Future doctors make their mark at sites across Cook Children’s Health Care System, where they engage with patients, conduct research and practice their clinical skills.

From the outpatient clinics to the operating rooms and Emergency Department, medical students at Cook Children’s are shown the best practices of pediatric health care in hands-on experiences beyond the classroom.

There were almost 900 medical student rotations from four medical schools at Cook Children’s in the 2023-2024 school year. Students at one of those schools, the Anne Burnett Marion School of Medicine at Texas Christian University (TCU), are placed at Cook Children’s at least once during their four-year education

For primary training in the various medical specialties and surgery, the Burnett School of Medicine at TCU uses a unique and innovative model designed to provide long and potentially broad encounters with the same patients over an extended period.

Hannah Fouts Smitherman, M.D., Pediatric Clerkship Director at the Burnett School of Medicine at TCU, works in the Emergency Department (ED) at Cook Children’s Medical Center – Fort Worth. Because she has roles in both organizations, she has a unique vantage point for recruiting her hospital colleagues as preceptors, another name for teachers.

“The relationship with Cook Children’s is so pivotal, and our preceptors are amazing educators,” Dr. Smitherman said. “We really couldn’t do it without them.”

Before Nicole Jamieson, M.D., graduated in May 2024, she honed her research know-how by analyzing data related to a specific endocrine disorder, alongside Don Wilson, M.D.

Dr. Jamieson also spent time in Cardiology; Hematology/Oncology; Ear, Nose and Throat; and the Neonatal Intensive Care Unit (NICU). She observed how physicians, nurses, dietitians, child life specialists and other staff take a team approach.

“I learned so much about what it means to take care of the whole child and the whole family,” Dr. Jamieson said. “I was inspired across the board by how they make the child feel comfortable, the families feel comfortable. Everyone goes above and beyond to make sure everyone feels understood.”

Construction has wrapped up on the new Burnett School of Medicine medical education building named Arnold Hall just a few blocks from our medical center at the corner of South Henderson and West Rosedale streets. Welcoming the medical school to the Medical Innovation District, we want to spotlight the track record of collaboration between TCU and Cook Children’s. Here’s a closer look.

Research and Specialties

During the 2023-2024 academic year, students from the Burnett School of Medicine at TCU contributed across Cook Children’s:   

• 20 students in Special Projects & Thesis research
• 44 students immersed with hospitalists, NICU and Pediatric Intensive Care Unit
• 27 students in outpatient clinic rotations lasting 40 weeks
• 55 elective rotations in 34 pediatric specialties
• 4 students in psychiatry, neurology and trauma surgery  

One notable example of surgery instruction: two TCU medical students were present in the operating room during the complex and history-making separation of conjoined twins in January 2023.

“We start students seeing patients from Day One so they can start to assimilate the anatomy and physiology they’re learning in the classroom,” Dr. Smitherman said.

She mentors students in the Cook Children’s ED, where they learn to do resuscitations by shadowing the staff. Many parents appreciate the chance to share their point of view, she said. And some children in the ED enjoy showing off their injuries.

“I explain that they’re helping train a doctor, and they puff up with pride,” Dr. Smitherman said.  

Deep and strong ties form between the preceptors and the medical students they mentor.

“It’s a true apprenticeship that fosters the development of the whole physician. They’re not just teaching the skills – it’s the professionalism, it’s how the office works. They get to know the office staff and the families because they get to see repeat patients,” Dr. Smitherman said.

Sandra Peak, M.D. trains TCU medical students at Cook Children’s Pediatrics Lewisville-Castle Hills for 40 weeks. Students see continuity when patients come more than once for routine checkups and sick care. A student might meet a 2-month-old baby, for instance, and then see the same baby again at the 4-month, 6-month and 9-month visits. 

What’s one memory that sticks with her? Seeing an amazed look of understanding when a student in her clinic heard pneumonia in a child’s lungs for the first time.

“His face got concerned, and it was like watching the moment the student become a doctor. It was like a shooting star,” she recalled. “The students bring fresh eyes to things you’ve seen as a doctor over and over again. It’s hard not to be inspired by people who are that excited.” 

Empathetic Scholars®

The Burnett School of Medicine at TCU aims to instill compassion and an aptitude for communication in its students, an approach the school calls Empathetic Scholars®.

Dr. Jamieson said she saw empathy displayed in the Cook Children’s NICU. She remembers in particular one NICU patient who didn’t have family support.

“The nurses and physicians and every ancillary staff loved on this baby and treated him as if he was their own,” she said. “They made sure he was receiving optimal care. People advocated for him as if his family was there.”

Grace Newell, M.D. did research and rotations at Cook Children’s before graduating from the Burnett School of Medicine at TCU in 2023. Her two research projects – in conjunction with Christos Papadelis, Ph.D. and Scott Perry, M.D. – dealt with aspects of epilepsy. The research ignited her passion for child neurology. 

Spirit of Collaboration

James Marshall, M.D. serves as a professor and the academic chair of Pediatrics at the Burnett School of Medicine at TCU. Most of the approximately 300 faculty members in his department are Cook Children’s physicians – including Dr. Marshall, a Pediatric Critical Care Medicine subspecialist.

Dr. Marshall highlighted the scholarly output that results from the four-year research projects the TCU students conduct at Cook Children’s and other sites. Students develop a hypothesis, pursue the research with the one-on-one assistance of a mentor, and even have their work published or presented nationally. 

“Young people just have that mental plasticity and the time and opportunity to develop questions with physicians,” Dr. Marshall said. “That coming together of young minds and trained wise minds is just super fertile.”

Students aren’t the only ones who value the relationships that develop during medical education. Preceptors appreciate the chance to nurture the up-and-coming doctors. They tell Dr. Marshall that mentoring gives them joy and keeps them sharp. 

The only way to guarantee a steady supply of health care professionals is to train them, he pointed out. There’s still work to do, but Dr. Marshall predicts North Texas will be a leader in forming and retaining the medical professionals of tomorrow. 

“Cook Children’s and the Burnett School of Medicine at TCU have collaborated beautifully on an incredible elevator ride. Who knows where the top is together with the other health care systems in our region?”

As students gear up for summer break, it’s not too early to get a physical or the immunizations they’ll need before school starts again in August.

Incoming kindergarteners and seventh graders are due for routine vaccinations. Junior high and high school students need a physical before they can participate in athletics or marching band.

Cook Children’s neighborhood health centers and pediatric offices can help your family check these items off your to-do list. Make an appointment early in the summer, come in for the required shots or a physical examination, and beat the back-to-school rush.

Amy Medalie, RN, MSN, CPNP advises parents not to postpone scheduling those visits. She wants children and teens to stay on track for their vaccines – or get caught up if they’ve fallen behind.

“This is a topic we talk about all day,” said Medalie, a nurse practitioner at Cook Children’s Neighborhood Health Center Richland Hills. “I tell parents that vaccinations are our best defense at helping prevent illnesses.”

Vaccines to protect against certain contagious diseases – including measles, polio and chickenpox – are safe and effective at stopping the spread. The boosters required in Texas for kindergarten and for seventh grade can usually be administered in one visit to your pediatrician or neighborhood health center.

