The doctor who never gives up

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FIGHTING FOR THE BEST: Dr Miles Bartlett checks up on a young patient in the paediatric intensive care unit at Garden City Hospital in Mayfair, Joburg. Pictures: Paballo Thekiso

Sheree Bega

Matthew Everett should have died before his second birthday. The 18-month-old was immersed in a swimming pool for so long there was little hope he would survive.

But last year Matthew, now 18, paid Dr Miles Bartlett a surprise visit at his rooms at Netcare’s Garden City Hospital in Mayfair, Joburg. “He came to visit me from the UK where he is studying aeronautical engineering. I was so chuffed.

“I asked him: ‘What are you doing here?’ He said he had come to thank me, but I told him: ‘Don’t thank me, thank the man up there. He’s got a job for you to do’.”

The child’s case is one that Bartlett, a paediatrician and intensive care specialist, will never forget.

It was one of his first near-drownings in 1991, long before the paediatric intensive care unit for which he fought would be created.

A MIRACLE: Anice Kruger with her daughter Pippie before leaving the Garden City paediatric ward. Picture: Chris Collingridge

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“He was under for 10 minutes. I started CPR at around 10. I would do cardiac massage, give him a shot of adrenaline, get a heart rate and then it would go again.

“One of my colleagues, Dr Keith Bolton, came in four hours later and asked me what I thought I was doing, that the child was dead.

“I remember sitting in front of the monitor looking at this straight line and thinking: ‘God, what do I do?’ I gave one more shot. And he revived. The sister said: ‘Look, you’ve made a cabbage now.’ But today, Matthew is studying aeronautical engineering.”

Bartlett’s walls are covered with photos of the children he and his team have helped bring back to life, among them a smiling portrait of the curly-haired Matthew. On his desk is a framed collage – a series of tender snapshots of a grinning Isabella “Pippie” Kruger.

Some show the then two-year-old running with her parents and playing in the garden, others feature the little girl grimacing as she lies bandaged in Bartlett’s ICU after a freak fire burnt 80 percent of her body. “Still my hero,” reads the inscription to the gruff-voiced doctor.

“Dr Bartlett saved Pippie from the inside, not just from the outside,” says Anice Kruger, Pippie’s mother, who presented the collage to him when her daughter was discharged last week. “He is a miracle. I wish I could clone him and take him home.”

For the children: Dr Miles Bartlett laughs in his office.

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In the six months that Pippie – who last month underwent a pioneering skin graft using cells cloned from her own skin – spent at Garden City, Bartlett saved her life over and over. But he cares little for the “glory” as ICU is “in the backroom”.

Kruger wants to credit her daughter’s lifesaver. “I miss him to bits. He is bombastic and doesn’t have any bedside manner. I remember he was sitting on a chair last week and I gave him a hug from behind. I told him I love him and I’m going to miss him. He stood up, walked out and ignored me for four days. But he was so touched. He told me he was not going to get emotionally involved (with Pippie), but he did. It was very hard to say goodbye.”

Bartlett and his team have saved many lives.

“We’ve done about 200 drownings since we started in 2005.”

Renowned for his work using hypothermic or “cooling” treatment to prevent brain injury in victims of near drowning, he explains it was first used in the 1950s by cooling a patient’s body to between 20ºC and 25ºC. The treatment was stopped, though, because of the risk of infection at those low temperatures.

Bartlett introduced a milder form of hypothermia by dropping the body temperature to 34ºC and his unit has seen dramatic successes.

“Any child with a predicted brain injury score of under 90 percent we can guarantee will come out normal, whereas before we couldn’t… but it’s not just cooling. If the ICU is not good, then the cooling is not good.

“We’re trying to create something very different because there are no other paediatric ICUs in Joburg… It has been shown internationally that if children are managed in adult ICUs by paediatricians that are untrained and nursing staff that don’t know children, the outcomes are poor.

“In the UK, they found that 75 percent of the children who had died should not have died. What they did then was intensivist-driven ICUs, so there must be people trained in intensive care and sisters that know children – and only children. It’s volume-driven. The more you do this, the better you get.”

That’s a challenge in Joburg. “You have to bump up against financial interests… paediatricians thinking you’re going to steal their patients, that they’re going to lose money.

“It’s been an incredible battle but we got it right – we managed to build it up into a credible unit. Every year, we build up, you know, and add on. Really it’s the ideal unit for children and only children because that’s what we do and that’s what we’re good at.”

It’s about teamwork and he appreciates the dedication of his team, many nurses who were not initially trained in paediatrics, but who thrive in the unit. “We also rely on pre-hospital management and what we’re trying to do these days is take the ICU out of the child, so liaising with the paramedics and telling them what we want done.”

SA is behind its international counterparts. “We’re about 20 years behind the rest of the world. We can’t even get paediatric intensive care units established. Overseas, they have neurointensive paediatric units, paediatric burns units and paediatric trauma centres.”

Bartlett, 64, jokes he used to sleep at work. “My kids accuse me of liking other kids more than them,” he laughs. “It’s stressful and tiring work, but it’s very rewarding. The children’s families become part of our family. We feel the same emotions when we lose a child. You can’t put yourself in the parent’s shoes because you’ve never been there, but you’ve seen it all the time.

“I don’t think we ever get immune to the death of a child. And working in ICU, you get burn-out. We regularly start getting emotional by September.”

Bonds are formed. “It’s almost like it’s our child and we’ve got to be very careful or we start bossing mom around,” he laughs. “We have to be family-friendly, which you can see can be difficult because the nurses can get in the mother’s hair, the mothers can get in the nurses’ hair, we all get in each other’s hair. It’s a child with a family. It’s not just a patient lying there.

“It’s rough, because you get multiple organ systems failures, and their hearts (fail), and then you sit and wrestle with yourself and think are you actually doing the parents a favour? If it’s going to be a bad outcome, is it worth putting the child through all of that? We’re draining the parents financially. But we always ask the parents, do they want us to be active.

“You know it’s easy when there’s brain death – but when there isn’t, it’s a very difficult decision. We know it’s going to be a long, hard struggle and we’re going to be dealing with multiple system failures.

“Pippie had lung failure. We had to give her drugs that must have cost R100 000 to get her lungs open again, then her kidneys failed, we had to dialyse her. We had to put her on massive blood pressure drugs.

“Sometimes I think I’m the only idiot that does it, going way over what’s recommended, but it works. With my drownings, the very first one, I had her on so much adrenaline it was unheard of. Other doctors told us to switch off but we didn’t. She’s alive and walking. Yes she can’t talk.

“But that’s when I decided you know the books are one thing, it’s what you’re faced with at that point in time. So you pull out all the stops. If you don’t you’re going to lose anyway. The sisters always laugh at me because I won’t give up. I go on until I know I’m beaten. I have faith because I’ve seen miracles.”

The ICU beds are full with children who are paralysed, who have suffered septic shock or are victims of abuse. This is when the unit thrives, explains unit manager Liesel Theron.

But few nurses can deal with the emotional roller-coaster of healing children. “We’re all mothers. Sometimes we see our own children in these beds.

“It takes a very special person to work here. With Pippie the first few days were just prayer and now to see her respond and those beautiful blue eyes looking at you, it’s amazing.

“The child comes home from hospital three months later, walking and talking. Yes, maybe they won’t be cum laude students, but they are part of their family and they’re home again,” she says.