Caroline Miller was a very active, physically fit and healthy 5-year-old. She swam several times a week and participated in weekly gymnastics lessons.
On December 18, 2012, Caroline came home from school with the sniffles and a mild cough. Caroline has mild asthma and occasionally uses a nebulizer, but as the evening progressed, her breathing became more labored than usual and her parents contacted the pediatrician. Their doctor recommended alternating doses of Caroline’s asthma medications and told her parents to stay in touch. Unfortunately, by 1 a.m. there was no real improvement – in fact, her condition had worsened. Caroline’s chest heaved as though she were running on the playground. After consulting again with the pediatrician, her parents took Caroline to the local hospital, as a precaution. Within 48 hours of her initial symptoms of coughing and congestion, Caroline would be rushed from hospital to hospital in order to save her life.
At the first hospital Caroline was diagnosed with influenza A and double pneumonia, and placed on oxygen as doctors monitored her breathing. After a long and sleepless night with no improvement, an ambulance took Caroline to a second hospital with a dedicated pediatric unit. At this hospital, she was prescribed Tamiflu but the hospital did not have a children’s suspension. An attempt to mask the bitter flavor of the adult version with chocolate milk backfired and after two sips Caroline began to gag and vomit. At this point she had effectively been awake for nearly 36 hours. The physical exertion of vomiting seemed to be the last straw for her little system. Her condition began to deteriorate, and she slipped further into life-threatening acute respiratory distress syndrome (ARDS). Caroline was immediately intubated, and her family and medical team decided she needed to be transported via helicopter to a third hospital — Children’s Hospital of Philadelphia (CHOP).
The five-person airlift medical team of doctors and respiratory therapists would hand-respirate Caroline for the entire 27-minute flight to CHOP. Once there, Caroline was put on an oscillating ventilator. This high frequency ventilation process serves to recruit lung tissue by never letting the alveoli completely collapse and has been developed to help patients, especially toddlers, with severely damaged lungs. The oscillating ventilator hadn’t been an option at the other hospitals.
The list of what Caroline was facing was long and frightening. Flu, pneumonia, severe sepsis, septic shock, hypoxemia, and impending cardio-respiratory failure. Her small body was flooded with antibiotics – everything and anything to help her fight off the infections ravaging her lungs. Caroline would remain in the CHOP PICU in a drug-induced coma, intubated, and on the oscillating ventilator for two weeks.
On Christmas Day, Caroline’s condition started to take a clear turn for the better. Each day between Christmas and New Year’s Day there were small signs of progress: the chest x-rays showed signs of clearing in Caroline’s lungs; her kidneys were functioning more normally; and her heart was beating as it should. Caroline was fighting her way back! And then, as 2012 turned to 2013, her breathing improved enough that she was switched back to a conventional respirator. The recovery process was agonizing over the next several days, with two steps forward and one step back. But she did move forward. Finally, on December 30, Caroline was taken off the paralytics and removed from the respirator. For the first time in two weeks Caroline spoke: she wanted a soft pretzel and a popsicle. Never before had a request for snacks brought such joy!
Caroline was able to leave CHOP a week later, and Santa Claus visited her at home on January 12, for a very merry belated Christmas.
Caroline had been vaccinated against the flu every year except this particular year. The vaccine wasn’t readily available prior to the beginning of school and once the busy school year began, it fell off the “radar.” Caroline’s mother admits, “The fact that we neglected to make it a priority was the biggest mistake I’ve ever made as a parent. That mistake and lack of judgment nearly stole my child’s life and has changed our entire family’s lives forever.”
- Jennifer Pool Miller (mother)
Place of Residence:
- Westfield, NJ
- 5-years-old, 2013