Before the final school bells ring this May, here’s a quick look at a few key points.

Immunizations

The 2024-2025 Texas Minimum State Vaccine Requirements chart lists in English and Spanish the number of doses that students need. If an incoming kindergartener has missed out on vaccines normally given at age 4, these additional vaccines are due now:

• MMR (measles, mumps and rubella)
• DTaP (diphtheria, tetanus and pertussis)
•  IPV (inactivated poliovirus)
•  Varicella (chickenpox)

And between the ages of 11-12 years, these additional vaccines are due:

• MCV4 (meningitis)
• Tdap (tetanus, diphtheria and pertussis)

How do vaccines work? If someone who’s been vaccinated comes into contact with that infectious disease, their immune system has already been primed to respond, Medalie said.

“Vaccines teach our bodies to recognize a certain bacteria or virus. If a person is exposed to those bacteria or virus, the immune system is already prepared to fight off infection,” she said.

Sites across Cook Children’s offer a Comfort Menu of items that help patients relax and feel less of a pinch when the needle goes in. Children can request cold spray or a buzzy tool on their skin for comfort and distraction. 

Medalie and her colleagues are happy to answer any questions to provide families with accurate information and reassurance about vaccines.

Sports Physicals

Early summer is also an ideal time to come to Cook Children’s for the physical exam UIL requires before participation in school athletics and activities such as cheerleading and marching band. The form contains two parts:

1. Medical history – a list of yes/no questions about headaches, dizziness, chest pain, seizures, allergies and more. This portion must be filled out every year by the student and parent or guardian.
2. Physical exam – performed by a health care professional to check the student’s lungs, joints, vision, weight, heart rate, blood pressure and more. UIL requires the physical exam before the 7th, 9th and 11^th grades. Some school districts require it annually.

The provider checks one of three options on the form: cleared for participation, cleared after completing additional evaluation or rehabilitation, or not cleared due to concerns.

Medale said the physical exams can identify issues such as irregular heartbeat, vision problems, spine curvature or uncontrolled asthma. A referral might be needed for follow-up testing, such as an electrocardiogram (EKG) if a possible heart rhythm disorder is noticed.

Sports physicals give also teens the chance to ask questions or report any problems that might impact their ability to practice or compete safely. Medalie urges her patients to speak up if something feels off … shortness of breath or a lingering sprain for instance.

“Be honest with yourself and your parents about how you’re feeling, so that you’re not just pushing through something that can contribute to reinjury,” she said.

As a mom, Medalie has seen in her own teens the endurance it takes for marching bands and drill teams to perform in the Texas heat. Connecting with student athletes for physicals early in the summer gives her the chance to remind them to stay hydrated, avoid excessive caffeine, and don’t skip meals.

9th Annual Slime-A-Doc

Ahead of National Doctors' Day on Saturday, March 30, we are celebrating our doctors with some fun! 

On Wednesday, Cook Children's employees, patients and patient families helped us celebrate with some slime in our 9th annual Slime-A-Doc. We had five categories of participants: doctors, nurses, child life specialists, advanced practice providers and members of our administrative team. Watch the Facebook Live here. 

Thank you to everyone who participated! A big shout-out to Martin Aguado and the Facility Appearances team for making this event possible!

The medical professionals were separated into two teams, one for each girl. Those in purple scrub hats belong to JamieLynn’s squad, while Team AmieLynn dons the green. Everyone worked together until the babies were separated, then each team focused solely on their assigned baby.

We want to acknowledge and celebrate the individuals who successfully performed this historic surgery at Cook Children's! 

• Chandra Reynolds, M.D., lead anesthesiologist
• Cole Carrillo, CRNA, lead CRNA

Team A (JamieLynn)

• Jose Iglesias, M.D., primary surgeon
• Daniel Lodwick, M.D., first assistant
• Ben Gbulie, M.D., plastic surgeon 
• Syma Monzales, RN, Coordinator
• Sarah Shaabani, RN
• Darrell Wortham, CST
• Claudia Hernandez, CST
• Imad Yamout, M.D., anesthesiologist
• Michael Gonzalez, CRNA
• Raul Guerrero, anesthesia technician

Team B (Amie Lynn

• Marty Knott, D.O., primary surgeon
• Chad Hamner, M.D., first assistant
• Eric Hubli, M.D., plastic surgeon
• Sarah Doyle, RN, coordinator
• Kristen Cherry, RN
• Brittney Fuentes, CST
• Tania Gonzales, CST
• Gavin Fine, M.D., anesthesiologist
• Paul Downing, CRNA
• Daniel Jones, anesthesia technician

Team C (backup on standby)

• Hailey Hanson, RN
• Jamie Gomez, RN
• Rosa Leos, RNFA
• Diana Bravo, CST

Neonatologists

• Chad Barber, M.D.
• Mary Frances Lynch, M.D.

Written by Ashley Antle. 

All babies are special, but 16-week-old twin sisters JamieLynn Rae and AmieLynn Rose Finley are making history in one of the most unique ways possible. On Monday, they became the first conjoined twins ever to be separated at Cook Children’s Medical Center in an 11-hour procedure months in the making.

Conjoined twins are estimated to occur in only 1-in-200,000 live births. JamieLynn and AmieLynn are omphalopagus twins, meaning they are joined at the abdomen and share one or more internal organs. In their case, it’s a liver.

“As far as conjoined twins that reach and stay viable after birth, at least for the first few days, there's really only about five to eight of those per year on the entire planet, so it is very rare,” said Jose Iglesias, M.D., Cook Children’s medical director of pediatric surgery.

Even so, the girls’ story begins like many others.

James Finley and Amanda Arciniega of Saginaw, Texas, wanted to add one more baby to their family of five. The youngest of their three children at the time, 7-year-old James, was elated at the prospect. He’s always wanted a younger sibling and playmate.

Little did any of them know — or expect —their hope for one more would become a gift of two.

“She said that's the baby's head,” Finley said, describing how their obstetrician shared the unexpected news of twins at their 10-week ultrasound. “I was like, ‘What is that?’ and she said, ‘That's the other baby's head.’ And I was like, ‘What?’”

Double Blessing

The revelation of the twins' connection came early in the pregnancy. The 10-week ultrasound showed the babies had little to no separation between them. Images taken at the following appointment confirmed the babies were conjoined. Suddenly, the family’s excitement for welcoming two new additions was covered by a cloud of questions, uncertainty and fear. 

“I would not have thought in a million years that I would have twins,” Arciniega said. “And then conjoined twins on top of that.”

In the months that followed Arciniega enjoyed an easy and uncomplicated pregnancy, save for the many appointments with specialists across the state to determine who best to deliver the twins and what hospital was most capable to care for them after birth.

The couple settled on maternal-fetal specialist Bannie Tabor, M.D., whose practice is located at Texas Health Harris Methodist Hospital Fort Worth in Fort Worth, Texas. He is also the medical director for Cook Children’s Fetal Center. In his 32-year career of caring for high-risk pregnancies, Dr. Tabor has delivered more than 5,000 babies.

