By Maureen Gilmer, IU Health senior writer, firstname.lastname@example.org
Justine Atkinson has lost count of the number of hands that worked in unison to save her child.
Nurses, doctors, therapists, technicians – all using their skills to make sure that little Mathew “Mattie” Atkinson would be home to celebrate Christmas.
It all started with a peanut.
It was about 6:30 on a Friday night, Nov. 4, when 16-month-old Mattie got hold of one of his brother’s snacks and inhaled a peanut. He launched into an on-and-off coughing fit that lasted about a half hour, his mom said, but seemed OK afterward.
Still, she called the pediatrician after hours, worried about putting her son to bed, and left a message. By the time the physician called back, Mattie had fallen asleep, and the doctor told her not to worry.
By the next day, the toddler was wheezing, and his mom was worrying. The following Monday, she took her son to the pediatrician, who diagnosed Mattie with RSV – a respiratory virus – and a double ear infection. At home his parents gave him antibiotics and breathing treatments.
But by Friday, he still wasn’t getting better. He wasn’t interested in eating or drinking.
“SOMETHING WASN’T RIGHT”
“Everything spiraled,” Atkinson said. “My husband (Brad) and I just knew something wasn’t right.”
It was clear the next day that something was definitely wrong when Mattie began coughing again in the family’s living room and turned blue.
They rushed him to a hospital near their Greenwood home, where he was stabilized before being transferred to Riley Hospital for Children’s pediatric intensive care unit. There, he was sedated and put on a ventilator to help him breathe.
That was the beginning of a two-week stay filled with ups and downs as doctors treated Mattie for multiple viruses. But it was more than that.
It was that pesky peanut.
The worst moment for Mattie’s parents came when a code blue rang out in their son’s room as his vital signs dropped just days after he arrived. Both were in the room when it happened. Also there was Kelsi Croy, PICU nurse and Mattie’s aunt.
She was Mattie’s “guardian angel,” Justine Atkinson said about her sister-in-law, who stepped away from her job for several days so she could help support the family.
Atkinson will never forget that code blue.
“It happened so quick,” she said. “His stats started to drop, and Rachel (Dr. Rachel Gahagen) pulled the code blue. To see all the people who came in and how they each had a job … if it wasn’t for them and all of their knowledge and skill, who knows if he would have survived.”
As Atkinson had feared, that peanut her son had choked on a week earlier hadn’t gone away. Turns out it was lodged in his left bronchus, which conducts air into the lungs. And it explains why his left lung kept collapsing.
Dr. Alvaro Tori, a critical care physician and associate professor of clinical pediatrics with the IU School of Medicine, said Mattie’s case was unusual because he presented as a patient with bronchiolitis and tested positive for two viruses, so that’s where the care team initially focused its efforts.
But a chest X-ray looked “unusual,” Dr. Tori said, even though the peanut wasn’t visible. He called for a pediatric pulmonologist to do a bronchoscopy, a procedure in which a thin tube is passed through the nose or mouth, down the throat and into the lungs to get a better look.
The peanut was in the left bronchus and needed to be removed. But it would move on its own before they could get him into the operating room.
Within hours, pediatric surgeon Dr. Brian Gray was called in to place Mattie on a lung bypass support system emergently to give his lungs a rest when the peanut became dislodged from the bronchus and floated up into his trachea (windpipe), an even more critical problem.
“Normally in a situation where we have a foreign body in the airway, we can go to the operating room and do this or we can even do a bronchoscopy in the ICU to remove the foreign body,” Dr. Gray said. “Unfortunately, this was stuck in the worst possible place, so really almost no air could move at that point.”
FOUR DAYS ON ECMO
After Dr. Gray, surgical director of ECMO (extracorporeal membrane oxygenation) and technicians placed Mattie on the lung bypass support, the surgeon inserted a bronchoscope with a tiny camera and a grasper tool on the end to remove the peanut, which came out in two pieces.
