A Hard-Won Graduation

Ori Shadmon was in a coma. He was unable to breathe without a medical ventilator, and most of his organs were failing.
 
The culprit, an adenovirus, typically afflicts its victims with flu-like symptoms for a week or so. But for Ori, 16, the virus had landed him in the intensive care unit at Lucile Packard Children’s Hospital, where he was diagnosed with acute respiratory distress syndrome (ARDS) — a deadly condition in which fluid accumulates in the lungs, inhibiting oxygen from entering the bloodstream.
 
“Most people didn’t believe he could survive,” said David Cornfield, MD, the hospital’s chief of pulmonary, asthma and critical care. But Cornfield and his team were not among them.

Ori and his Uncle Dudu visit the hospital's rooftop garden, a place where Ori’s spirits were lifted during his lengthy stay.

 
What happened between Ori’s arrival in 2008 and his discharge seven-and-a-half months later is a testament to both the vigorous care he received at the hands of more than 500 physicians, surgeons, nurses and other hospital staff and the Shadmon family’s steadfast sense of hope.

Unconventional treatment

A native of Tel Aviv, Ori underwent heart surgery when he was 3 weeks old to repair his aorta. At 9, he got a kidney transplant at Packard Children’s. As a result of the drugs Ori had to take to keep his body from rejecting the organ, his immune system was compromised and especially vulnerable to ARDS.
 
So when the condition struck him at the start of 2008, he was left severely weakened. By the time he was admitted on January 10, the situation was desperate. “I was exhausted. I thought it was the end,” he recalled. “Unless they do something drastic — it’s over.”
 
Once Ori’s lungs failed, his doctors placed him in a medically induced coma, began mechanical ventilation and hooked him up to a dialysis machine; his kidney was failing. In addition, Ori developed pancreatitis, bloodstream infections, vocal cord paralysis and small blood clots in his blood vessels.
 
Cornfield, also the Anne T. and Robert M. Bass Professor in Pediatric Pulmonary Medicine, said that Ori lived “on the edge of a knife” for two months, but the doctor never wavered in his belief that the teenager could pull through.
 
“ARDS is one of the few disease states in which if you’re not getting worse, you’re actually getting better,” Cornfield said. “Most deaths from ARDS are in the first two weeks; nearly none are after five weeks. A number of trials have reproduced this.”
 
In its efforts to keep Ori alive and minimize damage to his lungs, the critical care team adopted less-than-conventional strategies.
 
First, the team used an innovative and unusual treatment: nitric oxide. Inhaled nitric oxide has been shown to help patients with severe cases of ARDS and compromised immune systems by increasing oxygenation to the bloodstream.
 
The doctors also put Ori on a ventilator that delivered small puffs of oxygen at very high rates. The aim was to keep the lungs from stretching too much, which can produce inflammation, Cornfield said.
 
This two-pronged treatment is setting a new standard for how some ARDS patients should be cared for, Cornfield said. He believes it’s what helped Ori turn the corner.

Hope is good medicine

Ori’s eventual recovery was not just about the excellent medical care he received at Packard Children’s.
 
Cornfield gave a recent presentation to colleagues and residents about the case and was joined by the teenager, who spoke about the importance of a more abstract kind of treatment. “Doctors need to understand that hope can start with the smallest interaction with the child or his parents,” Ori said.
 
“Think about my mom: She was sleeping outside the pediatric intensive care unit 24/7, terrified of receiving bad news,” Ori said, seeking to explain how critical it was that she receive some sort of encouragement. “Dr. Cornfield told my dad when I was in the PICU that it will take time, but ‘Ori will be able to ride his bike.’ That message provided strength and hope.”
 
And his parents’ hope gave him strength to fight, he said. “They made a promise that as long as I didn’t give up, they wouldn’t give up.”
 

Ori celebreates with hospital school teachers Thayer Gershon (L) and Kathy Ho (R) at the 2010 Hospital Prom

Letting Ori’s family know he had a chance of surviving, despite the severity of his illness, was essential, Cornfield said. “It’s OK, in my estimation, to warn people that the odds are long and the journey will be hard, but that there still remains hope,” he said.
 
On May 14, 2010, Ori, who is now 18, came to the Packard Children’s prom, which is held annually for current and former students of the hospital school. On that evening, he talked happily about playing the clarinet and going to the gym again. In June, he’s graduating from Gunn High School in Palo Alto and taking a vacation to Paris with his family. In the fall, he plans to attend Foothill College.
 
“When I came to this prom the first time, I was fully intubated, I had tons and tons of IVs and I was paralyzed from the waist down,” Ori said. “This time, the prom feels like closure. I’m really excited about what lies ahead.”