In the summer of 1996 Jacob was riding in a van on a family outing when the van was struck by a truck. His twin brother, Jeremy, was not injured, but Jacob suffered a serious head injury.

The accident killed Jacob’s mother, his older brother, an aunt and a cousin. Steve Middendorf, who was not on the outing, was called to meet Jacob at Cardinal Glennon.

"I had no idea where Cardinal Glennon was," he said. "When I got here, people had to lead me around. They just helped so much -- they cared so much for me and the family rather than just the child. They’d do anything for us, and were always checking up on us. Even after we had left the hospital there were a lot of phone calls to see how we were doing."

Jacob remained in a coma for his first week at Cardinal Glennon. He spent weeks in the hospital’s rehabilitation unit as doctors, nurses and therapists worked toward his recovery and helped him regain his speech and motor skills while assisting his father in learning his new care needs.

Cardinal Glennon is designated as a Level I trauma center and serves as an emergency treatment resource for communities within a 150-mile radius of St. Louis. Each year 750 to 800 children come to the emergency room with injuries serious enough to require admission.

When the hospital is notified that a child with serious injuries is coming, the trauma team is activated. The team incorporates the services of not only emergency room physicians and nurses but also the transport team, operating room, plastic surgery, orthopedic surgery, neurosurgery, laboratories, radiology, pharmacy, respiratory therapy, critical care and pastoral care. This multidisciplinary team is led by pediatric surgery and assisted by other surgical specialists as needed.

Pastoral care serves as the liaison between the trauma team and the parents and siblings of injured children.

"When parents come in with an injured child, it has got to be really, really scary for them," said Diana Fendya, R.N., M.S.N., director of trauma services. "The biggest thing for them is fear. They ask what injuries did the child sustain. Are the injuries life-threatening? There also is the element of guilt -- they wonder if they could have done something to prevent what occurred even though they often couldn’t have.

"We try to alleviate that guilt and make sure they know their child is getting optimum care. The staff here is very much attuned to parents. We don’t treat children by themselves. They are part of a family, and we treat the whole family unit. We would not be in pediatrics if we didn’t like working with parents," she said.

"Pastoral care is a critical part of what we do. Whether or not we believe in God, somehow or another miracles occur. We see them every day here. If we didn’t have someone here to help support the families and take them to that next step, it would make our jobs very difficult."

The pastoral care staff finds great acceptance from the families of injured children, even those who are not decidedly religious, said Sr. Judith Carron, R.S.M., director of pastoral care.

The staff includes Catholic and Protestant chaplains. Jewish rabbis and volunteer chaplains of other faiths can be called if requested.

"We are frequently there to meet the family when they arrive in the emergency room," Carron said. "Many times the parents are feeling so lost they want you to stay with them. They understand what a chaplain is. We offer to call someone from their own church if they’d like, so they don’t feel that we have to be the ones to minister to them.

"Most families are pretty responsive. The human experience is so much broader than religion, per se. The spiritual needs of people are the same, and their love for their children is the same. Their need for God is the same, no matter if they call Him God or Buddha or Yahweh. We just tell them we will support you any way you want us to."

Families beset by a sudden crisis have many needs, Carron said. "We relay information from the trauma room to the parents. We help them with phoning other relatives. Sometimes the doctors ask us to prepare the parents for bad news. Usually families don’t think about eating or drinking and get weak, so sometimes we get coffee or juice or a sandwich for them. Sometimes they want to go to the chapel, so we take them there and sit with them."

Families often bond with their chaplains and stay in touch for long periods of time.

"With a major trauma we try to visit them daily, sometimes a couple of times a day, and follow them until the child is discharged," Carron said. "They can’t be prepared for the experience of a serious injury -- they couldn’t have imagined it. They are coming to us in shock. That is why pastoral care is on the trauma team -- to help them work through their stages of grief."

The hospital’s pastors are particularly attuned to the needs of parents after their child has died. "After the death of a child, the family will work through the grief process for one to two years. The family can be in grief for a long, long time when their child has a serious illness. We have a quarterly memorial service and a follow-up bereavement program for them."

Many parents maintain a connection with the hospital after their child’s death, participating in support groups and volunteer activities. "Parents need to find some meaning in their child’s illness or death. Sometimes it is very important for them to do something for others to help give meaning to their child’s life," Carron said.

Pastoral care also serves as a source of support and comfort to other members of the hospital staff who join families in facing the stresses of crises. "If we didn’t have pastoral care there to support us, and be there for us when bad things happen, it would be very hard for us to do our jobs," Fendya said. "One of the things that always strikes me here is the teamwork and compassion and true caring of all the staff for patients, family and one another."