Soon after taking Arciniega and her unborn babies as patients, Dr. Tabor reached out to Dr. Iglesias, a longtime colleague, to review the case and discuss the possibility of separation.

“It was a big surprise when I got the first phone call from Dr. Tabor saying he had conjoined twins that he was starting to follow,” Dr. Iglesias said. “At that time they really didn't know the babies’ anatomy specifically. So I said there is a big range of possibilities and we need to see what happened with the initial MRI to make some plans from there.”

Many conjoined twins die in utero or do not survive long after birth because of the nature of their joining and the organs they share. But scans showed JamieLynn and AmieLynn each had their own heart and heart sac, increasing their chance of survival and making them candidates for future separation.

“I think the key thing when we first met the family was they had a lot of anxiety about the situation, what the options were and what they could do,” Dr. Tabor said. “I think I gave them the confidence that, while I could not promise everything would work out, we would do everything that we could and, with everybody involved — from me to the neonatologists to the surgeons — they were in the right place.”

Family Ties

Texas Health Harris Methodist Hospital Fort Worth and Cook Children’s Medical Center have a long history of physical and professional collaboration. Both facilities are located in the heart of Fort Worth’s Medical District along a historical stretch of Pennsylvania Avenue that cattle barons once called home. The two facilities are joined by a skywalk and, in Cook Children’s early days, even shared some utilities. Local neonatologists practice at both hospitals’ neonatal intensive care units (NICUs) and many Texas Health Fort Worth obstetricians, including Dr. Tabor, regularly consult with Cook Children’s pediatric specialists.

“The working relationship between the whole team, that's made possible by the close relationship of the hospitals, allows us to be the center that can provide this type of highly advanced service to North Texas so families don’t have to go halfway across the state or halfway across the country or even to Dallas for care,” Dr. Tabor said.

Early in the pregnancy, Finley and Arciniega also consulted Ben Gbulie, M.D., F.A.C.S, of Posh Plastic and Reconstructive Surgery in Mansfield, Texas, and a member of the plastic surgery faculty at Cook Children’s. They learned of Dr. Gbulie through Finley's mother, whose friend told her of a local plastic surgeon with experience in multiple conjoined twin separation surgeries.

After long discussions with the couple, he pointed them toward Cook Children’s Medical Center.

“I explained to them that traveling for surgery is not a problem, and a lot of people do that,” Dr. Gbulie said. “But if you can get the same quality of care where you live, it's always better because you want to be able to have long-term follow-up. While this is a major, complex operation, it is not something that is beyond what I felt Cook Children’s could do.”

Finley and Arciniega were relieved to hear Dr. Gbulie’s recommendation. The family lives less than 30 minutes from Cook Children’s. To know that they could stay close to home, close to their other children and close to their support system was comforting.

Cook Children’s was also familiar. Two of the couple’s older children have received care at the medical center. Their daughter, Aaliyah, 13, spent weeks in Cook Children’s pediatric intensive care unit (PICU) when she was 7 for a nearly deadly bacterial infection called Bartonella henselae. It’s commonly known as cat scratch fever and can be acquired when scratched by a cat. Big brother, James, is a frequent visitor to Cook Children’s as he manages sickle cell disease. 

“Sometimes we come in here and I’m like, ‘Hey, I’ve seen you before,’ to a doctor that has been around our son or Aaliyah, and they’re like, ‘Hey, I’ve noticed you, too,’” Arciniega said. “So it’s kind of like we’re family here.”

“Everybody’s always treated us nice,” Finley added. “It takes a lot of pressure and anxiety off when you know your kid is going to be taken care of.”

Delivery Day

As the babies grew in utero, Dr. Tabor closely monitored their progress and, together with a team of doctors from both hospitals, prepared a delivery and post-natal game plan. During Arciniega’s third trimester, Dr. Tabor became concerned with the slow growth rate of the babies and determined it was best to deliver them early.

On Oct. 3, 2022, at 34 weeks gestation, JamieLynn and AmieLynn were delivered via C-section at 10:40 a.m. at Texas Health Fort Worth. Arciniega required a vertical incision over the traditional horizontal approach to delivering the babies safely. Both weighed 4 pounds, 7.8 ounces. JamieLynn was the longer of the two, measuring 16.9 inches to AmieLynn’s 16.5 inches.

“It wasn’t an easy delivery, but we made it look easy,” Dr. Tabor said reflecting on that day.

Upon delivery, neonatologists Chad Barber, M.D. and Mary Frances Lynch, M.D., took over the babies’ care in Texas Health Fort Worth’s NICU. Like with any set of identical twins, telling them apart can be tricky and, if mistaken, dangerous in the hospital setting. To help keep their identities straight, Dr. Barber and Dr. Lynch chose a favored color for each girl, purple for JamieLynn and green for AmieLynn, and used Sharpies to mark each baby’s color on one of their nails.

After a month, the girls were transferred to the NICU at Cook Children’s Medical Center where they remain today, still under the care of Dr. Barber and Dr. Lynch who practice at both Texas Health Fort Worth and Cook Children’s. The girls’ color codes followed them there, too, and are used as an additional layer of safety when identifying the babies for medication administration, feedings and individual care needs. They even inspired the purple and green crayon costumes the girls sported for Halloween.

Home Away From Home

In the NICU room, which has been their babies’ home since November 2022, Finley and Arciniega attend to their infants like many other parents of twins — together. It takes two to pick them up, especially considering how they must navigate the tubes and wires that monitor the babies’ vitals and deliver nutritional support. Scripted signs handmade by the NICU nurses hang on the wall, making their private NICU room look a little more like a sweetly appointed home nursery.

The girls lay face-to-face on their sides, carefully and frequently repositioned from one end of their shared crib to the other in order to give equal time on each side. Although currently the smaller of the two, JamieLynn is wide-eyed and alert. Her gaze fixes on and follows those that enter the room. She’s feisty and makes sure everyone knows when she is unhappy. Sister, AmieLynn, is more reserved. She’s often the calmer and more chill of the two.

Together, the beloved girls evoke the attention of their parents who make sure there are enough cuddles and kisses to go around, especially from their protective dad. He’s already planning ahead for the days when young men come calling for any one of his three daughters.

“Every window will have a rose bush underneath,” Finley said with a laugh, but only half kidding.

Their days in the NICU are filled with feedings, naps, diaper changes, baths and a number of therapies to help with mobility, strength and eating. The girls respond especially well to music therapy and love it when Grandma sings to them during her visits. Their siblings, brother Isaiah, 15, Aaliyah and James, visit regularly, too. James loves to entertain them, and the girls respond with delight.

Their face-to-face positioning makes feedings and diaper changes a challenge, but nurses have developed creative workarounds to accomplish both. Most of the time they can be bottle-fed one at a time by a single caregiver, with AmieLynn often waiting patiently until sister is satisfied. When patience runs out, feeding is a two-person job.

