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Diaphragmatic hernia, pulmonary hypertension
Joel Metcalf

The depth of the bond shared between mother and child is like none other. Motherly instinct kicks in and one can be all consumed by the need to nurture and protect. Just ask Rachel Metcalf, whose youngest son, Joel, spent time in the Neonatal Intensive Care Unit (NICU) at Children’s of Alabama.

Joel was admitted to Children’s after he was diagnosed with a hernia in his diaphragm – an abnormal opening that can allow the stomach and intestines in the abdominal cavity to move into the chest cavity and crowd the heart and lungs. Diaphragmatic hernias are typically diagnosed in utero, however, Joel’s diagnosis came after his birth.

“We had no idea and then he was born and wasn’t breathing well or crying,” Rachel said. “They quickly did an X-ray, which revealed the hernia.”

Joel was transported from his birth hospital to another local hospital in his hometown of Huntsville, where he was stabilized. The pediatric surgeon wanted to perform a surgery to correct the hernia the next day, but parental instinct gave the Metcalfs pause.

“The more my husband, Sam, and I thought about it and learned about it ourselves, we realized that was not what was best for Joel,” Rachel said. “They were literally prepping Joel for surgery when Sam told them to stop and send him to Children’s of Alabama.”

After arriving at Children’s, doctors also diagnosed Joel with pulmonary hypertension. The Metcalfs spent the next two weeks waiting for Joel to be stable enough to handle surgery. “They were great because they were so patient with us and made sure to wait until he was really ready to go through that surgery,” Rachel said. “They were being very precautious, which told us we 100 percent made the right decision in taking him to Children’s.”

Once Joel was stable, his pediatric general surgeon, Dr. Scott Anderson, scheduled a surgery to move his organs back in place and fix the hole in his diaphragm. “They didn’t know for sure how bad it could be until they were in there,” Rachel said. “There were many unknowns.”

Luckily, Joel’s left lung was in good shape. Only his small intestines were out of place and the hole in his diaphragm was small enough that it could be stitched and heal on its own.

“Dr. Anderson was also able to do all of this as an orthoscopic surgery, only making about five tiny incisions around his chest and back,” Rachel said. “Had we done this surgery elsewhere, they would have had to make a huge incision.”

Post-surgery, Joel was weaned off oxygen in about a week. Then it was on to eating—something he hadn’t done without a tube since birth. He took bottles from nurses, though he was spitting up a lot and not finishing them. That’s when Rachel stepped in, knowing just what her son needed.

“I eventually asked if I could try to breastfeed him, like I would at home, to see how he would do,” Rachel said. “He did so well with me that after four days he had gained enough weight to be discharged.”

While Rachel was proud to be the one to help Joel learn to eat, she credits everyone at Children’s for his excellent care. “Children’s was incredible,” she said. “The nurses and doctors treated him like he was their own. It meant a lot to us because he wasn’t just another sick baby to them. They went above and beyond.”
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