Dr. Mike McCabe never had that “aha” moment in his youth some people experience when describing what led them to their life’s work. If you ask him, he’ll tell you his path to becoming a doctor was a journey.
“Working in pediatrics was more of a calling than a field of study or work,” said Dr. McCabe. “The opportunity to impact a child in need, or a family struggling with life, is such a privilege.”
If you had the chance to have Dr. McCabe treat your child, it would quickly become apparent that the privilege was yours.
A veteran pediatrician who ran a successful practice for 19 years, Dr. McCabe accepted a position as a pediatric hospitalist at Aultman Hospital in 2006 because he was ready for an opportunity to do something different.
A unique partnership between Children’s and Aultman offers families in the Stark County area access to the expert care they have come to expect at the Akron hospital – only closer to home.
“It works well because we have long been established in the Canton community and have good rapport with local pediatricians and family practice docs who refer patients to the unit,” said Dr. McCabe.
This week Dr. McCabe is working 4, 9-hour day shifts. One of his partners will take over from 3 p.m. to 7 a.m.
“We take care of mild to moderately ill kids who aren’t high risk,” said Dr. McCabe. “They’re sick but stable.”
At 7:30 a.m. Dr. McCabe touches base with registered nurses Donna Mann and Carrie Hensel to discuss any special concerns regarding the unit’s 7 inpatients.
After reviewing charts, labs and X-rays, a pre-round huddle occurs at 9 a.m. to discuss which patients to see first. This decision is often based on simple courtesies like whose parents need to get to work soon and whose family is still asleep.
“We are a family-centered unit,” Dr. McCabe said. “It’s important to us that parents and families are partners in their child’s care plan.”
In addition to Dr. McCabe, Carrie and Donna, others are rounding on patients, including: Katie Wilhelm, a medical assistant; Krystal Kohlman, a physician assistant student from Baldwin Wallace University, and 3 nursing students from Kent State University Stark Campus.
Teaching residents and students is another part of Dr. McCabe’s job.
In other community hospitals, hospitalists often are also in private practice seeing office patients after hospital rounds.
That’s not the case for Dr. McCabe and his partners.
“My only responsibility is to the 7 patients I have on the floor today. I like that I can focus all of my attention on them.”
Today’s caseload starts with 2-month-old Mason who was born premature and spent 4 weeks in Aultman’s neonatal intensive care unit. He was discharged 2 weeks ago and was showing signs of breathing difficulties yesterday in his pediatrician’s office.
“One of the challenges primary care doctors face is when patients come into their office and seem really ill but they aren’t sure why. These doctors have to decide whether or not it’s safe to send their patients home and that can be very tricky in really young infants,” Dr. McCabe said. “Often the safest thing to do is to admit them for observation overnight.”
Family-centered care approach
Using the family-centered care approach, Dr. McCabe asks Mason’s parents if they think he looks and seems better than yesterday.
“Sometimes these babies are fragile and sometimes it’s hard for the parents to see them as anything other than being fragile because of everything they’ve been through,” he said.
Dr. McCabe explains that Mason’s nose was pretty clogged and because babies try to breathe almost exclusively through their noses, suctioning his nose has helped tremendously. He suggests the use of a vaporizer at home to help keep the air humidified.
Sixteen-month-old Leahnee hasn’t been eating much since experiencing coughing, febrile seizures, mucousy stools and a rash that has spread on her trunk. Mom and dad are clearly worried.
Dr. McCabe kneels down at the bedside to check Leahnee’s vitals and jokes as the little girl plays with the TV remote, “I bet you wish you had a button you could push to make me go away.”
Dr. McCabe explains that Leahnee’s tests all came back negative for anything serious.
“I know the febrile seizures are scary to watch but kids eventually outgrow them,” he told her parents. “If they continue when she doesn’t have a fever then we would look at doing an EEG down the road.”
He tells mom and dad that the respiratory therapist will be coming in to teach them how to use a spacer and puffer to help with Leahnee’s coughing and wheezing.
Cammi, 7, was admitted to the hospital last night to rule out Kawasaki disease. Cammi’s mom explained that she’s had a cold for the last few days and spiked a fever yesterday. She was sent home from school with a noticeable case of pink eye that seems to have worsened since starting eye drops.
