Caitlin Whyte (Host): Welcome to In Their Words, a podcast from the UPMC Pinnacle Foundation and UPMC in Central PA. In this episode, we sit down with two inspiring leaders in pediatric healthcare, Abby Flanders, Executive Administrator at UPMC Central PA, and Dr. Becky Smith, Pediatric ICU physician at UPMC Children's in Harrisburg. Together, they share their personal journeys into medicine. What drew them to Pediatrics and the realities of caring for children and families in the fast-paced, emotionally charged world of pediatric intensive care.

Abby Flanders: I am Abby Flanders. I'm an Executive Administrator for the Pediatric Neonatal and Anesthesia Services for UPMC in Central PA. I'm a nurse by trade, so I've been with the UPMC system for 16 years. I practiced as a pediatric nurse for three years before joining UPMC, but I was a nurse with the system for five years before starting my leadership journey. And all 11 years of leadership, I have been in Pediatrics. And then, just recently this year, I added anesthesia services. So, the reason I got into the field was actually my grandmother was a nurse. And she and I had a lot of conversations about caring for patients and the joy that it brought her and I wanted to do the same. And then, whenever I had that opportunity, I actually realized that I have other skills too in administration and leadership and, you know, bringing a team together and taking a vision forward. So, that's when I started my leadership journey and was a manager of a pediatric practice and then the director for the region. And then, I started overseeing the Pediatric service line in 2021. I've been with the pediatric service line in that capacity ever since.

Dr. Becky Smith: My name is Becky Smith. I am a Pediatric Intensive Care Unit physician, and I've trained both in PICU as well as Peds Cardiac ICU. So, that's for kids who have predominantly congenital heart disease. Lots of people don't understand what PICU stands for or what it means. It's the Pediatric intensive care unit. These are generally slightly older kids than the neonatal intensive care unit, and we take care of these kids when they need support for their breathing. Sometimes that's just higher levels of oxygen. Sometimes it means they need breathing machines. We give them special medications via IV to help with their blood sugar or their blood pressure. And these medications basically help them get better. I've been doing this for probably at least 15 years. And I've been working here in Harrisburg at UPMC Children's for the last three years. And my role here at Harrisburg is both a pediatric ICU physician as well as I'm the Associate Regional Medical Director for the Pediatric ICU. I also work as a liaison with the emergency room to help coordinate improvements in pediatric care and work with the quality group here at Harrisburg to improve quality for pediatric care as well.

When I was a little kid, I first wanted to be an artist and then I wanted to be an architect. And as I became older, I realized I just didn't have enough talent to do that. So, my mother was a physical therapist and she did home health in rural Central Pennsylvania. So, I used to go home to home with her as she did rehabilitation for patients. And I think that's probably my first introduction and where I sort of found a love for taking care of others, even though it's a very different job than what I do now. And when I went to college, I worked in the college health center and just sort of went through my years of training, kind of finding myself.

Usually, people ask why Pediatrics? And I think the why pediatrics is because I both love children and love parents. And you actually need to love both to be really good at this. So, I love working with kids, I love working with parents. And I like fast-paced action type work. So, the ICU is that type of environment. My artistic skills were not up to what they needed to be to be an artist or an architect. But yeah, that is what I wanted to do when I was a little kid.

Abby Flanders: I always wanted to be a nurse. I mean, my earliest memories are playing with, you know, the Fisher-Price doctor kit. And my family would joke and say, "Are you going to be a doctor? And I said, " Absolutely not. I'm going to be a nurse. I want to be a nurse." So, I wanted that since I can remember.

But I do think the role that I currently serve in, I found my niche in serving those who serve. I enjoy it so much to make sure that their barriers are removed and they have everything that they need in order to serve the patients well. I love it so much to be in the background and make sure our operations are smooth and the team is satisfied and content and have all that they need.

Host: For families entering the pediatric ICU, it can feel overwhelming. But as Dr. Becky Smith describes, Harrisburg's model is unique. One child, one family, one room. That consistency of space and staff helps create a sense of stability, even when circumstances are frightening and uncertain

Dr. Becky Smith: Yeah. So, for families that come through Harrisburg Hospital, sometimes you'll see the pediatric experts even as quickly as you're seen in the emergency room. So, it's not uncommon, especially for the critically ill kids that will come down and we will work as colleagues alongside the emergency medicine physicians to take care of some of the really sick kids who end up in the ER. And we have lots of people with varying levels of talent within this group who will help us help your kid. So, we have nurses who have expertise and many years of treating children, who will do IV placement or blood draws.

