Special Education

Intensive Care

By Lavinia Edmunds — October 08, 2004 10 min read
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At Baltimore’s Kennedy Krieger Institute, class time is for kids with illnesses few doctors ever see.

It’s Monday morning, and Linda Andersen and Rachel Rosenblatt are sitting side by side in front of computers in their small classroom at the Kennedy Krieger Institute. The two Baltimore City teachers scroll through e-mails, learning more about the hospital patients they’ll be tutoring this week. The list includes two teenagers with traumatic brain injuries from automobile accidents, a 6-year-old being treated for a digestive disorder, a 9-year-old with autism who’s just learning to read, and a blind girl recovering from surgery for a dislocated hip.

Their shoebox-shaped classroom on the hospital’s second floor is a bright, cheerful room, with student papers crisscrossing the walls like banners proclaiming victory. When Andersen and Rosenblatt started working together at Kennedy Krieger in the early 1990s, they were sequestered in a closet-size room and usually rolled carts brimming with books and toys to bedsides. Now, patients well enough to leave their beds in the hospital’s state-of-the-art rehabilitative wing come to the classroom for half-hour, one-on-one tutoring sessions.

Many urban school districts offer in-hospital educational aid to students recovering from serious illness or injury, and Baltimore’s program, in place for nearly 80 years, serves two internationally known medical centers. Like its neighbor, the Johns Hopkins Hospital, Kennedy Krieger is a highly respected research center focusing on a wide range of pediatric illnesses, long-term rehabilitation, and developmental disabilities such as autism. But it’s also a last resort for children suffering from severe brain injuries and difficult-to-diagnose illnesses.

“You see kids there you wouldn’t see anywhere else,” says Idalyn Hauss, principal of the Upton School, the administrative headquarters for Baltimore City’s Home and Hospital program. Some children “come from hopeless situations, and some walk out of here,” says Andersen, a 59-year-old veteran of Baltimore schools who started working at Kennedy Krieger in 1989. “There are very sad stories, too,” adds her 50-year-old coworker, Rachel Rosenblatt, who joined her a few years later. Rosenblatt is all curves to Andersen’s angular features, but they seem a perfect match, claiming they’ve never had a disagreement.

As certified public school teachers, Andersen and Rosenblatt are familiar with IEPs and textbooks, but when faced with children with physical needs even medical professionals seldom encounter, they’ve learned to be flexible. You have to accept the kids for who they are at that moment, according to Andersen. But, she says, “finding out where they are is the hard part.”

After checking her e-mail, Andersen goes upstairs for a daily meeting with a dozen members of the hospital team—therapists, physicians, nurses, and other medical professionals. She sits quietly, spiral notebook on the table, as the night nurse reviews the patients’ progress. She hears that one of Rosenblatt’s students had a rough night. Andersen’s not surprised—doctors just removed the body cast that had discomfited the 15-year-old blind girl for the past month.

Baltimore City teacher Linda Anderson uses flash cards to jog the memory of 18-year-old Zach Bradley in his hospital room.
—Photograph by David Kidd

She also learns that another patient, Zach Bradley, attended his high school graduation, leaving the hospital for the first time since suffering a traumatic brain injury in November in a car accident that killed his best friend. Remembering the flash cards she made for his lesson, Andersen slings her large leather bag over her shoulder and excuses herself.

“Have teacher, will travel,” Andersen announces as she enters Zach’s room, its walls covered with visitor badges and photographs, some of them featuring Zach as a strapping soccer player. But propped in a wheelchair, he appears fragile. His thin legs are encased in white support hose, and one eye is half-closed.

Andersen gets to work, using the flash cards to spark Zach’s memory. Before these lessons began, the teacher had tracked the 18-year-old for a week, observing him in physical therapy. At one point, doctors predicted he wouldn’t recover enough to benefit from tutoring, and they considered placement in a nursing home. But his condition gradually improved. “The medical staff decides when the child is ready for education,” Hauss says. Then it’s up to Andersen and Rosenblatt to determine what kinds of tutoring will work best. So the first steps are often small ones. “I try to...get them back to doing something productive,” Andersen explains.

She positions herself so that Zach can see the cards, then holds up pictures of a soccer ball and a baseball. “Which one is soccer? Can you point to it, Zach?” He slowly and deliberately raises his hand to the soccer ball.

“Good!” she declares. She tries baseball and lacrosse with less success, then tells him about current movies. She shows Zach pictures of movie stars Halle Berry and Brad Pitt. “I want you to pick the one with Halle Berry,” she encourages him. Zach quickly lifts his hand and points at Berry, voluptuous in a black dress with a plunging neckline.

The extent of Zach’s recovery is still uncertain, but today’s lesson shows he’s making progress. Working on simple skills with head-injury patients helps them “reconnect some of the synapses and draw on previous knowledge,” Hauss explains. “There’s a lot of spontaneous recovery in head injuries. They’ll grow, then plateau for a while, then grow again. We’re just at the beginning of the process.”

One floor down, in the classroom, Rosenblatt is preparing for a more conventional lesson with Michael Weissbach, a precocious 6-year-old who’s been admitted to Kennedy Krieger as part of a six- week treatment plan for severe acid reflux. Michael, who’s just learning to eat again, saunters in and takes his place at the corner desk. School is his favorite time of day, says his mother, Lori, the time he feels “normal.”

Rosenblatt sits beside Michael, whose short legs dangle from the navy-blue plastic chair. “We’re going to write two sentences today!” she says. “What is your first sentence?”

