From a new pediatric emergency room to cutting-edge eye surgery, Valley medical centers lead the way in providing innovative health care
by Alex Silberman
Photographs by Kenneth Gabrielsen
No one would mistake taking a child to the emergency room for a family outing. But in Rockland County, a parent’s worry and a kid’s fear begin to ease the moment they come through the door of Nyack Hospital’s new Pediatric Emergency Department (Peds ED), which opened last October. Brightly painted stars on the floor, kid-friendly paintings on the walls, toys scattered on child-sized tables, and a TV tuned to the Disney Channel signal that this will not be the ordinary ER experience.
Actually, since this is the first dedicated Peds ED in the Hudson Valley, the experience will be somewhat unique. Although more than a third of ER patients are children and adolescents, less than 10 percent of the nation’s general hospitals have a separate space for pediatric cases. Even fewer are staffed by a pediatric emergency physician. There are only about 1,100 of this rare breed of specialist — pediatricians or emergency medicine physicians who have undergone an additional three years of training.
The Nyack Peds ED is new, but its director of pediatric emergency services, Dr. David Kroning, passes for an old hand in a sub-specialty that was first accredited in 1992. His previous post was as medical director of Pediatric Emergency Services at the Children’s Hospital at St. Joseph’s in Paterson, New Jersey. Its Peds ED is the largest in the state, treating upwards of 30,000 children a year. Training and experience have made him a passionate advocate of the pediatric emergency room.
“The old cliche is, â€˜Children are not small adults,’ ” says Kroning. “They have differences in anatomy, physiology, the pathology of their illnesses, and emotional needs. Children are more prone to respiratory complications, for instance, than adults are. A six-month-old acts differently than a one-year-old. Understanding these developmental differences is very important — knowing the different illnesses that affect children at different ages.
“Ninety percent of what we see is pretty routine,” Kroning reports. “A third of all pediatric visits are injury-related lacerations, fractures, and the like — scary, but not necessarily life-threatening. It’s the 10 percent where we can make the big difference between life and death,” says Kroning. “That’s where we shine, because we understand and recognize who is and who isn’t in danger… With our specialization, the quality of care for children goes up exponentially.”
Medical studies bear Kroning out. The number of pediatric resuscitations and life-saving procedures is relatively low (“Thank God,” he says), so it’s difficult for a generalist to obtain and maintain the necessary skills. In the regular ER, children frequently receive less pain medication than adults with similar injuries because non-specialists are hesitant about dosage and effect.
As important as expertise may be, attitude also has a great deal to do with what the Peds ED has to offer. About 30 percent of adults who come into the ER are in an acute condition, while only 10 percent of kids are at high risk. That’s why children are so often at the end of the triage line, consigned to long waits before their fevers or cuts are attended to. As far as Kroning is concerned, “Anything the parent deems is an emergency is an emergency. A lot of medicine is about reassurance. Think about what the parents are asking us to do. They’re asking us to take care of their most valuable possession. What an honor that is. As pediatricians, we have to honor and respect that.”
That respect seems to have made an impression on the local community. The Peds ED projected 7,000 patients during the first year. If the numbers of the first quarter continue, they will actually wind up seeing 12,000 kids, Kroning estimates. “Already the community physicians are really feeling comfortable with us. We’ve become part of the team and physicians trust us. When you build that confidence with the team, you can only grow and get better. We’re not here to be a substitute for the pediatrician; we’re here to complement their practices.”
“Nyack Hospital’s commitment to pediatrics goes back to the mid-1980s,” says Dr. Douglas Puder, its chief of pediatrics. At a time when many hospitals were down-sizing pediatric care, Nyack had full-time neonatologists and pediatric residents on staff. An affiliation with Columbia University College of Physicians and Surgeons (where Puder is an associate clinical professor) regularly brings pediatric sub-specialists (in cardiology and pulmonology, for example) to Nyack. “Now the Peds ED is really the last piece in our comprehensive pediatric care,” Puder observes.
Is that a hint of lemon in the air, a tinge of lavender? It’s not the antiseptic smell you usually associate with a hospital — and that’s the point at Benedictine Hospital in Kingston. Though many hospitals have begun offering various alternative treatments, Benedictine is among the few to have attempted integrating complementary medicine throughout the institution.