We have Child Life who will help, you know, support your child and your family with things that are probably new and sometimes strange, and they'll help sort of explain what next steps look like and help demystify some of the medical things that may happen. As we get to the point where we've done the emergency resuscitation or the emergency care, then we'll eventually transfer your child as well as with your family up to the Pediatric ICU, which is on the ninth floor. A lot of these pediatric experts float between the ER and the ICU. And we have a really unique model in Harrisburg that I love, which is sort of one kid, one family, one bed space. So, you might be admitted to a certain bed, say 904, and you may start your journey there, but you generally finish their journey there.

So, the pediatric ICU is special nurses and doctors, and each room can be an ICU room so that then, as your child gets better, you don't have to switch rooms, you just switch doctors to be in the general medical floor. And then, you'll eventually be discharged from that room. We have all the specialty ICU equipment that you've probably seen on television or maybe with experiences in hospitals. So, we have breathing machines. We have special IV pumps and things like that for the medical care that we give there. And we have a staff of both medical physicians as well as surgical physicians who can help your child.

Abby Flanders: My role in administration is mostly in advance of patient care. So for example, if we have a lack of services in some area, it's my role to either start or grow that service so it's robust enough whenever the patient's need it. For example, we currently have Pediatric Ophthalmology only in our neonatal ICU, and it's my role to grow that service so that we can also have Pediatric Ophthalmology services on the pediatric floor if we need. Or another example, we previously did not have inpatient Pediatric neurology service, but it was my role to recruit an additional pediatric neurologist to make sure that we can have in-person consults. The Pediatric Neurologist now is on the floor doing in-person exams. It's not just telecare anymore. And that's really the mode that we're in for UPMC Central PA. We're in growth mode. We're constantly expanding what we're offering so that we are a full-service pediatric department.

One other thing is, as an administrator, I get the, you know, joy of doing rounds on the Pediatric floor. So, I do get to see the patients and their families and talk with them and, you know, ask questions such as: How's your stay going with us and have all of your needs been met? Do you have any concerns? Anything that I can address and work on? And I get to share those positive stories with the rest of our team to continue encouraging them in their work, but also can pay close attention whenever there are concerns or issues and make sure that we work on those behind the scenes so that it's corrected or improved for the next time or the next patient.

So, I do enjoy those interactions as well. I don't get to do them as often. But, yeah, my nurse heart in me still appreciates being at the patient bedside and speaking with the patients and their families.

Dr. Becky Smith: One of the cool things about being a doctor and taking care of patients is sometimes things that are little things for you as a doctor are really incredibly impactful for families. So like one example is we had a very sick asthmatic child, and he had been with us numerous times. But on one of his visits he was having issues because he was so sick and in the hospital so much that he was losing his primary caregivers. In other words, the family medicine pediatrician doctors who were seeing him, he was missing appointment after appointment. And so, he was being dismissed from practices. And so, you know, when this kiddo was in the hospital, one day I walked in and his mom was in tears because she was literally on the phone explaining "We're in the hospital" and they were explaining, "But you've now missed three appointments. And unfortunately, our rule is three strikes and you're out."

And you know, for that mom, she and I sat for part of the afternoon. I called problem solvers like Abby. You know, Abby isn't the only problem solver in the system. We have some other really incredible administrative problem solvers. And I called some of my problem solvers on the administrative side, and I was like, "Help me find this kid, a pediatrician, and he needs a lung doctor." And we got him a note so that he could get a ride to school because he was so short of breath, he couldn't make the walk from his house to school without having to stop and rest between his house and the school.

So, sometimes the biggest impacts we make aren't like placing a breathing tube or putting in a special IV or giving special medications, but that like one-to-one connections that you develop with patients and families to realize like the really fancy medical stuff we do is important, but sometimes this individualized care. We can give at the bedside is what really truly does impact their lives. Obviously, if we didn't help him when he was really, really sick, he wouldn't be at that position. But I'm sure what that mom remembers about working with our team is not, "Oh, well they gave a lot of medicine," or "They gave really high levels of respiratory support." But what she remembers is that we sat down together and we made sure that her child had a pediatrician and got a lung doctor and we got him in, you know, really timely with appointments and we wrote letters to the school. And those things, honestly, I think that ripple effect is far more impactful than the really fancy medical stuff that everybody wants to talk about. But I'm not sure families really understand necessarily a lot of those things that we do because they're very technical.

But the care we give that is very different than the care I've given in other centers, that you do sit down with the attending every day. I go in every day and I sit in a chair next to the family and the patient and I talk to them. And that very individualized care, I think, is what makes the care at Harrisburg very unique. And for me, it's what makes the care extremely rewarding. That's the part of my job that I love. Yeah, I do love the fancy high-end medical stuff, but I really love the interactions that we get to have with patients and families. And I meet their siblings and aunties and grandmas and those sorts of things I think are really important too, and make us really unique at Harrisburg.

