Long, blonde hair covers a scar on the left side of her neck--one of four that mar her body. They are testimony to the strength and spirit of four-year-old Rebecca Hamilton, a child who knew more trauma in the first weeks of her life than many people know in a lifetime.

Yet, this little girl smiles easily, exuberantly. And rightfully so--she beat the odds.

Rebecca became Gina and Steve Hamilton's firstborn on May 5, 1997, at Loyola Center for Health, Elmhurst, Ill.

Fully developed with a head full of dark brown hair, Rebecca should have been a healthy baby. Instead, she was diagnosed with meconium aspiration, a condition that occurs when a baby inhales meconium, a tar-like substance that is the first excretion of every newborn.

If a baby is stressed, it can pass the meconium in the womb. If an infant inhales the meconium during the birthing process, the outcome can be deadly.

Breathing is made difficult because air can be sucked in, but cannot be expelled, says Erica Jannisch, R.N., Children's Memorial Hospital, Chicago. Jannisch is one of the nurses who cared for Rebecca during her stay at Children's.

Hamilton was in recovery when she was told about her daughter's condition.

"The doctor came in and said, 'Your daughter is very sick--she could die,'" Hamilton says.

Because Rebecca was the Hamiltons' first baby she didn't know what to expect. "I didn't have enough time to digest everything and to realize how sick she really was," she says.

Doctors at Loyola did everything possible. They performed emergency surgery, putting a tube in Rebecca's chest to get oxygen to her body and another tube in her side to release it.

Saving grace

Despite their efforts, Rebecca's condition worsened. The only other option was extracorporeal membrane oxygenation (ECMO), a highly specialized treatment used to treat babies suffering from meconium aspiration.

It is a heart/lung bypass procedure that allows the baby's lungs to rest and heal, says Jannisch. Tubes are surgically placed in a carotid artery, and blood is drained into a machine where it is oxygenated and pumped back into the baby's veins.

Loyola wasn't equipped to provide ECMO, so arrangements were made to transfer Rebecca to Children's Memorial, Hamilton says.

But time was fleeting. Only babies younger than five days old can receive this treatment--Rebecca was four and a half days old.

"ECMO is the last resort for meconium aspiration patients," says Linda Rankin, R.N., ECMO coordinator at Children's. "Otherwise, they will die."

Rebecca was prepped for the transfer, but not before a pastor from the Hamiltons' church delivered last rites.

"To go on ECMO means a very slim chance of survival--there's a 90 percent chance of death," Jannisch says.

"I was in the room when the transfer nurse debated whether to even transfer her to Children's because she was so sick," she says.

Prior to the transfer, Hamilton was able to touch Rebecca for the first time since she had been born--through the crib railings. It was the only way possible, because tubes in her body prevented anyone from holding her.

It was a brief interlude before Rebecca was whisked away to Children's and the Hamiltons were sent home to rest.

"Doctors advised us there was nothing we could do," says Hamilton.

Upon Rebecca's arrival, a doctor administered Pavulon, a paralyzing drug used to prevent expending unnecessary energy and from dislodging the ECMO tubes in her neck as well as the central line in her wrist.

"The doctor said she was so strong-willed it took three doses--she just kept looking around," says Hamilton.

For nine days Rebecca was hooked to the ECMO machine.

"When I first saw her at Children's, I walked in and saw what I thought was red tubing. It was blood," says Hamilton. "I still didn't get how sick she was."

Hamilton visited Rebecca every day--sometimes reading to her, sometimes singing. She wanted her daughter to know she was there.

Rebecca's lungs had been damaged badly and though she eventually was taken off ECMO, a ventilator was still necessary to help her breathe.

"It was traumatic. I saw kids come and go while Rebecca stayed," says Hamilton.

The central line in Rebecca's wrist was taken out May 30. That day Hamilton cradled her daughter for the first time.

"Other parents complained they weren't able to hold their child for two days--they had no idea what I was going through," says Hamilton.

"When I did get to hold her, it was an incredible feeling."

A long journey home

On June 6, more than a month after her birth, Rebecca was taken off the ventilator and performed the unthinkable--breast-feeding.

While she was hooked to the ECMO machine and various ventilators, she received sustenance through a feeding tube.

Babies with prolonged exposure to this method of feeding often develop an oral aversion, says Jannisch.

"When Erica said, 'She's sucking on a pacifier like Maggie Simpson,' we decided to try breast-feeding," Hamilton says.

It worked.

"It was the most amazing thing--I had never seen it happen before," says Jannisch.

Rebecca began to eat more and recovered quickly. She was released June 12, her grandfather's birthday, says Hamilton.

It was the end of a 26-week stay, which was remarkable, considering most infants with her condition remain in the hospital for five months, says Jannisch.

