Patient Stories: Children's

Children's Memorial Hermann Hospital

Tatum's Transport

Of the 3,000-plus Life Flight missions Memorial Hermann flies annually, about 15 percent of them carry members of the Children's Transport Team who fly neonates, children and teens to Children's Memorial Hermann Hospital for a higher level of care. Six-year-old Tatum's transfer from Brenham to Houston is just one of these 450 stories.

Tatum celebrated her sixth birthday with a helicopter ride and an array of stuffed animals. The helicopter was one of four operated by Memorial Hermann Life Flight, Houston's only hospital-based air ambulance service. The toys were gifts from her caregivers at Children's Memorial Hermann Hospital.
   

Children's Memorial Hermann's Children's Transport Team got the call to pick up Tatum shortly before 5 p.m. on Wednesday, June 27, 2007. "We flew out of Houston at 5:07 and arrived at Trinity Medical Center in Brenham at 5:37 p.m.," said Judie Haubrich, RN, BSN, pediatric transport nurse at Children's Memorial Hermann Hospital, while reviewing the transport record. "Her pediatrician reported abdominal pain and vomiting, as well as some swelling in her feet and ankles."

Recalled her mother, Beth: "Tatum's symptoms had begun the Saturday before, and they became increasingly mysterious. At first we thought she had the stomach virus that was going around her school. For a couple of days she couldn't keep food down, but then by Monday, she felt better and went to stay with her grandmother in Fayetteville, Texas. By Tuesday she was throwing up again. When I talked to her grandmother that afternoon, she said Tatum didn't feel good and was lying on the couch, but she thought she'd be okay. But when I called again around 7 that evening, Tatum was crying. She's my tough one so I knew something was wrong."

When Beth arrived in Fayetteville at 9 p.m., she saw that Tatum's left ankle was swollen. "I remember thinking that maybe she'd been bitten by a bug. But by the time we got home an hour later, the top of her right foot was swollen as well. When I picked her up at her grandmother's, she was limping. By the time we got home 45 minutes later, she couldn't walk at all."

By 10:45 p.m., mother and daughter were in the emergency department at Trinity Medical Center in Brenham. Tatum's vomiting had stopped but her joints continued to swell. Lyme disease, a bacterial infection marked by a skin rash, swollen joints and flu-like symptoms, was a natural assumption but was ruled out based on an imperfect set of symptoms. It was the first of several possible diagnoses that would be ruled out over the next few days.

Trinity Medical Center admitted Tatum at around 3 a.m. "Because of her unusual set of symptoms, diagnosis became a matter of observation and ruling out possibilities one by one," Beth said.

After Tatum's hometown pediatrician Donald Draehn, M.D., examined her around midday on June 27, he began to suspect that two other conditions needed to be ruled out: intussusception, an obstructive telescoping of the bowel, and a relatively rare autoimmune disorder called Henoch-Scholein purpura.

Characterized by abdominal pain, bloody stools, hives or angioedema, joint pain, gastrointestinal problems and glomerulonephritis, Henoch-Scholein purpura (HSP) is a type of hypersensitivity vasculitis and inflammatory response within the blood vessel. In HSP cases, a physical exam typically reveals skin lesions and joint tenderness. Urinalysis picks up microscopic traces of blood in the urine, and a skin biopsy shows vasculitis. Most cases resolve spontaneously without treatment.

As Beth recalled, "Our pediatrician's thought process, which I respect, was that he wanted her to be in a hospital where there are 100 doctors who all know what they're doing. So he arranged for her to be transferred to Houston."

When the Children's Memorial Hermann Children's Transport Team arrived, Beth and her daughter were ready. "It was excruciating for me to watch her be taken away by Life Flight, but I tried not to cry because I didn't want her to cry," she remembered. "Tatum held it together better than I did and made us take photos after I convinced her it would be really cool to be flying in a helicopter on her birthday. Judie, the Children's Transport nurse, was really great. I heard her tell Tatum, 'We're going to wrap you up like a burrito and fly you off to Houston. Don't worry even for a minute. Your mother will see you in two or three cartoons.'

"She was a sweet little girl," Haubrich recalled. "At first she was scared and crying and then she was excited because she got to fly on a helicopter on her sixth birthday."

By the time Beth arrived by car at Children's Memorial Hermann, Tatum was lying in bed watching TV with the remote in her hand. "Judie came in a little later to check on her. She wanted to know how many cartoons Tatum had watched before I got there. 'Just one and a half,' she said."

Tatum's symptoms dissipated during her three-day stay at the hospital. She was released the following Sunday with an inconclusive discharge diagnosis of bloody stools, diarrhea, abdominal pain, rash and swelling of the ankles. An ultrasound done at Children's Memorial Hermann showed thickening of the small bowel and swelling of soft tissue.

There were no bone or joint abnormalities on x-ray, and no evidence of intussusception. Because her case didn't present a perfect set of symptoms, Henoch-Scholein purpura was ruled out. Tatum is continuing treatment with Joshua Samuels, M.D., a pediatric nephrologist affiliated with Children's Memorial Hermann, for damage done to her kidneys during the episode.

When Tatum returned to the Children's Memorial Hermann campus for her two-week post-discharge follow-up, a Life Flight crew was landing. "She recognized it right away and said, 'That's my helicopter,'" Beth said.

"The Children's Transport Team really worked hard to make it a less frightening experience for Tatum and for me," she added. "I remember asking Judie if she would sedate Tatum during the flight to Houston. She said, 'No, nine times out of 10 the kids don't need sedation because the vibration of the helicopter puts them to sleep. If anyone needs sedation,' she said with a laugh, 'it's the parents.'"