The peanut was stuck in the boy’s bronchus for long enough that a large amount of mucus had built up in his lung behind the obstruction, Dr. Gray explained. Once they were able to get the peanut out, it took a while for the team to safely reinflate his lungs and to allow them to heal enough to bring him off ECMO four days later.
All of it, he said, was a major team effort across multiple specialties at Riley. But it started with parents who listened to their own intuition.
“I was quite impressed at the family’s persistence in making sure he received appropriate care because they knew something wasn’t right,” Dr. Gray said. “If this peanut had become dislodged and gone into his main trachea while at home, it could have been a much worse scenario.”
RELIEF AND GRATITUDE
Over the past few weeks, Mattie has continued to heal and return to his playful self, his mom said. He is home now, walking again thanks to physical therapy to strengthen his legs. He’s even trying to play basketball inside the house with his older brothers.
It’s a remarkable turnaround and one that his parents credit to Riley.
“The care we received and the compassion were amazing,” Atkinson said. “I don’t know how I can ever thank all those doctors and nurses who had a hand in his care.”
She’s trying though. She dropped off cookies in the PICU after her son was discharged and sought out Dr. Tori to get a photo with him before they left the hospital. Now at home, she is writing thank-you notes to everyone she can remember on her son’s care team.
For his part, Dr. Tori said Mattie’s case represents Riley at its best. He wants to recognize the surgeons, pulmonologists, respiratory therapists, ECMO technicians, pharmacists and social workers who were part of Mattie’s team.
“THIS IS WHO WE ARE”
“It was such a great collaboration. This is what the multidisciplinary approach looks like,” he said. “This is when different specialties, different disciplines come together to take care of patients. And this is what Riley represents. This is who we are.”
It’s not just about the medical care though, he added.
“We can know about medicine, we can know how to treat a disease, but we can never forget that there’s a human being in that bed,” Dr. Tori said. “That is someone’s child, someone’s loved one in that bed. And there are family members who are struggling through this journey. We need to think of them as well, with empathy, with compassion.”
That compassion was on display, according to Mattie’s mom, who said Dr. Tori, Dr. Gahagen and others took the time to sit with the family and talk about the treatment plan beyond normal rounding. And the nurses, well, don’t get her started.
“I always knew nurses were amazing, but seeing it firsthand, they truly are amazing people.”
She gives a special shoutout to Abby Tarbutton, who was Mattie’s night nurse and listened to her concerns about the peanut, suggesting the toddler get a bronchoscopy. And, of course, her sister-in-law, Kelsi Croy, whom colleagues call “the heart of the PICU.”
PICU nurse Kristen Freeman said to see Croy on the other side of such a scary situation was gut-wrenching.
“However, she has been superwoman, just like we knew she would be. She advocated for him from a medical perspective and from a family perspective, while also maintaining professional boundaries,” Freeman said.
They are all heroes to Justine and Brad Atkinson.
“Everyone was incredible, and I’m just so thankful,” Justine Atkinson said. “I feel like I’m leaving part of my heart here. The way they loved us and loved him, I couldn’t imagine being anywhere else.”
CHOKING PREVENTION TIPS
Drs. Tori and Gray want to remind parents and caregivers to be vigilant with babies and young toddlers when they are eating. The holidays present a challenging time, as food may be easily accessible during parties and family gatherings.
Both fathers themselves, the physicians know how quickly a child can get into something they shouldn’t. And while food accounts for half of all choking episodes – think hot dogs, grapes, candy, carrots, peanuts, etc. – be aware of other hazards, Dr. Tori said.
“Choking can happen with coins, buttons, small batteries, magnets, toys. It’s important that we always check our home, under tables and furniture, between cushions and on the floor for small items that can cause choking,” he said.
And supervise small kids at all times when they are eating.
“Make sure they never run, play or lie down with food in their mouths.”
For more tips on keeping kids safe, check out healthychildren.org, powered by the American Academy of Pediatrics.
Family photo by Macey Chase Design, all other photos submitted