Alaina’s story: Mother’s intuition and community-based care saves kindergartner after chest injury

One picture in this story contains a small amount of blood. Reader discretion is advised.

Alaina Harrington’s father had just gotten home from work when he started to make dinner. Always a diligent helper, Alaina, 6, took a glass cup out of the cabinet for her father. The glass slipped from her grasp. In an attempt to catch it, Alaina clutched the glass against her chest, but it was too late. The glass shattered on the kitchen floor at her feet.

Alaina’s parents, Maeghan Silvestri and Chad Harrington, of Kensington, NH, cleaned up the broken glass and checked their daughter for injuries. Alaina had a tiny cut on her chest from when she clutched the glass, which Maeghan covered with a pink princess bandage. To make sure all the glass was cleaned up, Maeghan and Chad reassembled the glass as best they could – and noticed that one piece was missing.

“It feels funny when I breathe,” said Alaina a few minutes later. Knowing something wasn’t quite right, Maeghan, who is also a nurse, took her daughter to the emergency room at Exeter Hospital in Exeter, NH. “She could breathe well and wasn’t turning blue or anything, but I just knew something was off.”

Alaina was seen by Derek Trapasso, MD, a pediatric hospitalist from Mass General for Children (MGfC), who initially wasn’t concerned with the small cut. Trapasso examined Alaina’s skin surrounding the cut and felt crepitus, which indicates that air from inside the body is trapped under the skin.

“Dr. Trapasso felt the wound and he knew I’m a nurse, so he had me feel it as well,” said Maeghan. “We both knew it was crepitus because of the crackling feeling.”

A chest X-ray revealed that the air had come from Alaina’s lungs, one of which had partially collapsed. Doctors placed a chest tube into Alaina’s chest to remove the excess air before she was transported by ambulance to MGfC. Exeter Hospital is one of many community locations throughout Massachusetts and southern New Hampshire where MGfC providers care for children and their families.

“Our close relationship with MGfC allows us to care for children and their families in their communities,” said Trapasso, the director of MassGeneral for Children (MGfC) at Exeter Hospital. “We are in New Hampshire, yet we have the full slate of resources at MGfC and Massachusetts General Hospital available to us.”

Upon arrival to MGfC, she went to the Pediatric Intensive Care Unit (PICU), where she had a chest ultrasound to locate the shard of glass. To ease her fears, a nurse gave Alaina a stuffed animal and a blanket with horses on it – one of Alaina’s favorite animals.

While the ultrasound didn’t show anything untoward, Maeghan had a feeling that the glass was still lodged in her daughter’s chest. The next day, the Pediatric Surgery team looked at a picture of the broken glass that Maeghan and Chad had reassembled and examined Alaina’s wound. They agreed to do surgery to look for the glass but couldn’t guarantee they’d find anything.

Two days later, Alaina had surgery to remove the glass. After surgery, Allan Goldstein, MD, Surgeon-in-Chief of MGfC and Alaina’s surgeon, met Maeghan in the waiting area.

“Mothers always know best,” said Goldstein, as he held up a specimen cup that contained the nickel-sized piece of glass.

“Maeghan and her family are amazing. They reconstructed the glass and knew exactly where each piece went,” said Goldstein, who is also the chief of Pediatric Surgery at MGfC. “She felt confident that there was a piece of glass in Alaina’s chest, and I am glad she persevered.”

At MGfC, family members are considered essential members of a child’s care team. “As doctors, we want to not only understand what happened, but we also want to listen to what families are telling us,” said Trapasso. “The common thread is that families have an intuition, and they know their children much better than we do.”

From the initial trip to the emergency room at Exeter Hospital to the time Alaina went home from MGfC, the focus remained on Alaina’s wellbeing as a child. “MGfC was great at answering questions and they laid out their plans very well,” said Maeghan. “I also appreciated how her care team would complement her nails or her eyes as an ice breaker instead of asking how she was feeling. It made Alaina feel valued as a person and it opened the conversation for her to share the name of the nail polish or what color she liked.”

As soon as the anesthesia wore off, Alaina was back to her normal self. “Her mood lifted instantly,” said Maeghan. “She wanted to visit her grandparent’s house and play on her swing set.”

All photos courtesy of Maeghan Silvestri.