The older they get, the more they move their limbs. It’s not uncommon for one to unintentionally punch and sometimes anger the other. The girls wear mittens to protect each other from scratches.

All the while doctors monitor their progress, study their anatomy and plan for the enormous task of separation. 

Journey to Separation

The timing of conjoined twin division varies from case to case and primarily depends on how complicated the anatomy is. In the girls’ case, their anatomy and growth support a surgery date sooner rather than later.

While the girls are thriving in the NICU, they are not growing at the same rate, partly because they share some blood supply.

“One is stealing groceries from the other, basically,” Dr. Barber said.

AmieLynn is beginning to develop scoliosis. Feedings are becoming more and more challenging with their size, mobility and face-to-face proximity. While separate, their hearts are exceedingly close together and grow ever closer as the girls age.

“They're pretty much at their maximal, I like to say, baby stretchability,” Dr. Iglesias said. “So their skin is pretty stretchy. Their abdominal walls are stretchy. We've got the benefits of using that. By separating early, they're not going to be as used to the loss of having essentially part of you that is different, so hopefully, that transition will be better. There are not very many more benefits to waiting longer versus doing it now.” 

At nearly 4-months-old, the time is right.

It’s taken months of planning and collaboration. Countless hours have been spent building a comprehensive medical team, studying scans of the girls, building models of their anatomy, mapping out potential surgical solutions, identifying the what-ifs, troubleshooting potential problems, inventorying equipment needed to accomplish the surgery, preparing the operating room (OR) and rehearsing the carefully choreographed surgical production. Dr. Barber estimates there have been at least 100 medical professionals, from physicians to nurses to therapists and other clinical specialists, intimately involved in the girls’ care and surgical planning.

“I think the teamwork is a great point to bring up because it's everything,” Dr. Iglesias said. “It takes a huge team to get all of this working as smoothly as you can make it, given the unknowns that we'll have. Having everybody open and honest talking to each other regardless of their position, that's the definition of teamwork.”

The surgery comes with great risk and a number of unknowns. Because they must dissect the liver, an extremely vascular organ, bleeding is a concern. A significant risk of infection also exists, for which the twins will be monitored weeks into recovery. Doctors are unsure of how the babies’ hearts will respond to their new anatomic position as the girls lay on their backs for the first time in their lives. Then there are questions about how to best close the abdominal wall, many of which can not be fully answered until separation is accomplished. The girls may require additional surgeries to complete closure and reconstruction.

“In order to prepare for this, it's a lot of practice, practice, practice and more practice, trying to really think of every possible scenario so that we're not surprised by anything,” Dr. Barber said. “There's always going to be unexpected things, but if you're prepared for the worst possibilities and the most unlikely outcomes, then you can hopefully not get too caught off guard.”

For their part, mom and dad pray, leaning on the same faith in God that carried them through when their older children faced medical crises.

Separation Day

Monday, Jan. 23, 2023. JamieLynn and AmieLynn are ready for their big day. Thanks to their NICU nurse, they’re sporting fresh mani-pedis in their signature purple and green to help identify them in the OR.

Before the sun rises, family and members of the medical team gather in the girls’ NICU room. It’s calm and quiet as mom and dad steal a few final pre-surgery kisses from their babies. Grandma sings softly. Others pray. The girls are awake, content and comfortable. Just before 7:30 a.m., they begin their journey to the OR.

Inside the OR is a sea of medical professionals: three anesthesiologists, four pediatric surgeons, two plastic surgeons and about a dozen other clinical professionals. They are separated into two teams, one for each girl. Those in purple scrub hats belong to JamieLynn’s squad, while Team AmieLynn dons the green. Everyone will work together until the babies are separated, then each team will focus solely on their assigned baby.

“The reason that's important is because you need focus,” Dr. Gbulie said. “You want to minimize room for errors and the risk of confusion. So little things like color-coding everyone and everything minimizes the risk of giving the wrong medication on either side. It's truly a community effort that involves a multi-specialty team.”

The first few hours involve inserting central lines for delivering anesthesia and placing breathing tubes. Then, sedation begins. The process is slow and methodical.

“When we're talking about taking care of conjoined twins compared to taking care of just a single baby, one of the biggest questions is what is shared, and there does seem to be some shared circulation between the girls,” said Chandra Reynolds, M.D., the lead Cook Children’s anesthesiologist on the surgical team. “What is the response going to be for baby B when we give baby A certain medication? It’s a very slow and stepwise approach until we better understand what happens to one when the other receives medication. The key thing is to give one baby a certain amount of medication, watch and wait for a while to see how things are going and, based on that response, we can give her sister a certain amount as well.”

Once the girls are safely asleep, the surgeons begin marking incision lines. At 12:28 p.m., the separation officially begins. Guided by plastic surgeons, they are careful to make cuts that give the girls’ abdomens the best chance of closure.

First, surgeons open the abdominal wall and dissect the lower part of the sternum and the liver. A little under two hours in, the family receives word that the girls’ shared liver is separated. The private waiting area where the family anxiously awaits news of progress erupts with cheers. Finley and Arciniega embrace.

Surgeons painstakingly work layer-by-intricate-layer until they reach the backside of the abdominal wall where they complete the dissection.

The update everyone’s been waiting for comes at 3 p.m. JamieLynn and AmieLynn are officially separated and on their backs. Tears and shouts of praise flow from family and friends in the room. Their relief is palpable.

“I want to tell you that all of the people in there taking care of them cheered even louder than this,” said the nurse delivering the news, followed by laughter from the family.

There is still a long way to go.

“Once the babies are finally physically separated, then we have to initially look for other additional anomalies and see if there is anything else going on,” Dr. Iglesias said. “We transfer one baby to the other bed where one surgeon will follow and an additional surgeon will pick up with the other and continue to do the evaluation.”

Once each baby is ready for closure, their assigned pediatric surgeons, Dr. Iglesias for JamieLynn and Marty Knott, D.O, for AmieLynn, begin closing the chest and abdomen. Plastic surgeons Dr. Gbulie and Eric Hubli, M.D., Cook Children’s Surgeon in Chief and medical director of craniofacial and cleft surgery, assist with skin closure.

By 6 p.m., the surgery is complete. This time Dr. Iglesias, Dr. Gbulie and Dr. Knott deliver the news to the family.

“We did it,” Finley said in response. “I don’t know what I did, but we did it.”

To this Dr. Iglesias replies, “You trusted us. That’s what you did.”

All the while, neonatologists Dr. Barber and Dr. Lynch stand by for the girls’ post-surgery return to the NICU.

One by one, the sisters exit the OR on their way back to their familiar home away from home in the NICU. For the first time in their lives, they lay on their backs, each in their own crib. The family gets a momentary glimpse from afar as the girls are wheeled past the waiting room, and cheer them on as they pass. About an hour later, mom and dad are able to join the girls in the NICU.

The first look at their twins in separate beds brings a wave of emotion. For the first time, they must divide their attention between the two. They start with JamieLynn. Arciniega places her pinky finger in her baby’s hand.

“It’s OK, Mommy’s here,” she whispers.