Dr. McCabe asks mom about the health of everyone else at home.
As far as the prospect of Kawasaki, he explains, “It’s not a testable condition – it’s something we rule out and so far I don’t think she has it.”
Lab tests show a possible urinary tract infection so Dr. McCabe orders a repeat urine analysis.
“Cammi, can you lie down for me?” he asks. “My teddy bear (attached to his stethoscope) and I are going to take a listen.”
He presses gently on her belly asking about any pain.
When Cammi sits back up he takes a peek in her ears. “Hello, is there anybody in there?” he jokes.
He notices that one ear canal is draining pus. Mom states that it wasn’t there earlier.
Dr. McCabe explains to mom that a lot of what he’s seeing looks like adenovirus.
“Let’s treat her like she has a middle ear infection because I can’t be sure if the draining ear is a secondary infection or not. The antibiotics may help clear up the eyes as well,” he said. “Cammi has a number of common things going on right now, but the good news is none of them are anything scary.”
Cammi’s nurse, Carrie, writes down the plan of care on a white board in her room which includes a regular diet, measuring urine input and output, getting a repeat urine culture and stopping eye drops.
Dr. McCabe takes a short break from rounding on patients to input orders into the computer.
After seeing a 3 year old with croup, Dr. McCabe and Krystal, the student physician assistant, confer over the chest X-ray of 2-month-old Ella who may have a slight case of pneumonia.
“It’s hard to know for sure because you get the best images when a person is vertical and can take and hold a deep breath,” he said. “Both of these things are impossible to do with a baby.”
Ella was admitted through the ER last night. Mom says Ella has been lethargic, feeding less and breathing hard.
Upon exam it’s determined that Ella doesn’t appear to have an ear infection although she does have a considerable amount of wax in her ears. Dr. McCabe asks for an ear picker to remove it.
He explains the care plan to mom, which includes turning down Ella’s IV to help her appetite and watching her cultures to see if her pneumonia worsens.
“In babies Ella’s age, it’s common for respiratory congestion to plug things up,” he said. “We’re going to suction her nose and see if that helps. It can be hard on a baby’s body to be on antibiotics so we aren’t going to put her on them right now.”
His last patient on rounds is 11-year-old Caiden who has pneumonia. He was admitted last night for a high fever and low oxygen saturation levels.
Nurse Donna rattles off Caiden’s current respiratory vitals. After being on oxygen through the night his saturation levels have improved significantly.
Mom lets Dr. McCabe know that Caiden has been sick for a week with a dry cough that has worsened over the past 3 days.
Dr. McCabe asks whether he has a history of asthma.
Chad, one of the nursing students, has been working with Caiden on using an incentive spirometer to help clear his lungs.
“He’s making good progress,” said Dr. McCabe. “The bad news is pneumonia makes you sick, but the good news is it responds well to medication.”
Dr. McCabe explains to mom that he likes to observe patients for 8 to 12 hours after coming off oxygen before making a determination on discharge.
After completing rounds he spends the next hour typing notes, reviewing orders and following up on lab results. He clears Cammi and Leahnee to go home later in the day and stops back in Caiden’s room to answer some questions he has about the incentive spirometer.
Supporting the community
After returning emails about Akron Children’s physician initiatives and discussing them with Dr. Kilkenny during the shift change, he speaks with the charge nurse about pharmacy issues and answers emails about an upcoming event in December.
“We try to support hospital and community initiatives,” he said.
Dr. McCabe will accompany Aultman’s WOW van (Wellness on Wheels) and its mascot, Freddie the Frog, to a local grade school to accept money raised by the students.
“The project is called Pennies for PJ’s and last year they raised more than $2,500 to buy pajamas for our patients,” he said. “I wrote a song for that called, what else, ‘Pennies for PJ’s’ which we played last year.”
Tomorrow he’ll be back at the hospital doing it all over again.
“Patients and families allow me to know them and help them in a way that is unique and humbling,” he said. “We, in medicine, are servants if we’re doing our jobs right. This is the role I love the most.”
Akron Children’s hospitalists also care for children in other inpatient pediatric units including on the Akron campus, Beeghly campus in Boardman, and at Wooster Community Hospital and MedCentral Health System in Mansfield.