24 Hour Tour

2 a.m. Somewhere over Main Campus

A helicopter descends through the night sky, bringing a desperately ill infant to our Children’s Hospital from a hospital in Ashtabula. The baby pants for air because a virus has inflamed the tiny airways within his lungs. The transport team — a pediatric critical care nurse and paramedic in direct communication with the staff physician always on duty in the PICU — start to administer adrenaline by aerosol through a mask. As the medication relaxes the child’s airway, the boy’s breathing begins to slow back down to a normal rate — and his mother begins to breathe more easily too.

3 a.m. Fairhill Sleep Center

A 4-year-old girl has been coming to preschool unfocused and out of sorts, and has been snoring during naps. Her parents, after an evaluation by Children’s Hospital sleep specialists, bring her for a “sleep study” in the Sleep Center’s Pediatric Room. Experienced, child friendly technologists keep vigil over her throughout the night, measuring her sleep, breathing and oxygen levels. When the girl gets up to use the bathroom, a technician gently un-hooks her from the monitors and then hooks her back up. Coming back to bed, the girl clasps her teddy bear and glances at her parent in the double-bed next to hers. Reassured, she sinks back into sleep as the technician melts into the night.

4 a.m. NICU, Main Campus

A neonatologist, available 24 hours a day at our Main Campus Neonatal Intensive Care Unit (NICU), talks with a new mother and father about their premature baby boy. Right now, the boy is breathing with the aid of an especially gentle respirator tested at Children’s Hospital. It will help the boy breathe as his lungs grow stronger — and will avoid damaging the delicate lung tissue.

5 a.m. Overseas Adoption Expert at Home

A 15-month-old howls in the background as a frantic couple calls from China to speak to the pediatrician heading our International Adoption Program. Despite a thorough pre-adoption consultation through eClevelandClinic, they are taken aback by the toddler’s wailing. The experienced pediatrician asks how the young girl has been eating, and whether she has a fever or other symptoms. She concludes the child is having problems “transitioning” from the familiar orphanage setting to the strange hotel room where the family awaits her visa and passport. Performing triage from 7,000 miles away, she helps the couple comfort their child and begin to adjust to their new life.

6 a.m. Obstetric Unit, Huron Hospital

A Cleveland Clinic Children’s Hospital pediatrician peers into the face of a brand-spanking-new human being. She will examine the newborn from head to toe, checking reflexes, anatomy, vision, flexibility and complexion. The mom has been taking special classes at Huron Hospital for young, first-time parents. Now that her baby is here, she can begin putting those skills into practice. After discharge, she will return for two to three more classes to “brush up” on her parenting.

7 a.m. Pediatric OR, Fairview Hospital

A pediatric general surgeon begins to operate on a baby with a groin bulge where part of the intestine is poking through the abdominal wall. Ten to 30 percent of these babies have another hole, or hernia, on the opposite side. During hernia repairs, exploratory surgery to find second hernias was once routine. But today, this surgeon will introduce a laparoscope — a small, illuminated viewing tube — through the original hernia to check for an undetected hernia on the other side. Fortunately, there is no second hernia, and the surgeon takes comfort in knowing the infant can avoid an unnecessary incision and the pain it brings.

8 a.m. Bunts Auditorium, Main Campus

Pediatricians from Cleveland Clinic and private practice finish their coffee and take a seat in the auditorium as Pediatric Grand Rounds begin. Today, a pediatric infectious diseases specialist will update them on tuberculosis. Once thought to be eradicated, the disease has been making a comeback, and the audience will hear how to prevent it and combat its spread.

9 a.m. Lerner School for Autism, Shaker Campus

Children have just settled into class at this unique school, where the ratio of teachers to students is nearly 1 to 1. Its 78 students are learning to cope with a lifelong, challenging neuro-biological disorder. Using a scientific technique called Applied Behavioral Analysis, teachers and therapists work to increase positive behavior and eliminate behavior that interferes with the ability to function in the world. The program’s built-in milestones give students a chance to experience success, keeping them feeling engaged — and the dedicated staff fulfilled.

10 a.m. Family-Centered Rounds, Main Campus

A pediatric hospital medicine specialist follows residents and nurses into a room on the children’s unit where colorful “fish” paint the walls and blinds. The team greets the 11-year-old occupant and asks how he is doing. The pediatric hospitalist explains a potential change in medication to the boy’s family, along with the next steps in his treatment. A resident asks a question, and he and the nurses listen closely to the hospitalist’s reply. So do the parents. The team leaves with everyone feeling better — and better-informed.

11 a.m. Pediatric Dialysis Unit, Shaker Campus

During three weekly kidney dialysis sessions, a 10-year-old boy divides his time between homework, a video game and a game of “basketball” that a recreation therapist initiated. Colorful murals, depicting famous scenes around the world, are the backdrop for lively conversation, competitive antics and schoolwork. The boy is awaiting a donor kidney, and as soon as one becomes available his transition to the Pediatric Kidney Transplant team will be seamless. More importantly, the friendships he is forging in this unit will continue long after his dialysis days are over.

12 Noon Cleveland Clinic Solon

A medical student learning outpatient pediatrics at Solon Family Health Center confers with an experienced pediatrician just outside a child’s room. The patient has a sore throat and the mother is requesting antibiotics. The student follows her mentor back into the exam room and listens to her explain that antibiotics are only needed if a throat culture reveals Strep infection. The child’s mother nods in understanding, and the student learns that it’s not just what you say — it’s how you say it — that makes a difference in the way patients “hear” what their doctors have to say.

