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Tristen: Back in the Saddle

TristenLaura and James were unloading hay from a lowboy trailer near their barn when the horses trotted up and began to nibble at the bales. Standing on the trailer, their five-year-old daughter Tristen, a rodeo rider, began waving her arms to shoo them away. Spooked by the motion, the horses turned to kick at each other, and one of them caught Tristen with a hoof to the left side of the chest just below the heart.

“Her dad saw her fly backwards about 10 or 15 feet and land on the ground,” Laura says. “She stood up as we were running over to her. She just looked at us for a minute, and then she started throwing up bright red blood. We pulled up her T-shirt and didn’t see a mark. Tristen is our only child, and we were scared to death she was dying.”

Her parents scooped Tristen up in their arms and drove to the nearest hospital, five miles away in Cleveland, Texas. James ran to the ER, his daughter in his arms, and kicked at the door. “When the doctors and nurses saw all the blood, they immediately went to work on her,” Laura says. “By then she was in shock and very lethargic.”

Transfer to a Level 1 Pediatric Trauma Center

The emergency team at Cleveland Regional Medical Center stabilized Tristen and made the call to transfer her Children’s Memorial Hermann Hospital, which operates Houston’s only Level I pediatric trauma center. “When we arrived at the emergency center, it looked like a madhouse the way everyone was running around,” Laura says. “But it was clear they knew exactly what they were doing. Questions were asked and answered, and no one repeated anything. It was clockwork, like pieces of a puzzle all fitting together exactly the way they were supposed to fit together. From the outside it looked like chaos, but it was harmony. Everyone did their job.”

Memorial Hermann-Texas Medical Center, where Children’s Memorial Hermann Hospital is located, operates the nation’s busiest trauma center. “When a patient with serious undiagnosed injuries like Tristen had comes in, our emergency team works very fast,” says pediatric surgeon KuoJen Tsao, M.D., who was Tristen’s attending physician. “Everyone functions as part of a well-trained team, following trauma protocols developed at the national level. We often see patient situations that may seem very chaotic on the surface, but in reality, everyone works together like a well-oiled machine. Knowing our roles and executing them with precision ensures that we care for each patient efficiently without missing an opportunity to identify injuries that could adversely affect outcomes.”

Tristen was admitted to Children’s Memorial Hermann Hospital on September 10, 2010. Tests conducted revealed a grade 4 spleen injury. “She had a major laceration of the spleen and had lost some blood into the abdominal cavity,” says Dr. Tsao, who is an assistant professor of pediatric surgery at The University of Texas Health Science Center at Houston (UTHealth) Medical School. “But she was stable when she presented and we’ve learned over the years that we can often treat blunt injury to the spleen without surgery. In the pediatric ICU we watch for signs of instability, and check blood to make sure the counts are in an acceptable range. When her blood counts showed an improvement, we gradually eased her back into eating, getting out of bed and walking. If we watch our patients closely, the vast majority who present with lacerated spleens will not need surgery.”

Tristen was released four and a half days after she was admitted, with orders to avoid contact sports for four to six weeks. “They treated us so well at Children’s Memorial Hermann that we drove the hour and a half to their pediatric clinic for follow-up instead of going back to our local pediatrician,” say Laura and James, who are police officers for the Harris County Sheriff’s Department. “We wanted her to continue seeing the same people who had provided such wonderful care for her in the hospital.”

A Great Recovery for Tristen

Tristen recovered quickly. She participated in her elementary school’s Turkey Trot during Thanksgiving weekend 2010, running more than 1.5 miles to raise money for families in need. On December 10, she won the barrel-racing competition in the age-8-and-under category at a rodeo held in Stancil Park Arena in Cleveland. She won the blue ribbon in a stick-horse race and took second place in the rodeo’s mutton-busting event.

“Tristen is tiny for her age, but she’s tough,” Laura says. “She took a big wallop, and she never even cried.”

Laura and James wish to thank KuoJen Tsao, M.D., James McCarthy, M.D., Trisha Goings, N.P., Jaimee Westfall, N.P., Rebecca Peters, N.P., and all the other physicians and nurses who provided care for their daughter during her hospitalization at Children’s Memorial Hermann Hospital.