An injury can mark the beginning of a child’s long relationship with Cardinal Glennon.

"Some traumatic injuries go on for the life of the child. After they start recovering from their injuries, some kids stay up on the rehab floor for six weeks to three months and may continue coming back here for care until they’re 18 years old," Fendya said. "Their relationship goes on as long as the child still requires our physical and psychological support, or as long as the parents feel like they need continued ties with the hospital."

Glennon’s social services department also becomes a critical link in the care of children facing serious injuries or chronic illnesses.

"The family gets a sudden shock. It stops everybody’s life for the moment. In a number of cases, these injuries and illnesses create life-long disabilities for the families. There is the adjustment of going through the acute, often life-threatening episode to the realization that this perfect child they had may not be the same child in the future," said Wayne Munkel, M.S.W., supervisor of social services.

Glennon’s 10 social workers, who cover every unit of the hospital, share in the provision of counseling and emotional support to families and help them cope with the nuts-and-bolts realities of caring for their children.

"An acute episode may be the beginning of a long-term relationship with the social worker and Glennon because of needs produced by disabilities," Munkel said. "We do social evaluations of the family to see how it is functioning as it relates to the injury or illness. We do discharge planning, and help the family arrange for whatever the child needs to go home, such as home health care services and durable medical equipment. We refer families to income sources like Medicaid and Social Security, and help arrange services like housing and transportation for families who need them."

Social workers continue to guide families through the many years of out-patient care their child may need. "Taking care of children with chronic conditions can be very stressful. When the child goes home, that’s when some of the struggles begin. Social workers do a lot of support over the phone with parents," Munkel said.

Traveling through crisis with a family can be stressful for members of the hospital staff, but working with children and families is a calling to many of them, Munkel said. Nearly all the members of the social services department have been employed at Glennon for 12 to 20 years.

"When people see kids hurting and suffering, it brings out the best in them," he said. "You can see a child in the intensive care unit who everybody thinks is going down for the count, and then you get to see them walk out the door. Or you can see kids who have serious disabilities who overcome them, or at least adapt to them and function. Seeing kids recover and get better is rewarding, and this is a supportive environment for the people who work here."

The Pediatric Rehabilitation Institute at Cardinal Glennon is the halfway house between intensive care and home for many patients who have suffered serious trauma.

"The majority of children admitted to rehab have had traumatic brain injuries," said Monica Ultmann, M.D., medical director of the institute.

At the rehabilitation stage of recovery, patients again require the services of many specialties.

"Most kids require comprehensive rehabilitation care, physical therapy, occupational therapy, speech and language therapy, psychology and nutrition." Ultmann said. "Recreational therapy is a big part of our program, because many of these children need to learn adaptations to their new physical limitations.

What is a child’s work, other than play?

"Teachers in the hospital will be involved with school-age children to help them with studies. Psychological counseling is an important need for older children and adolescents to help the child and the family adjust to their community and disability," Ultmann said.

When needed, the institute’s therapists will accompany children to their schools and other community locations to help them get used to new ways of going about activities and to assess accommodations that they may require. Through their rehabilitation work, social workers continue to assess needs and help parents prepare for discharge.

Some of the rehabilitation patients who came to Glennon’s first special needs clinics eight years ago continue to receive follow-up care at the hospital. "This is a small unit, but there is very intense interaction between care-givers and families," Ultmann said.

Jacob Middendorf spent six weeks in the rehab unit on his way to recovery.

"They kept saying it would be a slow process. I remember looking at him and thinking it wasn’t going to happen," said his father, Steve. "Slowly and gradually, he started coming back. When they said it was time to go home, I didn’t think he was ready, but they knew what they were doing."

For two years Jacob received outpatient therapy care and attended special school classes. He has returned to a regular third-grade class, one year behind his twin brother. Jacob continues to see Dr. Ultmann twice a year for check-ups.

Middendorf occasionally returns to Cardinal Glennon to visit the many people who helped him and Jacob resume their lives.

"Diana Fendya was my right arm when I was in this building," he said. "Pastoral care really helped a lot that first day. It was touch and go and they sat up in that room with me the whole time.

"In rehab we saw the same therapists every day -- there were so many people we got to know on a first-name basis. They made all the difference in the world. How do you put into words what they mean to you? You think about them every single day of your life, but you don’t always pick up that phone or write that letter. But you do think about them every single day."