where they live.”

For Proctor, the process was much easier than she anticipated.

“Besides a minimal amount of soreness, this really hasn’t been a bad recovery,” she said two days after her donation. “There’s some hoarseness in my throat from the breathing tube, but honestly, this is nothing compared to what my recipient has been going through.”

While donors don’t know who they are giving to, they are likely of the same ethnic background since donors and patients need to be a close genetic match. Given the current makeup of the National Marrow Donor Program registry, the likelihood of finding a match for a white patient is 77%. African American or black patients only have a 23% chance of finding a match.

To improve these odds, ethnic diversity among people on the registry needs to increase. To put it simply, more people are needed to join the registry.

“Everyone, when they turn 18 years old, should sign up for the National Marrow Donor Program registry,” urged Kayser. “We believe every patient should have an equal opportunity to find a match, regardless of their ethnicity.”

To increase those odds, Kayser’s team hosts booths at live events in North Texas as well as West Texas to enroll potential donors. They answer questions, collect information and cheek swabs.

Proctor, like most donors, encourages others to join the registry. Having gone through the process herself, she says she is glad she was able to help someone in need.

“This is something I am so proud to say I have done. Looking back, I would do it again in a heartbeat.”

"There are a lot of patients who need specialized care or even higher levels of care and it’s really important that in this rapidly growing community that we have that available to these families," said Dr. Hogan, pediatricitian at Cook Children's Pediatrics Prosper Trail.

Dr. Hogan is one of 24 Cook Children's pediatricians currently treating patients in this region of North Texas. She says patients like hers need a place to access specialized and emergency pediatric care without having to drive 30 minutes to an hour away from home.

"A lot families have hardships and are not able to drive that far, or take off work all the time to go to these visits, and having this inpatient hospital and specialized care right her will make it easier for all the families," Dr. Hogan explained.

Construction of Cook Children's Medical Center North is in the initial phases with plans to have a full service hospital completed in 2022. The new hospital will be located on a 23-acre site in Prosper at Windsong Parkway and Highway 380. Having started in October of last year, phase one is already underway with plans to open a primary and urgent care clinic in the fall. An outpatient surgery center and specialty clinic with imaging and lab services will open in 2020.

"I'm really excited about the hospital opening up and being able to refer my patients to specialists, right here in Prosper, and being able to send my patients to get the specialized care that they need, having higher levels of care right across town," said Dr. Hogan. "I think that is going to be really wonderful for the families here."

Currently, Cook Children’s operates eight primary care offices in and around the Town of Prosper. The expansion near Windsong Ranch marks the first time in Cook Children's 101 year history that a full-service hospital has been built outside of Fort Worth.

"Just like the Town of Prosper is family, a close knit community, so is Cook Children’s," said Dr. Hogan. "We are all here wanting your children to be healthy and do better in life and be able to get the care they need to grow up to be happy and healthy adults."

It may sound like a melee, but this is part of a unique program that launched last fall at the Jane Justin School at Cook Children’s Child Study Center. The program began as a R.A.D. self-defense course and has since evolved into a curriculum called ‘Hard Target.’ The 12-hour class teaches self-defense to students with developmental and learning disabilities in the Center’s Upper School.

On this morning, four female students are participating in a drill. The scenario includes being attacked at an ATM and sadly, because of their disabilities, it’s a situation they’re more likely to find themselves in than the average person.

“We know that individuals with developmental disabilities are three to five times more likely to become victims of bullying, assault and sexual assault,” said Joyce Elizabeth Mauk, M.D., CEO and medical director of the Child Study Center.

According to a recent investigative series by NPR called ‘Abused and Betrayed’, the rate of sexual assault among people with intellectual disabilities may be even higher. Reporter Joseph Shapiro said in his report that unpublished data from the U.S. Justice Department shows people with intellectual disabilities are sexually assaulted at seven times the rate of people without disabilities. His series calls the issue an “epidemic.”

