Here No Matter What
The team at Seattle Children’s Emergency Department
stands ready round-the-clock to treat any childhood illness
and injury – from the catastrophic to the common.
Reviewing the chief complaint list, Dr.
Brianna Enriquez (left) and Linda
Keenan, RN, see the daunting list of
maladies of kids in the ED and on
“I’m there for the greatest
and worst moments of families’ lives,”
says Enriquez. “I always carry that
responsibility, and it’s insanely
When Dr. Brianna Enriquez accepted
a job at Seattle Children’s in 2006, she
figured she’d seen the worst cases in
pediatric emergency medicine. After
all, she often treated teenage gang
members for gunshot and stab wounds
at the tough county hospital in
Los Angeles where she practiced.
It took Enriquez just a few days in
her new job to understand that
Children’s Emergency Department (ED)
is in a different league: as the region’s
front door for kids in medical crisis, the
ED serves the sickest children in one
of the nation’s largest geographic
areas – Washington, Alaska, Montana
“We have a tracking board in the
ED where the nurses note the chief
complaints of all the kids, some of
whom are being transported to us but
haven’t even arrived yet,” she explains.
“As the list gets longer and longer
throughout the day, I see worst-case
words like ‘lethargic, hypoxic and
cyanotic.’ If you weren’t used to
practicing here and you walked into our
ED and looked at that board, it might
scare the heck out of you.”
An extension of critical care
Being flown by emergency
transport to the ED
being admitted to the hospital
surgery is a distant
memory for Sarah Hand.
5-year-old now matter-of-factly
it as “the time I went
to Seattle to have the bug
out of my head.”
Sarah Hand, age 4, was one of nearly
800 critically ill children transported
to Children’s in 2011.
Typically very active, the little girl
was unusually tired during a trip to
Disneyland – her parents even rented
a stroller so she could get around the
park. Once home in Richland, Wash.,
Sarah started waking at night,
screaming and complaining of
“She kept telling us that there was
a bug in her head,” recalls her dad,
Paul Hand. After several doctor visits, Sarah’s parents insisted on a CT scan
that revealed a golf ball-sized tumor
on her spinal cord at the back of her
brain. She was immediately airlifted to
Children’s ED with mom Merlita Hand
by her side.
Enriquez was first on the scene
when Sarah arrived. A quick evaluation
revealed abnormally high blood
pressure because the tumor was pressing on Sarah’s brain. Enriquez
stabilized Sarah by starting medication
to decrease the swelling, then quickly
consulted with the neurosurgery team
and started the admit process with
clinicians in critical care.
Emergency medicine doctors like
Enriquez are the hospital’s front line
for critically ill children. They stabilize
and resuscitate kids who arrive needing
a higher level of care than their local
hospitals can provide.
“We don’t know when you’re coming,
we just know it’s the worst day of
“Our ED wouldn’t be the best
without the expertise of our critical
care specialists,” says Enriquez. “And
critical care wouldn’t be the best
without our ability to get kids stabilized
and admitted in the shortest amount of
Dr. Eileen Klein, pictured
with Nikoli, 3, is as much a
detective as she is a
Her work to diagnose Nikoli’s
mysterious symptoms saved
Jenny Hood knew something was very
wrong with her 2-year-old son Nikoli
when he couldn’t even smile at things
that once made him giggle with delight.
“When I’d say something funny, I
could see in his eyes that he wanted
to smile, but he just didn’t have the
energy,” remembers Hood. “He was
Nikoli had been sick for several days
with various perplexing symptoms – yet the providers Hood consulted had
not offered any satisfactory answers.
“At the point he refused to drink
water, my mother-in-law and I headed
to Children’s,” she says. “I had to find
someone who would help my son."
Hood was relieved when the triage
nurse in the ED waiting room agreed
that the toddler needed immediate
assistance. After being ushered into an
exam room, they met Dr. Eileen Klein.
“After she examined Nikoli, Dr. Klein
kneeled down and looked in our eyes and said ‘I know you’re concerned and
so am I. We’re going to test absolutely
everything we can think of to figure
out what’s wrong so we can start
treatment,’” remembers Hood. “Then
she leaned over and gave me a hug
and said, ‘It’s going to be OK.’”