Then to AmieLynn. Finley gushes about her strength and how proud he is of his quiet fighter.

It’s a monumental moment, but none of the physicians are ready to say “mission accomplished.”

“The challenges the girls may face after surgery are very difficult to fully prepare for,” Dr. Lynch explained. “We do still have some unknowns as far as how their shared vasculature and their shared anatomy and positioning over these last three months will affect them. As Dr. Barber alluded to earlier, we have to prepare for many different scenarios. The things that will worry us and that we’ll be the most focused on in the first few days are going to be breathing support and pain control. As you can imagine, this is an incredibly big surgery and pain control will be at the top of our list.” 

They’ll be watching for signs of infection, too.

“The soft tissue usually swells over the first two to three days,” Dr. Gbulie said. “If you get through those two to three days, you're usually OK. That being said, we are going to be going through potentially some bowel and definitely the liver, so there is a relatively higher risk of wound infection and that usually shows up at about five to 10 days.”

Road to Recovery

Recovery is best described as slow.

“I'm sure mom and dad are going to think we're moving in slow motion,” Dr. Iglesias said. “The first steps are going to be healing of the very large incision that is required to separate them. We have to wait for their gut to start to work before we start allowing nutrition to move through their intestines. Some of these things may require staged procedures so the family's ready that the abdominal closure may take more than one operation. We're hopeful it won’t, but that's a possibility.”

They’ll need extensive rehabilitation, too, which will include nutritionists, physical therapists, occupational therapists, speech therapists and more.

Doctors say they’re optimistic but will continue to hold their collective breath until they are waving goodbye to the girls as they leave Cook Children’s for their first ride home.

“I'm very hopeful that they're going to have a good recovery and lead healthy lives in the future,” Dr. Iglesias said. “They're going to have a bit of a ramp up from the recovery, but I think they're going to be able to get there eventually, and very close to normal if not completely normal.”

Until that chapter of this story begins, JamieLynn’s sassy spirit and AmieLynn’s sweet smile remain on full display as their NICU team continues to care for their daily medical, physical and emotional needs. This time, together, but separate.

Cook Children’s is a not-for-profit organization. Donations to Cook Children’s Health Foundation allow us to care for our families when and how they need us. Give today to support patient families like Jamie and Amie. Go here. To donate items at the Medical Center for Jamie and Amie, email AandJ@cookchildrens.org.

This pediatrician has watched your mental battles from the sidelines this year, Mama.

2020 was not an easy year to be a mom.

Personally, I can tell you it kind of sucked, right? Just a little. The pandemic brought about so many hard choices that NO mother should ever have to make. My brain’s stream-of-consciousness ran a little something like this:

“Should I let my kids play with other kids? Will they get sick if they do? Will not interacting with others harm them more than catching COVID will? Should we start in-person school? Will masking all day be hard for them? Is virtual school a better option for us? Will looking at a screen all day hurt my kid’s eyes? Will lack of interaction with peers lead to social regressions? Are my kids eating and snacking too much? Do I need to choose between my kids seeing their friends, and my kids seeing their grandparents? Is my child in his room too much? Is he exercising enough? Is he sad too often? Is social media going to influence his behavior? Is it normal for sleep to be this much of a struggle – for both me and my kid? Am I telling my kids to wash their hands too much? Will this give them a germ complex? What do I tell my kids when they see those protests on the street? What do I tell them when they see the news on TV? What do I say when they hear people angry and shouting at each other?”…and so on and so forth…over and over…and for me, usually happening at 3 a.m.

So now that you know that I worried about a lot of the same things you did, let’s talk.

This Mother’s Day I’d like to tell you about what I’ve seen and heard in the privacy of my exam rooms.

More anxiety than I’ve ever seen in my career. In both parents and kids.

More depression in children and teens.

More mental crises.

More weight gain.

More screen addiction.

More sleep problems.

More suicidal thoughts.

Momming has never been more difficult. Not only have we been burdened by our own mental struggles, but we’re trying to cope with our kids’ mental strain now more than ever.

Some advice:

1. “Put on your own oxygen mask first – and then help your children with theirs”. Take care of yourself so that you can then throw that energy into your child and his/her struggles.
2. Look for help – Cook Children’s pediatricians, psychologists, and psychiatrists and hospital staff are here for you. We know kids - especially the mental health of kids. Check out the new Cook Children’s JOY Campaign for TONS of resources.
3. Please, ask questions. If your kid is struggling, ask your pediatrician – will some socializing be okay? Should my kiddo return to school/ go to camp? Is it safe? What are the pros/cons? What is the risk by doing this activity or that one? How much screentime is healthy for my kid? Is this behavior normal, or is my teenager showing signs of a problem? What are some resources so I can learn more?
4. Look into counseling. At my office EVERY DAY I tell parents: every single human on the planet goes through a time in their life where they’d benefit from therapy. Do it. Don’t feel weird about it. Just go talk to someone – and take your kid to talk to someone. Psychologists are trained to help you through this.

From one mom to another: we are not meant, as humans, to deal with as much stress as we have in the past year and come out unscathed.

There’s a reason you keep hearing the word “unprecedented” when it comes to 2020 and 2021. The pandemic, the politics, the civil unrest - this was a year that no one anticipated, and no one was prepared for. Know that you’re not alone in what you or your child may be dealing with.

So put down your armor, you warriors. And reach out your arms and accept some help! And give yourself a little grace.

This year was a scary and painful mess. And this Mother’s Day, no matter how much you yelled at your kids, no matter how much you felt you didn’t have the answers, and no matter how much you questioned your decisions, I want you to pat yourselves on the back. Because just surviving has been the victory here. And you’re doing the best you can.

“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.”

Dr. McGehee, seen here with his daughter Brigid, became a stepfather of two younger girls 15 years ago, after his own four children were nearly grown and out of the house. He feels like the commitment he keeps to his wife, Pam, is what makes him a better father of a strong family.

“I know, to some, it sounds like it defies common sense to say put the children second,” Dr. McGehee said. “But, I think you have to have a strong marriage and a strong bond between the husband and wife. From there, everything grows from the love in that relationship. If the marriage is solid, the kids will benefit.”

That strong relationship between spouses will also be needed, Dr. McGehee said, with the extra challenges that come from being a stepparent.

Children of divorce often have emotional issues, sometimes of abandonment and sometimes of anger against the new father. Dr. McGehee said the parents need to have a unified front in dealing with their kids.

“You have to eventually find that place where you trust the stepparent and their objectivity,” Dr. McGehee said. “The stepparent can look at things with fresh eyes and without some of the emotional entanglement that may be there with the biological parent and the children. Hopefully, the biological parent will find that objectivity helpful.”

And then there’s one more relationship that Dr. McGehee feels stepdad has to at least attempt to make – with the biological dad.

“We have something in common – the relationship with the kids,” Dr. McGehee said. “I would hope that we are both trying to love and nurture the child. You have to try to get along with each other, eventually you will have things like graduation and weddings to attend together. You may not ever be friends, but you should at least be colleagues in raising a child. All the parents involved should have the same goals for the child – making them a happy, healthy and successful person.”