The concern surrounding these statistics sparked an idea with the Child Study Center’s team. What if they taught students how to defend themselves, especially during the transitional years when students are preparing to go out into the world to seek employment and possibly even live on their own? Dr. Mauk and her team contacted Security Services at Cook Children’s, which already provided self-defense courses to employees. Together they developed a curriculum specifically tailored to the needs the school’s students, aged 13 to 22.

“The most important thing we want these students to learn is how to protect themselves,” said Brennan McCullars, ‘Hard Target’ instructor and security services trainer at Cook Children’s. “These are people who are much more vulnerable to predators than the majority of the population. They are often trusting of others. They don’t always know what behaviors are inappropriate, so we have to work on that.”

One of the girls in McCullars’ class is 18-year-old Elizabeth. She’s a soft-spoken junior at the Child Study Center’s school where she also interns as a teacher’s aide. She’s small in stature and supportive of her classmates, cheering them on as they move through the course. When it’s her turn to approach the “ATM” – a punching pad leaned against the wall – Elizabeth transforms. There’s no reservation in her voice as she belts out ‘’NO!” and blocks incoming hits. She throws eight punches before sprinting away from her “attacker.”

When asked what she thought of the course, Elizabeth said she feels more confident now.

“In self-defense class, they taught us how to use our voice and how to use our hands and our feet (against an attacker),” said Elizabeth. “It has eased my concerns because I know I can protect myself when my brothers and my support system are not around.”

For Elizabeth’s father, Lonnie Ramon, these new skills are just one more tool in her toolbox. He and his wife believe Elizabeth will be able to live and work independently. He says he feels better about her future knowing she’s had to think through what should be unthinkable situations.

“It’s a crazy world nowadays. You see too many weird and crazy things on TV. People take advantage of others and I’m afraid of that,” said Ramon. “But that’s part of this self-defense course. It’s helping her think about how to get herself out of situations, God forbid they ever arise.”

Along with the four females, a group of eight male students are also going through ‘Hard Target.’ All of the students who complete the class will have a chance to take a refresher course next school year.

“We are excited to offer this one-of-a-kind curriculum,” said Tracie Mann, Ph.D., LBA, the headmaster of the school. “The ‘Hard Target’ program demonstrates our unwavering commitment to preparing our students for the future, both academically and in life.”

Targeted cancer therapies are biologic or immunologic drugs or agents that target cancer cells in the body while leaving most healthy cells alone. These drugs have become a common treatment option for adults with certain types of cancer and, in recent years, clinical trials have shown success for some childhood cancers.

“Targeted therapy is the future of pediatric cancer treatment,” said Dr. Vallance. “Being able to offer more targeted therapy through clinical trials means Cook Children’s cancer patients will have access to the newest treatments available.”

The oncology team at Cook Children’s diagnoses approximately 220 new cancer cases each year. Approximately one thousand patients undergo active treatment or follow up through Cook Children’s each year.

The grant money awarded by St. Baldrick’s will be used to fund a Targeted Therapeutics Program Coordinator. Under direction of Dr. Vallance, this person will coordinate and collaborate with consortiums and pharmaceutical partners to open new targeted therapy clinical trials at Cook Children’s.

“We’ll be able to efficiently open more trials, which will give all patients in North Texas and surrounding areas access to leading edge clinical trials closer to home,” Dr. Vallance explained.

Cook Children’s is one of five hospitals in Texas, and the only hospital in North Texas, selected to receive a portion of $2.26 million dollars in infrastructure grants awarded bySt. Baldrick’s this year. All of the grants awarded will support groundwork for childhood cancer research.

The St. Baldrick’s Foundation is the largest private funder of childhood cancer research grants worldwide. Since government funding for childhood cancer research is limited, research institutions like Cook Children’s depend on private organizations like St. Baldrick’s for support in finding new cures and treatments.

“The majority of childhood cancer patients are treated on a clinical trial,” said Kathleen Ruddy, CEO of St. Baldrick’s. “Research relies on enrolling large numbers of patients on clinical trials to ensure results are meaningful and advancements are made. Funding from St. Baldrick’s will ensure more kids have access to clinical trials, giving them a better chance at survival and a future with less long-term effects.”