I think we have really personalized care and there are people in other centers that can do exactly what I do. My skillset is not so outrageous or incredible that it can't be duplicated somewhere else. But I think the personal care is what's unique here.

Abby Flanders: I think that that's unique about my role in administration that I not only get to, in a removed way, serve the patients and their families, but also very directly serve the people who care for them. And therefore, I have a story for each. First, the patient side. My husband and I are also foster parents, so we get to walk in other circles that expose us to some more immediate or urgent care needs in really stressful times.

So when a child is placed in a new placement and the foster parents are discovering some unique medical concerns or symptoms that worry them, and they need to find care pretty rapidly, I heard recently from a fellow foster parent that was so relieved whenever they called Children's Specialty Services for a single Endocrinology appointment, and happened to mention when they were on the phone, "Thank you for scheduling this. Now, I got to hang up and call the gastroenterologist and the allergist, and the pulmonologist too." And the person on the line said, "Well, actually, we're all of those things so I can help you." So, she was so relieved. And I thought hearing stories like that remind me why I invest so much time in recruitment and why I invest so much time in smooth operations, and making sure that we have a multi-specialty center and making sure that we have really pleasant and caring staff members who are going to do everything they can to ease the parent's concerns and make their lives easier.

And then, alternately kind of serving the providers, I recently had a very, very kind physician reach out and let me know that they appreciate how they feel respected, they feel cared for, they feel valued. They feel that, you know, whenever they have a need or an issue or a question, they know they can reach out and are confident that they're going to receive attention for their concern and we're going to work on these things behind the scenes. And he said that it mattered to him because it is a really hard job to care for sick kids. and it takes a lot out of him every day. And whenever he's able to think I'm cared for, it helps him to care, I think, better and stronger for his patients. And that was another reminder of why I do what I do, because whenever our providers are satisfied and feel cared for, then they're caring longer and stronger for our patients.

Host: Beyond the medicine, Abby and Dr. Smith remind us that what truly shapes a family's experience is the way care is delivered. A quiet conversation, a moment of reassurance, or an advocate who helps remove barriers can transform overwhelming circumstances into something a family feels they can endure.

Dr. Becky Smith: Nobody really comes to the hospital and thinks about getting cared for in ways that are non-medical. But I think we do a really great job caring for both the medical and the non-medical needs. One specific example that I think of that I feel like happens every time I do an admission is that, you know, we'll do an admission and sometimes children end up coming to the ward at like two o'clock in the morning and you can just tell these parents are very harried.

And one of the questions that I always ask is, "Have you eaten? And many times," obviously at two in the morning, they're like, "The last meal I had was lunch." And so, we have facilities for families to be supported, to have coffee and tea and drinks and meals that they can warm up even in the middle of the night to just help support, not just the patient, but also everybody around them who is an integral part of their care, right? We need parents to be present and we need them to be supported to have a really strong team. And so, we don't just support the patient, we also support, you know, all these caregivers as well who come and work with us. And sometimes that's as simple as free parking, which for some of our families the cost of parking in a city is a lot of money. So, sometimes it's just free parking and sometimes it's meals in the middle of the night. But you know, typically, if a family's admitted at two o'clock in the morning long before I ever even get to the room. One of our PCTs or our nurses have made the bed for the family member so that there's not just a place for the child to sleep, but also for the family to sleep.

And I think these intangibles are really, really important when it comes to just having a little bit of that weight lifted off your shoulder because you have the weight of the world that your child is sick. The last thing you want to think about is, like, "How do I get a meal in downtown Harrisburg at two in the morning?" Or "Am I going to have a place to sleep while my child is here as an inpatient? And we do a great job making sure that things like that are taken care of. Cell phones get charged, kids have iPads to watch if they're bored in the hospital. There's toys seven days a week. So, I think those things are really important and often get overlooked when we talk about the medical care at Harrisburg because people want to focus on the medicine. But the medicine's great and you'll get great medical care, but you'll actually get entire care for the family. It's not just about the medical care that that kiddo is going to get while they're here.

But I think hopefully from Abby and I, you just sort of see like the passion behind this effort. Because we really do think we have great services and a great product. And I feel at least personally, a lot of the community doesn't necessarily know how it's never nice to be in the hospital, but that there are things here that make this a lot easier to deal with as a family.

Host: Thank you for listening to In Their Words. This conversation reminds us that while technology and expertise are essential, it is compassion and personal care that families remember most. We are grateful to the UPMC in Central PA physicians, nurses, and administrators who bring this commitment to life every day and to the donors of the UPMC Pinnacle Foundation, whose generosity makes it possible to expand services and improve care for children and families in our region. Until next time, thanks for listening.