“I like school!” proclaims Michael, as he bears down on the paper with his pencil. Rosenblatt reviews the sentence, then says, “Excellent! That’s a nice straight ‘I’!” They segue into a reading of The Very Hungry Caterpillar, complete with hand puppets, and when the time is up, the boy bubbles over with confidence. “No homework allowed!” he announces as he walks out the door.

Rosenblatt and Andersen cherish their one-on-one interactions with kids, a much-sought-after luxury in the overcrowded classrooms of Baltimore City Public Schools. “I usually have a voluntary transfer list the length of my arm,” Hauss says of Home and Hospital, which served nearly 2,900 kids this past school year. Rosenblatt, a longtime special ed teacher, was on the waiting list for four years, and Andersen, who’d been working part time as a substitute and traveling to homes to teach children with chronic health problems, saw in the program an ideal transition to full-time teaching.

Blind and recovering from surgery on her hip, Monica Savage works with Rosenblatt and her adoptive mother, Melanie. Parental involvement plays a key role in the hospital environment.
—Photograph by David Kidd

Teachers who do well in the program, Hauss says, tend to be independent and flexible. They have to be—the two Kennedy Krieger teachers, like their counterparts assigned to a half-dozen hospitals, have no on-site principal. Any school-age child hospitalized in the city for more than three weeks is eligible for tutoring, as are Baltimore students recovering at home. Teachers also work with kids with chronic conditions, such as asthma, that lead to regular absences. Andersen and Rosenblatt sometimes miss the excitement and feedback of a mainstream classroom, but Kennedy Krieger’s patients keep them challenged. “We probably see more different kinds of disabilities than anyone in the world,” Andersen says.

Rosenblatt is definitely challenged by her next student, 16-year-old Monica Savage, who was given up for adoption at birth after suffering a brain hemorrhage that left her blind and afflicted with cerebral palsy. She found a permanent home with adoptive parents in Montgomery County, Maryland, and is at Kennedy Krieger for surgery to correct a painful hip dislocation. Because her fingertips aren’t sensitive enough, Monica can’t read Braille. She communicates with only a few words, biting herself or throwing things when she’s unhappy.

Sitting in a wheelchair, Monica has a pretty face and long black braids that she likes to fling back like a movie starlet. But today, Rosenblatt is having a tough time engaging her. Monica’s mother, Melanie Savage, a cheerful woman who’s homeschooled her adopted child for seven years, tells the teacher that Monica requires “ironclad consistency,” to which Rosenblatt nods.

They sit on either side of the wheelchair, which is parked in the middle of the classroom. Rosenblatt produces a collection of big and small blocks shaped like circles and squares. “I want you to put this in the box,” she instructs as she hands Monica the first block. With some effort, she does so with a plunking noise. Attuned to sound, Monica grins broadly. Soon she’s fishing for another block to sort, and when she finishes the activity, all three hug.

Like anyone who works in a hospital, Andersen and Rosenblatt must constantly temper their hopes for good outcomes. And because Kennedy Krieger is a treatment facility of last resort, it has its share of heartbreak. A sheik’s son once arrived, his entourage in tow, after being injured in a car accident. He recovered sufficiently to return to the Middle East, but a year later, at the hospital for a routine follow-up, he died unexpectedly.

Carol Wilson’s daughter, Kathryn, was in a coma for 21 days following a car accident. She recovered and will return to school this fall.
—Photograph by David Kidd

The only patient Andersen and Rosenblatt ever resisted teaching was a Somali refugee. Battling malaria and hepatitis, he was highly contagious and prone to violent outbursts. Eventually, the teachers agreed to work with him, wearing face masks, gloves, and shields to protect themselves. As it turns out, the boy made some progress. Both educators have found that, even when the prognosis is poor, a child can prove amazingly resilient.

Today, Kathryn Wilson is in her hospital room reading aloud “Two Kinds,” a short story from Amy Tan’s The Joy Luck Club, slowly but accurately. When the17-year-old arrived at Kennedy Krieger after a car crash, doctors gave her parents little hope. Her brain stem had been sheared, leaving her in a coma for 21 days. Yet she awoke, and following intensive therapy, her brain began to heal. Andersen started a reading program, using her computer to print simple passages in large type. At first, still seeing double from the accident, Kathryn could not read at all. With Andersen’s help, they’re now able to have substantive conversations about the stories they read together.

After the teen finishes “Two Kinds,” Andersen says, “You know, I always find something new in this story every time I read it.”

“What did you find this time?” Kathryn asks.

“I understood more about the mother-daughter relationship. You know, how sometimes parents live vicariously through their children.”

“Me, too,” says Kathryn.

A week later, Kathryn is discharged. Trailed by a bouquet of balloons and family members, she goes to the classroom to tell Andersen goodbye, and thank you. Her father, Joe Wilson, says that the time spent with Andersen, who took great pains to treat Kathryn as her old self, was “invaluable.”

Back home in Fairfax County, Virginia, where she excelled in almost everything she did, Kathryn now gets around with the help of a walker. Full recovery from a brain injury can take years, not just months, and the two teachers at Kennedy Krieger are accustomed to saying goodbye without knowing what the final outcome will be. But Andersen beams as she talks about Kathryn’s progress. “She’s one of those kids with a spark about her,” she says. “She’ll be fine.”

A version of this article appeared in the September 01, 2004 edition of Teacher as Intensive Care


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