Teamwork After Trauma

Parker Rose makes remarkable recovery after complex spine surgery

The helicopter carrying Sarah Dobbin and her 8-year-old daughter, Parker Rose Outlaw, made its way through the dark of night to CHKD, the closest Level I Pediatric Trauma Center. The two had just survived a head-on car accident that happened on their way to a beach house rental in the Outer Banks, where Sarah’s extended family was gathering for an annual summer reunion.

Although the crash had injured her legs, Sarah had managed to pull both of her kids out of the car to safety. Her son had a concussion and an abrasion above his eye, but something more serious had happened to Parker Rose. She had a large, tender bruise on her lower back and couldn’t move her left leg. As the helicopter flew toward Norfolk, Sarah spoke with the paramedics on board, who seemed to understand that letting her talk nonstop helped her hold it together. However, she couldn’t control her fear that Parker Rose, who loved to do backbends and the splits, might never walk again.

“Honestly, she was not in good shape,” Sarah says. “I knew she was critically injured.”

The trauma team at CHKD was assembled and waiting for Parker Rose when she arrived after midnight on July 16, 2023. In addition to an emergency physician, trauma surgeon, nurses, and technicians, the multidisciplinary team included a child life specialist, a social worker, and a chaplain to provide emotional support and guidance.

While Sarah was taken next door to Sentara Norfolk General Hospital, the CHKD trauma team, led by surgeon

Dr. Jeffrey Riblet that night, went to work to check Parker Rose’s airway, breathing, and circulation before moving on to a detailed head-to-toe exam. They quickly discovered bruising from her seatbelt and a large bruise over her lower spine. Parker Rose had a chest X-ray, a pelvic X-ray, and CT scans of her head, cervical spine, abdomen, and pelvis. A side image of her back showed that her spine was fractured and had shifted from the break.

Her lumbar spine was fractured and dislocated.

“It’s probably one of the worst spinal injuries I’ve seen,” says CHKD pediatric surgeon Dr. Jamie Golden, who was working with the trauma team that weekend.

Dr. Riblet picked up the phone to reach the orthopedic surgeon on call.

Dr. Carl St. Remy, chief of orthopedics and director of the spine program at CHKD, made a conscious decision years ago to live close to the hospital. It was important to him to know that he could be there within 10 minutes if he was ever needed. Listening to Dr. Riblet describe Parker Rose’s spinal fracture over the phone, he knew this was one of the moments. He got in his car and headed straight to CHKD.

Dr. St. Remy found Parker Rose in the pediatric intensive care unit. Looking at her X-rays, he knew that if she had been an adult, this injury would have likely made her paraplegic. But because she was young, there was a chance that her spinal cord had not been severed in the crash. He ordered another MRI to get a closer look and to figure out if she needed surgery immediately or if they had time to stabilize her before operating. The results gave him hope. “Her spinal cord was squeezed but continuous,” Dr. St. Remy says. “As bad as it looked, the spinal cord was still hanging together by a thread.”

Dr. St. Remy cleared his schedule for the next day. This would give Parker Rose a day to rest before he and his surgical team attempted to repair her spine.

In the PICU, doctors were also monitoring Parker Rose for abdominal injuries. Her left kidney had suffered infarction, which meant that its blood flow had been cut off. “When you have a spinal injury like that, where the force is enough to break your spine in that way, there can be other injuries, too,” says Dr. Golden. “Fortunately, we found nothing besides the kidney injury.”

Parker Rose’s mom, Sarah, spent the first night after the accident being treated at Sentara Norfolk General Hospital.

Realizing how anxious she had to be about her daughter, CHKD social worker Kayla Wilson kept Sarah updated on what was happening with Parker Rose.

“I’m very thankful for Kayla because I was panicking, not knowing if Rosey was OK,” Sarah says. “I was terrified that she would be paralyzed.”

Fusing Parker Rose’s spine was an option, but Dr. St. Remy decided to take a different approach to avoid the long-term effects of a spinal fusion. If Parker Rose chose to have a child someday, a fusion would prevent her from being able to have an epidural. Instead, Dr. St. Remy and his team planned to stabilize the spine using screws and rods to correct the deformity created by the injury as it healed.