Her doctor wrote a letter to the family stating, "From the time she was extubated to the time she went home, she progressed far more rapidly than any previous ECMO patient...I can say that Rebecca is one of the sickest babies I have seen with her condition and that it is a miracle she is with you today."

Adding to the miracle of her survival and quick recovery is the fact she only suffered hearing loss, which was caused by certain medications and possibly from the noise of the ventilators, Jannisch says.

Hearing loss is common, but other, more severe complications can occur due to both the meconium aspiration and the ECMO.

One of the most direct effects of ECMO is brain bleed. Babies are more susceptible because of thinner blood brain barriers, but the oxygenated blood from the ECMO increases the chances, says Jannisch.

Also, because babies are paralyzed during ECMO, their neurological status can't be measured prior to treatment. Potential problems could exist, but wouldn't be found until after the child is taken off the machine, she says.

Many kids suffer from chronic lung disease within a couple years and many remain on ventilators for a longer term because of the meconium aspiration, Jannisch says.

"She really is a miracle. I remember buying her an outfit to go home in--she took up a special place in my heart."

Binding ties

During Hamilton's daily visits, she became acquainted with the nursing staff, but formed a special bond with Jannisch.

"I think one of the reasons Erica and I became so close was because I am a chatterbox," Hamilton says. "I just felt very connected with her. The first time I saw Erica standing at the desk, I asked if she could take care of Rebecca."

She always has been there, says Hamilton. Aside from family members, Rebecca has had two special people in her life--her godmother and Jannisch.

"I've been involved with Rebecca since she was born--she's a very important part of my life," Jannisch says.

Sept. 8, 2001, was a monumental event in Jannisch's life and Rebecca was at her side to share it.

Bedecked in a pristine, white dress and a circular bouquet of fresh flowers crowning her blonde hair, Rebecca stood at the alter as Jannisch was wed.

"When she asked if Rebecca would be her flower girl, I was so honored," Hamilton says.

At the reception, Rebecca danced and twirled, taking full advantage of the attention she was getting from her role as flower girl--she was the picture of perfect health. Shining blue eyes and the healthy peach hue of her cheeks belied what this child had endured.

Hers is an exemplary account of what health care workers do every day to heal the young, the old, and those with little hope of survival.

"I see patients from their sickest, most acute phase, to the point where they are released from the hospital," says Jannisch. "It's an amazing thing."

"But, it's the special kids like Rebecca, who have really shaped me as a nurse."

Unsung heroes

It wasn't until the Thanksgiving following Rebecca's ordeal, that the gravity of her condition hit her mother.

"I finally got it. I felt so thankful and so blessed to have those people taking care of her," Hamilton says. "I have said over and over again they saved her life."

Doctors and nurses were the individuals directly involved with Rebecca's recovery and they were the ones who interacted with the family, but there are other health care workers who help make such miracles as Rebecca's possible.

Though contact with patients is minimal, materials management and central service departments affect the outcome of every patient, regardless of the severity of the illness.

Departments behind the scenes may not interact with the kids or the parents, but certainly they have an indirect effect on the patient, Jannisch says.

"If we didn't have the equipment, we couldn't do our jobs--that's the bottom line," says Rankin.

Materials managers are not front line workers, says Mark Overton, director of materials management, Children's Memorial Hospital, Ft. Worth, Texas.

"It doesn't matter whether the patient is an adult or a child, the purpose is to get the right product to the right place so the patient can be cared for," he says.

It's a collaborative effort at Children's, Ft. Worth. Materials management ensures the nursing department has input on items, especially in specialized areas.

Nurses at Children's, Chicago, also provide input to ensure that proper supplies are ordered, says Dianna Sonoras, director of operational analysis. With this kind of communication, purchasing can support what clinicians do on the floor.

"We really appreciate the hard work of our nursing staff," she says.

Central service also plays an integral role. If equipment used on the kids wasn't cared for properly, it would directly impact their recovery, says Jannisch.

An example is the I.V. pumps processed by central service. Sometimes they require a change from macrodrip to microdrip, says Paula Price, R.N., central processing supervisor, Washoe Medical Center, Reno, Nev.

"Little people obviously need a smaller dosage than adults and if we don't make sure it is in the proper mode for the patient, an improper dosage may be administered accidentally," she says.

It is also central service's job to ensure equipment is decontaminated and working properly, says Price. It's not just customer service for the clinicians, but also for the patients who are the primary customers.

"We don't have much interaction with patients on the floor, but when we do, we make sure it's positive," she says.

Such positive interactions from health care workers make a difference, especially to children like Rebecca who've been exposed to the hospital setting their entire lives.

The evidence is Rebecca's response to the question, "What do you want to be when you grow up?" She answers with a smile and a demure downward glance, "A nurse--like Erica."

This article first appeared in the January 2002 issue of Materials Management in Health Care