With the rates of burnout and suicide in physicians at shocking levels, it’s important that we continue to talk about the satisfaction and mental health of physicians. There are systemic issues at hand that lead to the situation that we are in. In her article “Physician burnout is physician abuse” for kevinmd.com, Dr. Pamela Wible has said that, “Burnout is physical and mental collapse caused by overwork. So why are we blaming the victims? The fact is medical students and physicians are collapsing because they are suffering from acute on chronic abuse.”

There are systemic issues that lend itself to the state that we are in. Many physicians are over-worked and over-stressed. And, it’s not just the grisly 30-year career doctor who is tired that feels burnout, medical students report high levels of emotional exhaustion as well.

There are various numbers in studies but the most recent available studies show symptoms of burnout in 40-50 percent of respondents. It’s a shockingly high number, especially those on the outside looking in. Doctors often appear to have it all together and they can make a great living.

So what’s there to be dissatisfied about? It’s not that simple. Demands to see more patients, giving up less control of our lives and other factors can make what should be a rewarding profession very frustrating.

All this is true and we need to continue to talk about it and continue to search for systematic changes that can lessen the burden on physicians

But, I love my job.

I love going to work every day.

I love the deep relationships I have with my patients and their families.

I love the relationships I have with my staff.

I love the other roles I have carved out within my health care system - Cook Children’s in Fort Worth.

Are there difficulties and frustrations?

Sure. Nothing is perfect but currently, for me, the good far outweighs the bad. Because of this, I walk into and out of work feeling energized and excited about the challenges rather than exhausted.

I certainly don’t think it’s because of anything inherent in me that has allowed me to continue to love my job. Is it just the confluence of good circumstances? Good luck? A great system to work for? Yes, but I’ve also fought to change the system in ways that make life better for myself and others. Maybe I’m just too young and burn out is just around the corner? (Although studies show that people with much less experience than me are already burned out.)

Any of those are probably partially true. But, just like the difficulty in pinpointing the reason for burnout is tricky, pinpointing the reasons for physician satisfaction would be difficult as well.

This post floated through my head for months. I hesitated to put it to paper. How would it be received? Is it trite? Would it be slammed for minimizing the problems?

It’s possible it could be all of those things. I hope not. I hope instead that it is seen as encouragement for those out there that love their job and for medical students and trainees who hear the burnout statistics and wonder if they’ve chosen the right field.

Those of us who aren’t burned out need to listen to those who are.

Together we could take their concerns and our energy and make medicine a fulfilling career for compassionate and empathic people again.

I have been having conversations with some very energetic pediatric leaders and recording them for a new podcast. I hope that you’ll find some piece of their story encouraging: https://soundcloud.com/pediatricleadership

About the author

Justin Smith is a pediatrician and the Medical Advisor for Digital Health for Cook Children's in Ft. Worth, TX. He has an active community on both Facebook and Twitter as @TheDocSmitty and writes weekly for Cook Children's checkupnesroom.com. His interest in communications started when he realized that his parents were relying more on the internet for medical information. He believes that strategic use of social media and technology by pediatricians to connect with families can deepen their relationship and provide a new level of convenience for both of their busy lifestyles. Dr. Smith’s innovative pediatric clinic, a pediatric clinic “designed by you,” is set to open in Trophy Club in the Fall of 2016.

The vaccine is only in the beginning stages and part of ongoing research, so it will not be available to the public any time soon. But if a vaccine does become available, it has the potential to be a lifesaver for children across the world.

NBC News reports that a team at the National Institutes of Health has genetically engineered a virus that should be safe and effective against RSV, which kills 200 U.S. children a year and hospitalizes 75,000 more. RSV can lead to several types of diseases, ranging from a cold to pneumonia.

So how big would this be? Mary Suzanne Whitworth, M.D., medical director of Infectious Diseases at Cook Children’s says a vaccine that can prevent RSV will be a difference maker for all of us.

“In terms of preventing hospitalizations, emergency room visits and outpatient clinic visits, it would be huge for infants and toddlers,” Dr. Whitworth said. “Everyone has RSV at least once in the first two years of life. It may just be a minor cold or it could progress to involve the lungs and cause wheezing. We then acquire it regularly throughout our lives as some of our winter colds. In older children and adults, who are generally healthy, it is just a mild respiratory tract infection. But we are all impacted in some way by RSV.”

A new vaccine for RSV is the latest in a line of vaccines that have helped fight against diseases such as the flu and the whooping cough. Dr. Whitworth hopes that this latest medical breakthrough serves as a reminder of the importance of vaccines and why the medical profession seeks them out.

“Scientists all over the world dedicate their lives and careers to developing vaccines because they feel passionate about preventing disease and death,” Dr. Whitworth said.

In the meantime, Dr. Whitworth says families can help prevent the spread of RSV through good handwashing, cough hygiene (covering your mouth with your elbow), using tissues, etc.

About the source

Mary Suzanne Whitworth, M.D. is the medical director of Infectious Diseases at Cook Children’s, which offers care for children and teens with diseases caused by bacteria, parasites, fungi or viruses. Our team provides a broad range of services including diagnosis, inpatient and outpatient consultations, immune deficiency evaluations and treatment of recurring infections.

Along with this goal of each child’s attendance, we have to balance the goal of keeping others safe from infectious diseases. Our contagious students need to stay home when they are sick to keep the rest of their classmates safe. (This is why I don’t really care for perfect attendance bike raffles. I prefer responsible attendance.)

Balancing these tensions is often hard for the parent, the school and the pediatrician because we often don’t know exactly when a child is no longer contagious. This is why I got so geeky excited last week to see a new study released in the Pediatric Infectious Disease Journal about the contagiousness of strep throat.

The study looked at 111 children with strep throat over two days.

Day 1: Children who tested positive for strep were given their first dose of amoxicillin before 5 p.m. (They also had cultures taken which allow to see if bacteria will grow from a swab of their throats.)

Day 2: Children were retested and cultured for strep in the morning to determine if they still carried the bacteria in their throats.

Here is what they found:

• 101 children tested negative for strep on the morning of day 2.
• 7 children had significantly decreased growth of bacteria from their throat cultures.
• 2 children continued to have high loads of bacteria.

The author’s conclusion: “all children treated with amoxicillin for streptococcal pharyngitis (strep throat) by 5 p.m. can, if afebrile (fever free) and improved, may be permitted to return to attend school on day 2.”

I’m pretty sure you’re not as excited as I am, but THIS IS HUGE!

Based on current guidelines, children must be treated for 24 hours before being allowed to return to school. If we treated according to the results of this study, it would allow for the child to be back in school and for the parent to be back at work a whole day earlier.

I feel like there is a lot of work to be done in this area and this type of study, along with other models of health care delivery, are good examples of the work that will be necessary.

Because I value education and our school districts so much, I want to be constantly thinking about ways we can do this better. As a general pediatrician, I can really boil down the goals of my job to these:

1.Keep kids growing and healthy.

2.Keep kids developing and learning.