The next day, after Sarah made it to her daughter’s bedside, she remembers meeting Dr. St. Remy. “He pulled me aside and showed me Rosey’s injuries on imaging. He explained exactly what I was looking at and what we were up against in a way I could understand. I remember him even giving me a hug,” Sarah says. “After speaking with him, I felt a huge sense of relief and hope for the first time since our accident.”

“He thought about everything,” Sarah says. “He really is like an angel.”

Parker Rose’s surgery lasted more than four hours. Dr. St. Remy and his team worked carefully and slowly to make sure they didn’t damage her spinal cord. As they moved the displaced portion of her spine back to where it was supposed to be, the cord fell right into place. The last step was to reconnect the injured bones of the spine with a framework of screws and rods. The procedure was stressful, but Dr. St. Remy was confident that he and his team could help Parker Rose walk again if everything went according to plan.

“One of the things that stood out in my mind was the feeling that I had been preparing for this surgery my whole career,” says Dr. St. Remy, a surgeon for more than 25 years. “Everything I’ve been trained to do came into play at this moment.”

While Sarah waited, Dallas Seitz, registered nurse and spine program coordinator at CHKD, checked in to give her continuous updates. “I never had to wonder or worry what was happening during Rosey’s surgery because Dallas was on top of it,” Sarah says. “She had this energy about her that reinforced that Rosey was not only in the best hands but that she was genuinely loved and being cared for throughout the entire surgery.”

Once the surgery was over, Sarah knew it would be a long road to recovery. Parker Rose, who was used to running, jumping, and tumbling, would need to learn how to move her legs and walk again. Over the next two weeks, she worked hard in physical and occupational therapy, sometimes breaking down in tears because she worried she might never fully recover. At one point, Sarah asked if Dr. St. Remy could visit her daughter to give her some reassurance.

“When he came to speak to Rosey, he communicated in a way that she understood and believed what he was saying. His words calmed her and boosted her confidence,” Sarah says. “At that moment, you could see in her eyes that she knew she really was going to be okay. Not that it wasn’t going to be hard work, because it was, but she was in it to win it and could take a deep breath and focus on what needed to be done instead of doubting herself.”

At the end of that July, Parker Rose had recovered enough to be transferred to a rehab facility near her family’s home in North Carolina. Months later, when she came back to CHKD for surgery to have the hardware in her spine removed, she amazed everyone by walking without any problems.

“I can’t believe how healthy Parker Rose looks,” says Dr. Golden. “She looks like nothing had ever happened to her. This is a great example of our teamwork within the trauma department. I give huge kudos to Dr. St. Remy for everything he did for her.”

Sarah is incredibly grateful to everyone at CHKD who helped her daughter. “I do not believe we would have had the same outcome if we had gone to any other hospital,” Sarah says. “She’s really a miracle.”

CHKD First in U.S. to Achieve Advanced Spine Certification

CHKD’s pediatric spine program is the first in the nation to receive an Advanced Pediatric Spine Certification from DNV Healthcare, the organization that provides hospital accreditation to CHKD and many other hospitals worldwide.

To earn this certification, a hospital must meet stringent quality and patient safety requirements. “The Advanced Pediatric Spine Certification affirms that we are providing the highest level of pediatric spine care for children,” says Dr. Carl St. Remy, chief of orthopedics and director of the program. “It’s also an acknowledgment that we are doing some surgical cases that people haven’t done elsewhere.”

For years, families throughout southeastern Virginia have turned to CHKD’s spine program for its comprehensive, multidisciplinary approach to caring for patients from birth to 21 with scoliosis and other complex spinal defects. Our thorough surgery preparation program ensures that patients and families know what to expect, have all their questions answered, and are prepared to have the best possible experience throughout their treatment.

“The CHKD Spine Program differs from others in the country in the way that we work as a team,” Dr. St. Remy says. “We’ve built a partnership of experienced surgeons, anesthesia specialists, highly trained physical therapists and nurses, child life specialists, and a designated nurse coordinator. Everyone on our team plays an important role.”

To learn more about our Spine Program and its certification, scan the QR code or visit CHKD.org/Spine.