By Madelaine Black
Baby Sami was born with holes in his heart. He was also born with congenital hydrocephalus. And he has Down syndrome.
At six weeks old, he had surgery to insert a shunt between his brain ventricles to drain away excess fluid. He recovered, developing into a smiling, active boy, turning over and lifting his head.
His next challenge was heart surgery — major surgery to correct the two holes in his heart: one between the atrium and another between the ventricles. When I first visited Hadassah Medical Organization's Pediatric Critical Care Unit (PICU) in December after his surgery, Sami was 5½ months old. He lay still in critical condition, intubated and sedated. He was struggling to recover.
His hydrocephalus seriously complicated his recovery. Yet no one was giving up on him.
I met Sami’s devoted PICU team, headed by Dr. Salmas Watane, who recently joined the Hadassah staff from Great Ormond Street Children’s Hospital in my childhood hometown of London, where she spent three years in their cardio ICU.
She explained that Sami’s outlook did not look good. So when I returned to the PICU on January 1 to profile the world-class unit, I tentatively asked head nurse Mor Levi how Sami was.
She jumped up from behind her desk and exclaimed with a joyful laugh, “We have had a miracle.”
Levi described how the past few weeks have been a roller coaster for Sami.
Sami has been weaned from his respirator and transferred from the PICU to the Pediatric Surgery Department (PSD), in the hope that he'd be released from the hospital in a week or so.
But four days later, Levi and Dr. Uri Pollack, head of the PICU, received a code blue emergency call from the PSD. Sami was crashing.
Along with two nurses, the doctors raced to the Charlotte R. Bloomberg Mother and Child Building and up to the surgical floor, knowing that every second counted. The PICU team members ran up and down the stairs, collecting vital machines and equipment; there was no time to rely on crowded elevators to bring oxygen, monitoring equipment and cables from the PICU. There were multiple, highly specialized procedures to implement simultaneously. Together, they administered 40 minutes of CPR on Sami’s frail, 6-month-old body.
Hadassah’s PICU treats critically ill children from birth to age 18. Patients require close monitoring and special care and include those who have undergone complex surgeries, were seriously injured in accidents, terror attacks or burn incidents, or suffer from chronic debilitating diseases. The PICU is an integrated interdisciplinary unit in which 24/7 care is provided by nationally recognized pediatric intensivists, pediatric cardiac intensivists, pediatric critical care advanced practice providers, nurses and respiratory therapists.
“It was crazy, but we finally got Sami back,” said Levi. “His heart and respiratory system restarted. We intubated him and gave him adrenaline to achieve good cardiopulmonary flow."
Meanwhile, back in the PICU, the nursing team was ordering blood, plasma and platelets from the bank and preparing to put Sami on extracorporeal membrane oxygenation (ECMO).
And then Sami was rushed back to the PICU. The pediatric cardiac surgeon had to open up his small chest and proceed with 20 minutes of CPR as Sami’s blood pressure and pulse dipped. At last, he was on a heart-lung machine and stable.
“ECMO, especially in the pediatric setting, is complex in that it requires meticulous comprehension of pediatric and neonatal physiology," Levi said.
Sami remained on ECMO for ten days. And he recovered.
“Last Shabbat, he was well enough to be taken for a walk in the garden!" said Levi.
In Sami’s hospital room, as Sami lay wriggling on his bed, actively looking around, his mother described how, at 14 weeks pregnant, a blood test and scan had indicated that her baby had a heart problem and probably Down syndrome, too. She worried about how she'd cope.
“The doctor had told me, 'God doesn’t give nuts to someone who doesn’t have teeth! You'll find them.' And I found them when he was born,” she said.
"When Sami crashed, I panicked,” she continued. “But when I saw Mor running into the room, I calmed down. The professional team cares so much. They're so reassuring. They're here for him, and they're here for me."
“We are good at what we do,” Levi said. “We know how to take the most critically ill children and to save their lives. We do it all the time. And we don’t give up.”
Sami is still recovering from his long-term sedation. His mom and his PICU team have begun feeding him again. His family is hoping to take him home in a week or so — once he’s drinking and eating and hugging and smiling again.
With the help and encouragement of her PICU team, Sami’s mom feels that she has been discovering her strengths. She feels able and empowered.
Levi said, “Sami crashed. He died. He was dead. So we started full CPR for 35-40 minutes. And we brought him back."
The team has become deeply attached to Sami.
"This time I'm keeping him right near me in the PICU until he leaves for his own house,” Levi said. “His parents and eight brothers and sisters are waiting for this loveable fighter."
“You have to understand: this child was dead in my hands! Nothing! Now he is eating. He’s okay. He’s here,” said Levi.
As for Sami, he’s such a gorgeous little fella!
Madelaine Black, whose favorite thing to do is to help Israeli charities and nonprofits, has spent 35 years in the UK and Israel as a consultant, focused on what she calls “creativity that matters.” The author of three recent children's books, she is a new volunteer at Hadassah.
Read More
Delivering Hope and Compassion at Hadassah Ein Kerem’s Pediatric ED