Early in your baby’s life, this looks like frequent checkups for preventing illness, monitoring growth (and talking about diet) and teaching ways that parents can help their child with development. (Read: Everyone should homeschool.)

As your child gets older and starts school, my role changes a little bit. I don’t ask my elementary age patients about fractions or my high school students about “The Great Gatsby.” Instead, I might ask, “How is school going?” “Any problems I need to know about?” “Any way I can help?”

On a practical level, this means offering school aged children after school appointments when possible. It means getting sick kids in the same day so that we can start treatment and get them back in their desks as soon as possible.

In the future, this may mean totally different modes of delivering health care and working with the school and school nurses in order to decrease missed class time.

But I’m getting ahead of my geeky self again. I’ll save that discussion for later.

Over the summer when I started to wonder if my soon-to-be first grader was having trouble seeing, I shocked myself (and my wife) by actually picking up the phone and calling to schedule him an appointment to have his eyes checked.

Our poor little guy was having to get up to walk over to the TV to check the score of the Rangers and was asking mom what time it was from the back seat, when he used to give us grief every minute we were late for church.

Here are three tips that might alert you to a vision problem in your child:

1. Sitting too close to the TV

2. Eye rubbing or watering

3. Squinting, closing one eye or tilting their head to see better

If you aren’t sure or have concerns, get your child’s eyes checked.

Vison screening should also be a part of school age checkups for your child. I have picked up plenty of kids with vision problems for which parents had no concerns.

Fortunately, we got our son checked out and in glasses just in time for the Rangers to make their second-half run. (Maybe it’s not such a bad thing he couldn’t see very well before the All-Star Break.)

Now that you’ve identified your child’s problem and he or she requires glasses, here are some tips for getting your child to actually wear them.

1. Make glasses cool. Talk positively about them at all times.

2. Make glasses routine. It’s just part of the day. On in the morning, off at night.

3. Make glasses helpful. Point out how much easier things are when your child can see.

4. Make glasses comfortable. Don’t pick out an uncomfortable pair and make sure the fit is right.

Watch the video below for five key facts about diarrhea that every parent needs to know in only a minute. 

In today's video, Doc Smitty explains:

1. What are the common causes?
2. How long can it last?
3. When are the symptoms more than a stomach bug?
4. When do you call your pediatrician?
5. What are the biggest risks?

Learn the answers to these questions. It only takes a minute.

Here's why:

There has been an outbreak of severe flu among dogs in the Midwest. Cases of the H3N2 strain have now been seen in dogs in Texas.

Most dogs have cough, runny nose and fever, but it has been severe and resulted in death in some.

So you may be wondering, “Is my child at risk if our dog has this flu?”

The answer, according to the CDC:

“To date, there is no evidence of transmission of canine influenza viruses from dogs to people and there has not been a single reported case of human infection with a canine influenza virus.”

That’s fortunate, but what are some health dangers associated with pets?

Bites

I’ve seen too many severe dog bites in my training to not mention bites first. The most common statement I hear about the dogs who bite is, “We just never thought he/she would do that.”

Dogs can be a great addition to a family but use caution:

• Be careful of rough play. Even a playful snip can be dangerous if it happens near the eye or a fingertip.

• Stay away from dogs when they are likely to be defensive: when they are eating, sleeping or taking care of puppies.

• Stay away from unfamiliar dogs or dogs that seems scared or anxious.

Here are some more tips from the ASPCA on how to avoid dog bites.

Allergies/Asthma

This is actually one of the most common questions I get regarding animals. It’s very intuitive. People can be allergic to dogs and cats, so wouldn’t owning one increase my child’s risk for allergies?

I have seen several studies that suggest the exact opposite. Often by having animals in the house early, kids may have slightly decreased risk of developing allergies. That said, if your child has frequent allergy and asthma symptoms, it may be reasonable to attempt to isolate the animal from the child for a bit to see if symptoms improve.

Infections

Infectious diseases are transmitted through animals frequently; think about the number of diseases that tics and mosquitoes can carry. Although it can happen, they are less frequently transmitted from pets.

Here is a list of pets and some of the diseases they can transmit:

Cats

Cat-scratch fever:

This disease is caused by bacterial infection (Bartonella) of an open wound or a bite that results in the breaking of skin. It is more commonly transmitted by kittens than older cats. Symptoms of the infection in humans are fever, headache and fatigue. There is often a large and tender lymph node near the site of the bite.

Toxoplasma:

Toxoplasma is usually a foodborne illness, but can be transmitted from cat feces. In people with normal immune systems, there are often no symptoms of toxoplasmosis. Pregnant women (and fetuses) are especially susceptible and, for that reason, should not handle cat litter boxes.

Dogs

Hookworms:

Dogs infected with hookworms can have bloody stools; which in severe cases can lead to anemia. Humans are infected by walking barefoot on contaminated soil and develop an interesting rash which consists of red, squiggly lines where the larvae have migrated under the skin.

Reptiles

Salmonella:

Salmonella is one of the most common pet-associated infections. It is estimated that 70,000 people will contract salmonella from pet reptiles. Salmonella generally causes bloody stools but in children and in people with weakened immune systems can be serious. The CDC recommends that houses with children less than 5 and with any household members with weakened immune systems not own reptiles as pets.

Many Animals

Campylobacter:

Ingesting food contaminated with the bacteria transmits most infections of campylobacter, but cases can occur from the handling of dog or cat feces. The main symptom of campylobacter infections is diarrhea (which can be bloody) and usually lasts about one week.

Ringworm:

The fungus that causes can be transmitted from many different animals but most commonly occurs from puppies and kittens. The appearance of the rash on human skin is a circular rash with a raised edge. It can be difficult to distinguish from eczema which sometimes causes circular patches as well.

Pets can be great additions to your family and, in most cases, will not cause any harm to your children. Be aware of the specific risks associated with certain types of pets and take caution to protect your children when appropriate.

Then, I was blessed to have a beautiful son...

….who decided that I needed to be re-taught a few things about children.

And by a few things, I mean everything.

Don’t get me wrong – you don’t have to be a parent to be an excellent doctor. I still dish out the same advice. The books and studies are spot-on and I’m going to give it to you straight. Breastfeeding does provide the best nutrition for babies. But I understand the pain you’re going through to meet that goal. And I understand the frustration of having a child who just won’t latch on. And I understand now why you look at me, with a crazy twitch in your eye, when I tell you to try an extra pumping session a day to build up your supply, mama. I hated that thing, too. Can anyone say “dairy cow”? And guess what – formula isn’t poisonous. I wasn’t physically able to meet my full breastfeeding goals with my kid – there’s no judgement here if you grab that can. And it’s okay if it makes your relationship with your child happier, healthier and more fulfilling.

Our car seat remains rear-facing at 18 months. It’s been proven to be five times safer than forward-facing. I’m sorry for my lecture during your little one’s checkup. And oh yes, I too want to rip my hair out when I can’t reach over far enough to give my kid that 400^th toy to keep them quiet on the trip to grandma’s.