All Hood could do was cry. “It was
such a relief to know that I could just
be a mom and comfort my baby and
not bear the burden of staying on top
of doctors to get answers.”
Building a sense of trust with
families – and providing a healthy dose
of compassion – defines doctors and
nurses alike in the ED.
“One of the things we do best is
quickly assess how sick a child is,”
explains Klein. “Once we figure that
out, we decide if we can handle it on
our own or if we need to consult with
our colleagues in another specialty at
Children’s. You can say we’re specialists
at figuring out when a child needs a
In Nikoli’s case, Klein called in a
cardiologist from the Heart Center
to help her figure out why the boy’s
chest X-ray showed an enlarged heart.
In the end, Klein’s diagnostic work
revealed that Nikoli’s enlarged heart
was connected to bacterial meningitis – a potentially deadly infection of
the membranes around the brain and
spinal cord. He was also suffering from
a severe sinus infection and pneumonia.
Hood was right. She did indeed have
a very sick boy.
Continuity of care
Seattle Children’s specialists
answer 3,000 calls each month
from clinicians throughout the
who depend on our ED
for expert advice on all types
of pediatric concerns.
Cindy Small stopped counting after
the 50th trip to the ED with her
daughter Allison, now 18. Born with
hydrocephalus, Allison has severe
developmental issues and the mental
capacity of a 6-month-old, and needs
care 24 hours a day.
“When Ali was one day old, we
brought her to Children’s and it’s been
one thing after another ever since,”
For many parents like Small, the ED
is the place they count on – especially
on nights and weekends – to manage
the multiple, complex health needs
that result from conditions like hydrocephalus, cancer, pulmonary
diseases, diabetes, spinal cord defects,
cerebral palsy and issues resulting
from premature birth.
“Ali is the type of kid that other
emergency departments look at and
say, ‘oh my, what do we do with her?’”
says Small. The few times she took Ali
somewhere else for emergency care,
they ended up being sent on to
“Kids like Ali who frequently come
through our doors aren’t treated like
first-time visitors,” Enriquez explains.
“We pick up where we left off and we
work in tandem with our Medically
Complex Child Service to give them
the continuity of care they need.”
In November 2011, Small and her
family moved from Arlington, Wash.,
to Idaho. She’s grateful for the years
of integrated care at Children’s – and
for the ED team who treated Ali just
like she was their own.
“The doctors and nurses in the ED
acknowledged that I knew my daughter
best,” says Small. “They listened and
they looked to me for answers. I can’t
say enough about how good that made
me feel as a parent.”
Easing the anxiety
After falling from play
equipment and breaking
her arm while in preschool,
Abigail Nelson, now 6, got
a full-arm cast in the ED
and left smiling thanks to
the team’s focus on delivering
Megan Nelson was headed to an
appointment when she received
an urgent call from her daughter’s
daycare: Abigail, 5, had fallen when
her friend threw a ball and she let
go of the climber to catch it.
The ED team manages nearly
40,000 visits each year – top
complaints include playground
mishaps, sports injuries, respiratory
infections, asthma attacks and
abdominal pain. In Abby’s case, she
broke both bones in her forearm.
Not only does the team want kids
like Abby to experience treatment
without trauma, they also want them
to head home with a smile.
Paul Foster, the ED’s child life
specialist, plays an important role.
He tells kids what’s happening in
words they can understand and uses
age-appropriate distractions during
procedures, which goes a long way
in turning down the volume on fear.
of all children in our hospital are admitted from the ED.
For Abby, that meant getting to
hold a sample IV tube while Foster
showed her how it worked, then
reading a fairy book with him while
a nurse inserted the IV.
“To this day, I can still see Abby
leaving the ED,” remembers Nelson.
“She had a cast from her shoulder to
her hand and a beaming smile.”
No worse for wear, Abby says she
wants to be an emergency room doctor
when she grows up because “they are
the smartest doctors of all!”