In 1998, a major study in the New England Journal of Medicine alerted doctors to a fact that their patients knew well: alternative medicine had a lot of fans. About 70 percent of Americans were seeking out treatments like acupuncture, therapeutic massage, and aromatherapy without ever mentioning it to their physicians.
“That was the lightbulb that went off,” says Dr. Douglas Heller, a board-certified internist who is medical director of the Complementary Medicine Program at Benedictine. “From a medical standpoint, we needed to learn more about what our patients were already doing, and what we could do to help them,” Heller recounts. “We sat down and said, in the Hudson Valley there are a tremendous number of practitioners in various modes of healing. Why not put a title to what they are doing, organize it in an efficient way, and see what kind of programs and initiatives we can put together?”
At the time, it was a radical idea for physicians to embrace, but a bit less radical at Benedictine. “Being a Catholic-based institution,” Heller says, “made prayer, meditation, and the spiritual aspect of medicine more part and parcel of the mind-set of the hospital.” Early on, Benedictine sponsored a program that offered acupuncture to patients in the detox and drug treatment programs. “That kind of set the stage,” Heller says, “for the use of acupuncture to treat other illnesses.”
As the Complementary Medicine Program began to shape up in committee meetings, the physicians made it clear they wanted the allied practitioners to be well-credentialed and go through the same kind of screening process physicians did. “It’s a way of maintaining quality care and a safe environment for the patient,” says Heller. “We were breaking new ground, developing a form, and checking from A to Z on educational background, references, and continuing education requirements.”
Today, as a matter of course, a patient at Benedictine can receive acupuncture for pain, aromatherapy for stress relief, and medical massage for improved mobility or immune system strengthening. Patients who want to try guided imagery or meditation can ask for a “bedscape” — a painted screen and soothing music to help them focus on getting well.
“It’s given the medical staff a sense of comfort, that they were getting help in delivering care, something complementary rather than an alternative,” says Heller. “It’s a turning point in the way you look at things.”
When a physician thinks medical massage or acupuncture will be beneficial to a patient, all that’s required is a referral form and then the nurses call in a request. The hospital works hard with insurance carriers to make sure these services are available with as little extra cost to the patient as possible. Sometimes there is no cost at all.
Last fall, Benedictine sponsored its first conference on alternative care. The well-attended event, entitled “Integrative Approaches to Health and Wellness,” was held at Ulster Community College. “We’ve taken a low-level approach to our Complementary Medicine Program, without a lot of fanfare,” says Heller. “This conference was sort of our coming-out party.” So now you know. If you believe that there are many paths to wellness, you’ll find them open at Benedictine Hospital in Kingston.
They’re a little bit ahead of the curve at St. Luke’s Cornwall Hospital (SLCH) in Newburgh. About a dozen times a week, Dr. Michael Sayegh puts in an intense 10 minutes changing the way his patients see the world. He removes their cataracts and inserts new intraocular lenses. That evening, or the next morning, the fuzzies and the color shifts and the cloudiness will have stopped plaguing their vision. Ninety percent of them won’t need to wear glasses (for distance — they’ll still need them for reading).
The first minutes of the procedure will be pretty much business as usual for a cataract eye surgeon. “We give them some drops to dilate the eye and lidocaine jelly for anesthesia,” says Sayegh (pronounced “sage”). “They’re laid flat on an operating table under an operating microscope. The procedure is essentially painless.”
In the old days, it was much more complicated, and injections into the eye made the procedure anything but painless. After removing the cataract, Sayegh makes a very small incision, just enough to accommodate the new intraocular lenses. Made out of silicon or acrylic, “they can fold into a taco-like shape,” says Sayegh. “Using small incisions lets people enjoy rapid healing.”
Sayegh is one of the few doctors in our region to have access to the recently FDA-approved AcrySof Natural lenses. These state-of-the-art lenses have a slight yellow tint that filters out blue light. Blue light is thought to be a potential contributor to age-related macular degeneration, the leading cause of blindness in the elderly.
“At 85 years old, it probably doesn’t matter what kind of implant you put in the eye,” Sayegh acknowledges. “There’s not going to be such a long period of exposure. But how about a 50-year-old patient? They’ll be exposed to a range of light for 30 or 40 years….There’s good enough data to suggest that if you can filter out the blue light, you should.”
Dr. Sayegh uses the AcrySof Natural lenses almost exclusively. “This is my personal lens of choice. Ultimately, I think everyone will use it.”