The infrastructure grant awarded to Cook Children’s is the first step in the creation of a formalized Targeted Therapeutics program.

“As this research continues for all types of childhood cancer, we will see more opportunities for each child and young adult to receive personalized, targeted therapies as part of upfront standard therapy,” said Dr. Vallance. “Hopefully, this will lead to higher response rates, less toxicities and more cures.”

Oehlert is currently a clinical operations manager at Cook Children’s and one of the more than 250 Cook Children’s employees who will be honored this Veterans Day.

Like many people in healthcare, Oehlert was inspired to pursue a job in nursing after a traumatic life experience. In her case, it was the brain aneurysm her mother suffered when she was 13 years old that set her on her path. For two and a half months, Oehlert learned tips from the nurses on how to help her mother recover while doctors worked to reduce the swelling in her skull. She received her LVN while still in high school and, like her father, enlisted in the Air National Guard at the age of 17.

“I was a health service technician, aka a field medic. We trained to take care of casualties either in the field or in a hospital setting,” said Oehlert.

Though most of her service was here in the United States, she was deployed overseas several times. She was sent to Saudi Arabia twice, but luckily never encountered combat.

A separate deployment to Landstuhl, Germany left one of the biggest impressions on her.

“Landstuhl was the first echelon of care that one would receive after being injured in the field,” she said. “I was working on the orthopedic floor during the time the Battle of Fallujah was happening. We were always full. The majority of the injuries were from IED (Improvised Explosive Device) blasts. We saw everything from amputations to broken appendages.”

While taking care of their physical wounds was her main objective, Oehlert also spent a lot of time talking to the service members who found themselves in Landstuhl. She said many didn’t know how to process what they had been through, so she would often sit with them and listen to their stories.

“It just kind of became natural because I’m the kind of person who always asking ‘how’s it going?’ and you could just see that some of them needed to talk about their experiences. It was part of the healing process and a way to make sure they weren’t closing themselves off,” Oehlert explained.

Another life-changing experience came when she was called on to help unload the body of a fallen service member from a rotator.

“I’ll never forget the first body I took off a plane. They’re still bloody and dirty from the battlefield. You’ll never forget those men,” she said in a somber tone. “You always have respect for putting on uniform, but you have even more respect when you see what the individuals down range have been through.”

After 26 years of service, Chief Master Sgt. Oehlert retired last year. She says she still struggles with considering herself a veteran, but is starting to grow into the role. In fact, she is one of the founding members of Cook Children’s newly formed Veterans Group, which aims to increase awareness and recognition for veteran and military families within Cook Children’s.

“I think it’s going to help not only our own employees realize how many military members are at Cook Children’s, but our patient families who may not even know how many of us are helping to take care of their children,” she said.

She is especially protective of Riley when looking out for her well-being. She’s on vegetable alert. Remember the peas and broccoli pizza? Disgust also acts as Riley’s social situation monitor, helping her make new friends.

So what really is the value in our children's everyday lives of feeling disgusted? To feel disgust, means we are offended by something, or have an extreme dislike.

When was the last time you said, “That’s disgusting!”? Was someone acting in a way you felt was inappropriate, or was there food on your plate that you truly didn’t want to eat? We can see disgust acted out in kids all the time.

Food sometimes just has to look like it doesn’t taste good, for them to turn up their noses and say, “yuck, not eating that!” Think about all the times you’ve tried to get your child to take medicine that they refuse, or spit back out at you. Those may not seem like the most positive examples, but they’re probably the most realistic. But, if disgust is protective, then it may also keep your child from eating something they shouldn’t, such as bugs, plants or medicine that’s not theirs.