1 p.m. Beachwood Surgery Center

A middle-schooler breaks a fall with her wrist during a soccer game, and it begins to swell. Her mother calls our Same-Day Fracture Service. The pediatric orthopaedic surgeon at our Beachwood Family Health Center X-rays her tender wrist. He discovers a fracture in the growth plate, the soft tissue at the end of the long bones that determines their eventual size and shape. The girl will be whisked to the Outpatient Surgery Center next door. Slender pins will be inserted just above and below the growth plate to ensure that her arm develops normally. She’ll be back once a year for checkups.

2 p.m. Pediatric Endoscopy Suite, Main Campus

A 6-year-old is playing video games in a glass-enclosed room on the sparkling new suite in the heart of our Children’s Hospital. A tiny capsule slowly works its way through her digestive tract. Over about eight hours, a tiny camera in the capsule will take pictures of her digestive tract and display them in sharp resolution on large monitors. Unlike older devices, the new-generation “scope” will easily and painlessly show pediatric gastroenterologists whether or not there is inflammation or bleeding in the lining of her small intestine.

3 p.m. Children’s Hospital Floor, Main Campus

The pediatric psychologist sits at the bedside of an anxious 8-year-old cancer patient facing her first chemotherapy session. She teaches the child how to think differently about her experience, and use breathing, muscle relaxation and imagery to control her fear and any chemotherapy-related symptoms. Her parents are pleased to observe their daughter’s relief and let her visit the play room. There, the activities calendar shows that tomorrow is the day for the Alice-in-Wonderland tea party! The girl loves tea parties and dressing up. She is so excited by the event, planned by Child Life workers and volunteers, that sleep won’t come easily tonight.

4 p.m. Children’s Rehabilitation Hospital

It’s time for supper, and a toddler waits in the Pediatric Feeding Disorders Program treatment area. She was on a ventilator for a long time and doesn’t like putting things in her mouth — including food. Because the girl is not eating well, she is not growing as she should. So the program’s psychologist, working closely with occupational therapists, speech pathologists and a dietitian, will help her learn new skills — and a newfound appreciation for eating.

5 p.m. Lerner Research Institute Laboratory

A pediatric cancer specialist spins down cells in the centrifuge at his state-of-the-art lab in Lerner Research Institute, at our main campus. He and an immunologist are working on tailored “vaccines” incorporating tumor cells to help children fight virulent brain tumors. His young patient has just come out of surgery, and the biopsy of his tumor will yield valuable cells for treatment.

6 p.m. Fit Youth Program, Independence

A 13-year-old is waiting to “weigh in” and turn in her weekly food and activity diary at Independence Family Health Center. Soon, a dietitian will explain to her and nine other 13- to 17-year-olds how to read food labels and figure out what a “healthy portion” means for them. At the same time, the parents are meeting with a psychologist to learn how to be supportive, so their teens won’t view them as the “Food Police.” A physical activity session with the exercise physiologist will follow, but the girl doesn’t dread it. She’s not alone — everyone there is learning how to manage their weight and become more fit.

7 p.m. Pediatric OR, Main Campus

A pediatric anesthesiologist gently checks on a toddler coming out of clubfoot surgery. The sleeping child sucks his thumb, a task he can manage because the IV line for his anesthesia was inserted in his foot to free up his hands. He isn’t aware of his IV because of the “kiddie epidural,” or caudal block. The anesthesiologist placed it after the boy fell asleep while inhaling anesthetic gas through a mask. Caudal anesthesia decreases sensation below the belly button, so that fewer anesthetics and narcotics are needed during surgery. Soon the boy will be fully alert, in minimal discomfort, and — with barely a trace of nausea — will be munching on a snack in the recovery room as he prepares to go home.

8 p.m. Pediatric Cardiac Cath Lab

A newborn “blue baby” enters the Pediatric Catheterization Laboratory at Main Campus on a ventilator. She is on intravenous medication to keep her stable. This baby is expected — our Fetal Care Center team has had a plan in place ever since her heart defect was diagnosed in the womb by a fetal imaging specialist. One of her heart valves is too tight to allow blood to circulate freely. The pediatric heart intervention specialist is standing by. Shortly, he will thread a slender tube through her leg and across the valve’s tiny opening. He will use a balloon on the catheter to enlarge the opening and spare the newborn from open heart surgery. She will need no stitches and, in a day or two, will be in her mother’s arms.

9 p.m. Regional Pediatrician’s Home Office

After a late dinner with her husband, an Avon Family Health Center pediatrician logs onto Cleveland Clinic’s secure electronic medical record system using her home computer. Are the lab results back yet on her 5-year-old patient with a possible urinary tract infection? Using two different passwords available only to Children’s Hospital caregivers, she enters the patient’s electronic medical record and clicks on “chart review.” Yes, the test is positive. She’ll let the concerned parents know tonight and will call in a prescription for antibiotics to their neighborhood pharmacy.

10 p.m. Pediatric ER Hillcrest Hospital

Parents rush a disoriented 15-year-old football player with a splitting headache to the Pediatric Emergency Room at Hillcrest Hospital. He has suffered a concussion at a night game. The pediatric nurse enters information into the electronic medical record as the pediatric emergency physician examines him. Pain relievers are prescribed, brain imaging is ordered and the results are normal. So the athlete lies flat on a bed for observation. Within a few hours, he’ll be back to normal and can leave with guidelines for a safe return to sports. Tonight, his parents will wake him every three hours to check his condition. Tomorrow, he’ll see a Cleveland Clinic pediatric neurologist at Hillcrest.