On January 31, the Fort Worth Stock Show and Rodeo will celebrate Cook Children’s Day. Cook Children’s Day is just like any other Stock Show and Rodeo experience, except the audience will get to hear fun facts and stories about the Cook Children’s NICU throughout the evening. Half of all proceeds will be donated to the Cook Children’s Neonatal Intensive Care Unit (NICU), so round up your cowboys and cowgirls to have some fun and support an incredible cause! 

A Long-lasting Partnership

The Rodeo has long been a treasured partner of Cook Children’s, benefitting the NICU for more than ten years. Brittany McLaughlin, MSN, RNC-NIC and NICU Director, says this is one of the NICU’s biggest fundraisers.

“Sometimes we can't look 12-18 months out and know exactly what we’ll need,” she said. “These are funds that we're able to use to fulfill the needs of our patients at any given time, which is tremendously helpful.”

Brittany says if you live in Fort Worth and have never been to the rodeo, now’s the time. 

“It's so much fun, and the fact that this night also directly impacts our tiny patients is just the icing on the cake,” she said.

The Cook Children's Impact

“As the only Level IV NICU in Tarrant County, we provide the highest level of care available to the sickest babies in our communities,” said Grant Harris, Chief Development Officer of Cook Children’s Health Foundation. “We hope families never need to visit our NICU, but if they do, partners like the Fort Worth Stock Show & Rodeo help make it possible for their babies to receive world-class care right here in Fort Worth.”

Landy Blackmore understands the worry and stress of having a child in the NICU. Landy gave birth to her daughter, Tillie, at 27 weeks and five days. “Tillie was born at one pound, 12 ounces, and I still cannot wrap my mind around how small she was,” Landy said.

“We were transferred to Cook Children’s when she was three days old because we almost lost her.” Tillie spent a total of 132 days in the NICU. During that time, the Cook Children’s staff became family. 

“We got so close to everyone, from the nurses, to Child Life Specialists, all the way to the Build-a-Bear workers,” Landy said. “It was a really great experience in the midst of the hardest thing we hopefully will ever have to go through. We’re really, really lucky that we were able to go to Cook Children’s. It's such a special place.”

Supporting the Littlest Patients

The support given to the Cook Children’s NICU does not go unnoticed by the staff. 

“I can’t express how blessed I feel every day to be able to come to work and have all the resources we need,” Brittany said. “It helps us as a staff to focus on what really matters and take better care of our tiny patients.”

Stock Show and Rodeo President, Brad Barnes, is proud to be a continuous source of support for Cook Children’s. 

“The joy that comes with knowing the children at Cook Children’s will benefit from this special rodeo performance is immeasurable,” he said. “Of all the projects we’re involved with in this wonderful city, hosting Cook Children’s Day stands out among them all. We look forward to seeing Dickies Arena packed for this wonderful event.” 

Purchase tickets for Cook Children’s Day at the Rodeo here. Can’t make it to the event? Support Cook Children’s NICU families by making a donation here.

National Teddy Bear Day is Sept. 9.  We're celebrating in a BEARY special way for this patient tradition at Cook Children's.

In July, the Cook Children's Spiritual Care team called on the community to restock the prayer bear den. As of Sept. 8, the den has more than 3,200 additional prayer bears thanks to our generous community.

Prayer bears are a way to remind patients that they are not alone. The Spiritual Care team gives out over 300 bears per week at the Medical Center. These bears are given to patients who need encouragement or support after a painful procedure, during a lengthy hospital stay or during difficult times.

Many congregations and community organizations participate in the interfaith ministry's PrayerBear program. New toy teddy bears of all shapes, sizes and colors are blessed during worship services, then they are delivered to medical center chaplains. 

Would you like to get involved? All bears must be new, with no scent, and with no words/logos. Email prayerbear@cookchildrens.org or donate at giving.cookchildrens.org.

“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.”

They could all learn a lesson from a young woman named Marissa Heintschel.

I learned about Marissa during one of my recent searches for news about my field, pediatric endocrine. The news story featured students in the Frisco high school independent study and mentorship program.

One of the students in this program was Marissa, who had chosen pediatric endocrinology as her focus of study. I reached out to her via Twitter to learn more about her experience in the program and was very impressed by her story.

Like many in my field, she had a personal connection to pediatric endocrinology, having been diagnosed with Type 1 diabetes at 7 years old. She shared with me her passion for medicine and her experience she’s gained and the research that she did during her year in the program.

I asked how her experience had changed her view of children living with a chronic condition such as Type 1 diabetes. Her answer gave me a fresh, personal perspective on challenges of life with this chronic condition:

“I have always made it very public that I had Type 1 diabetes,” she said. “I went through the whole phase of trying to hide it away from people. I wish I would’ve realized sooner the importance of taking care of myself because when I was 14 or so I was stupid and thought that if I ignored my diabetes it will go away and that I could run away from my problems.

I wear an insulin pump. I’ve been called things like a robot and people in random places will just stare at me.

There was once this kid in my class sophomore year that I started to become really good friends with. One day I asked where he went and someone said that he went to go take his shot because he was diabetic. It was so surprising to me because no one really knew he was diabetic.

So then I started talking to the kid more and more about his diabetes and he just opened up to me and was able to talk about his problems that only people like us could understand. After he opened up to me, he told me how thankful he was that we had grown closer because he now felt he had the confidence to tell people about his diabetes.”

Marissa’s story got me to thinking about the importance of sharing about having Type 1 diabetes and how difficult it can be. I, and others on the Cook Children’s diabetes team, speak to children and their families about sharing about their diabetes when we meet with them at Cook Children’s during the difficult period of initial diagnosis.

• Support
• Safety

These are the two important reasons for S haring with others about having diabetes.

Sharing opens the opportunity to understand better the routine (checking blood sugars, taking shots, meal planning, etc.) that someone with Type 1 diabetes must do daily. Sharing opens up opportunity for support and encouragement. In Marissa’s case, it may be the opportunity to encourage and support someone else with Type 1 diabetes.

Marissa’s story also shows that sharing does open up vulnerability and risk. I asked Cook Children’s endocrine clinical therapist, Kim Cox, how she talks to children and families about sharing about diabetes.

“I usually talk to them about how ‘secrets’ tend to make other kids think it’s a bigger deal.

Why don’t they want others knowing? Are they

…. embarrassed?

... afraid of bullying?

... etc.

Being honest (but brief) about answering peers questions seems to work best. For example, I have diabetes, I have to take medicine when I eat now. We then discuss those issues.”

I use the example of a kid who gets glasses in school. In the beginning, you notice every time you see them, peers will comment and possibly even say mean things, but as time goes on, their glasses just become part of them and you only notice if they don’t have them on. Other kids move on to something else.

Safety is important because even in the best of cases diabetes care is unpredictable. High or low blood sugars affect mood and behavior. In particular, a low blood sugar can cause erratic behavior and eventually unconsciousness. Knowing about the diabetes allows others to have the advantage of understanding and help someone with Type 1 diabetes.

Marissa has a future of opportunity ahead of her and will be starting college at my alma mater, Texas A&M, where she will major in biomedical engineering and pre-med. She told me that she chose biomedical engineering because the potential that technologies such as stem cell research and tissue engineering for a cure for diseases such as diabetes. Being a doctor is her dream, and I think that she has learned a lot from her experience that will help her in the long journey to a field in medicine.