Disgust in the role of acceptable social behaviors has the potential to be very important. If we teach our children there are certain values that are important, and morals to follow, they have the potential to be offended (disgusted) when behaviors opposite to their values are displayed. It may keep them from getting involved in substance abuse, risk taking actions and becoming sexually active. If disgust helps them to live up to the expectations they know are important, then it plays a very positive role with the voices inside their heads.

Disgusted behaviors aren’t always the most positive if you look at sarcasm, being snarky and generally thinking they know everything. We may laugh when we see children react to situations with some level of egocentrism, except maybe when they are our children and we think they’re being rude. So, lesson learned, how children (and adults) display their disgust is important. Just like anger, it’s OK to feel disgusted, but there may be certain behaviors that are unacceptable, such as throwing peas, when we are expressing our disgust. Providing examples of what is acceptable behavior when disgusted, such as using words, not actions, is definitely a teachable moment.

Disgust, in all her green-ness in Inside Out adds a certain level of humor that is probably better understood by adults because it’s subtle and mature. But, don’t we all want to have a little bit of her humor in our heads every day? I know I do.

Related 'Inside Out' topics:

• Sadness
• Fear

About the author

Jill Koss is director of Family Support Services and Child Life at Cook Children's. We know that a child’s illness or injury can impact a family physically, emotionally and financially. Fortunately, you don’t have to face these challenges alone. We provide a growing number of services for patients and families, all designed to help support, heal and encourage you through every step of your journey.

The flu season is upon us once again ... what do you need to know as a parent?

1.What are symptoms of the flu?

The flu may start like the common cold with symptoms of cough, congestion and runny nose, but may also be associated with prolonged fever, muscle and body aches and fatigue. It is spread from person to person when an infected person, coughs, sneezes or talks and droplets are released into the air. It can also be spread less often from touching surfaces where drops are present. The flu virus is contagious from up to 1 day before the person presents with symptoms and up to 5-7 days after the symptoms resolve.

2. How can you protect yourself?

The best way to protect yourself is by getting the flu vaccine as soon as it becomes available. Most doctors’ offices and clinics currently do have the flu vaccine available. Last year, flu activity peaked at the end of December to the beginning of January, but you may start seeing it as early as September-October this year.

Other means to protect yourself are effective hand washing and wiping down surfaces with anti-bacterial/viral cleansers.

3. Why get the flu vaccine?

In the United States each year, more than 200,000 people are hospitalized from seasonal flu-related complications. Last year, there were more than 105 pediatric flu related deaths in the United States. On average the effectiveness of the flu vaccine last season was about 61 percent.

4. Who should get the flu vaccine?

• Everyone over the age of 6 months.
• Higher risk populations include those between the ages of 6 months to 5 years, children with asthma or other chronic disease, pregnant women, people with immune problems and adults  more than 65 years old.
• Children under the age of 8 MAY require 2 doses of the vaccine 4 weeks apart from each other depending on their previous immunization status.

5. Which flu vaccine is recommended?

There are several options for flu vaccines this year. For 2014–15, U.S.-licensed influenza vaccines will contain the same vaccine virus strains as those in the 2013–14 vaccine.

Trivalent flu vaccine protects against two influenza A viruses (an H1N1 and an H3N2) and an influenza B virus. This is only available in the injectable form.

The quadrivalent flu vaccine protects against two influenza A viruses and two influenza B viruses. The quadrivalent form is available as an injection and a nasal spray.

Specific Age Recommendations

• 6 months to 2 years: injectable flu vaccine only.
• 2 years to 8 years: nasal form is preferable according the Centers for Disease Control and Prevention (CDC). There was 50 percent more effectiveness with the nasal form vs. the injectable form in this age group. If the child is between the ages of 2 and 4 and has asthma or wheezed in the last year, then the injectable form is recommended.
• 8 years and above: either form is acceptable.

6. What happens if you get the flu?

See your health care professional as soon as possible because if it is treated with anti-viral medications in the first 48 hours, the duration as well as the severity of the illness can be decreased. The CDC does not recommend treatment of healthy individuals with anti-viral drugs, but certain high risk populations will benefit from treatment.