“Crying it out” was a tough one for me. Pre-child, it was so easy to coach parents - encourage them to drop the constant rocking, the running into the nursery at all hours of the night, the fear of allowing their child to cry in order to learn put themselves to sleep. Then I went through it with my son. Let’s just say I give the same advice now (it really does work) …and recommend a glass of wine for every 15 minutes of crying. I probably cried more than my kid did. Motherhood helped me give this advice with a much softer tone. I get it, mom and dad. And I feel your pain (and exhaustion).

Pacifiers – I missed that thing so much. So, so much. Oh man I missed that thing when it had to go. I think I needed one myself when the time came to get rid of it.

As for the well-rounded, healthy meals I recommend offering your child throughout the day – I now understand why there are food shortages in some parts of the world. It’s because all that food is currently on the floor of my kitchen. Where my son threw it. I get it. And I’m here to help you find tricks to make things better. Tried and tested in my own home.

In all seriousness, motherhood has been the most exhausting, challenging, humbling thing I’ve ever experienced. But I can say without a doubt that it’s made me a better doctor for your child. Because helping you get through those everyday challenges is a huge part of what being a pediatrician is all about.

I recently polled some physician mom colleagues to get their take on how motherhood changed them:

• “I am that much more in awe of the composure, patience, faith, resolve my patients' families have, especially considering how chronically sick the kids are that I see, and how too not-infrequently, limited the treatments are. I see my son in every patient. Everything is different. Every heartache is my heartache. Each illness, each story seems to hit home that much harder. I am so so appreciative.”
• “I am much more empathetic and practical in some advice. I think that I am much more emotionally available post having kids and can understand a variety of stresses parents who go through NICU may encounter.”
• “You come to understand that "by the book" is not always what is possible in real life!”
• “I feel like when the kids have a tougher diagnosis - cancer- it hits closer to home and I hold my kids a bit tighter. Likewise, little pearls and tricks that I used help make it more of a village caring mentality for the family which has been lost over the last 30-40 years.”
• “My medical advice is not too different, but I understand the unspoken worry so much better now. So I try to address the emotional stuff first in ways that would not have occurred to me pre-kids. Now I'll directly say things like "you are a good mother even if you need to use formula," or "this lymphadenitis/rectal bleeding/etc is NOT cancer," or "they are not dangerous, but constant viral illnesses all winter TOTALLY SUCK.” I think it has made me a much better pediatrician.”
• “One of my favorite attendings in peds residency told me, as I was a mess after coming back from maternity leave with my first, that a little part of your heart will always be on the outside, dangling like a vulnerable little wisp in the wind that is parenting- and that little wisp makes you so much stronger and so much softer- all for the good....it's so true.”

Happy Mother’s Day, everyone!

If you want to start, visit Cook Children's guide to choosing a pediatrician. Then, go check out your doctor on healthgrades.com or vitals.com or any of the other rating sites you can find. What you’ll likely find is a sampling of a small handful of raters. These sites are a sample size and can be heavily skewed by one great (if you like your pediatrician, let people know) or one terrible one. 

So, where else can you go for advice?

Friends

Ask your friends who have kids what doctors they use. This especially works well if you have friends that are similar in belief systems, medical philosophy and personality. If they like their doctor and you’re similar to them, chances are you’ll like them too. Good old fashioned word of mouth (it’s actually more commonly via Facebook or what I like to call “word of mouse") is still probably the best way to learn about the doctors in your area.

Practice websites

Practice websites are helpful in determining the practical aspects of the practice you are considering. Look at office hours and availability of care after hours via phone, etc. If having a doctor that is up to date with latest medical knowledge and technology is important to you, make sure that their website looks professional and is updated. This is also a place where you can find a little bit about the doctor’s personality (from their bio) and see their picture but these often become pretty predictable. Everyone likes to spend time with their family and has a few particular interests in pediatrics like obesity or development. They also went to medical school and residency somewhere (in case you were wondering).

Ranking websites

There are several of these out there. Some of the most popular ones are healthgrades.com and vitals.com. I like vitals.com because it allows people to leave narrative comments and not just rate with stars. Some of those comments can really give some insight into what the doctor is like. These website are not without fault-because the number of reviewers is often small, they can be skewed heavily by someone who has a negative experience (this is a good reason to go over and rate your doctor that you like).

So, how do you know if your doctor is the best?

The right question is this: How do you know if your doctor is the best for you?

I think this comes down to two basic questions:

1. Can you ask your doctor any questions without fear of judgment or feeling silly?

2. Do you trust the doctor’s answers to your questions?

If you can answer a resound YES to both of these questions, then you are in the right place. If not, you should probably be looking elsewhere.

It’s the problem that many families have faced, but people rarely talk about. It can leaving you feeling like you are out on an island all by yourself.

Guess what? You’re not as alone as you think.

Here are the percentages of kids who are still wetting the bed at various ages:

• 5 years- 15 percent
• 7 years - 10 percent
• 10 years - 5 percent

Up until 10 years of age there is probably at least another boy or girl in your child’s class at school who is going through the same thing, it just doesn’t come up at the PTA meeting.

For the most part, the problem is just delayed maturation of a child’s ability to stay dry. This is evidenced by the fact that almost every case eventually resolves on its own without treatment. While the maturation may not happen fast enough for parents who are changing the sheets every morning (or even in the middle of the night), for most, it will happen.

If you want to blame someone for the problem, blame genetics.

There is often family history of delayed nighttime dryness. This is tricky to prove because this could be simply a result of the fact that it is so common. There have been some studies implicating genetics as a possible cause.

Some people will describe their children as “really deep sleepers,” but most kids are and it’s probably a bias based on the fact that most families with kids who are dry through the night don’t try to wake their kids up for anything.

So when should you call the doctor?

• The child is starting to wet after a period of being dry.
• The child has day-time accidents as well.
• The child has burning or pain with urination.
• The child is excessively thirsty and urinating frequently.
• The child has associated constipation.
• The child has other associated symptoms for which you are concerned.

There are some basic strategies to use in order to help your child stay dry:

• Limit or stop fluid intake after dinner.
• Have the child go to the bathroom regularly during the day and several times close to bed time.
• Children should not receive caffeinated or sugary beverages.
• Move toward underwear as soon as reasonable.

You can talk about further interventions with your pediatrician. Here's some advice I give parents:

Bedwetting alarms that wake children when they have wet the bed are the most consistently proven method to resolve bedwetting.

Medications for use with bedwetting can be used for temporary dryness, but have not shown to be effective for eliminating bedwetting long-term. Once you stop the medicine, it tends to come right back.

Most cases of bedwetting will resolve on their own, you should not blame yourself or your child. Punishment does not work!

About the author

Justin Smith, M.D., is a Cook Children's pediatrician in Lewisville . View more from The Doc Smitty at his Facebook page. He attended University of Texas, Southwestern Medical School and did his pediatric training at Baylor College of Medicine. He joins Cook Children's after practicing in his hometown of Abilene for four years. He has a particular interest in development, behavior and care for children struggling with obesity. In his spare time, he enjoys playing with his 3 young children, exercising, reading and writing about parenting and pediatric health issues.