KEARNEY — Forty years ago, when Ken Shaffer decided to become a pediatrician here, a doctor in Grand Island shook his head. “You’ll probably starve,” he said. Shaffer came anyway.
For a combined 80 years, he and Dr. Phil Gasseling have treated central Nebraska’s tiniest, most defenseless citizens: its babies. Now that both are retiring, the two native Nebraskans have witnessed transformational changes in pediatrics since they established their practices here.
“I love taking care of very sick children,” Shaffer said. “I saw a way to change the way sick children were cared for in central Nebraska.”
Gasseling said, “A childhood illness is the biggest crisis in the life of most families. I just enjoy taking care of children — not necessarily the well child, but children in crisis, like a premature baby, a child with meningitis or trauma. I believe I have an ability to get a child through a crisis. Years after a crisis, people still come up to me in the grocery store and say, ‘Thank you for fostering my child.” That’s the beauty of small towns.”
From Capri to Jimmy to ambulance to hearse
The son of a Holdrege dry cleaner, Shaffer, 68, graduated from Holdrege High School in 1964 and enrolled in the University of Nebraska College of Medicine. He chose pediatrics after finding deep satisfaction in treating very ill children and interacting with their families. “I could see myself doing that for a lifetime,” he said.
When he opened his practice in Kearney in 1974, there were just three pediatricians in the state west of Lincoln: one in Scottsbluff, one in Grand Island and one in Hastings. “They were ‘older,’” he said. “There were no neonatal intensive care units in ‘outstate’ Nebraska.”
At the time, Kearney had about 20,000 people. Good Samaritan was a community hospital with few specialists. Shaffer created a neonatal intensive care unit by clearing out a storage room and assigning two Omaha-trained nurses to staff it. He treated an average 30 or 40 sick babies every year.
In those early years, well baby care was handled by family doctors. Shaffer treated children suffering from heart disease, seizures, diabetes and more, not just from Kearney. He made 40 to 50 trips to places like Valentine, Imperial, McCook and northern Kansas each year to bring infants to the hospital.
At first, he used his Mercury Capri. He and a nurse would remove the front seat and place the isolette there. “One day, there was a snowstorm. The nurse’s husband gave me a map and a snow shovel. We got up to Broken Bow, and by the time I got back, I knew we needed a four-wheel-drive vehicle,” he said. He also used a van that “looked like a bread truck.” Eventually, he leased a four-wheel-drive Jimmy.
By the late ’70s, he used the new hospital ambulance, but it had no lights or siren. When a call came in, Shaffer would call police, who would block off Second Avenue and 25th Street. “We’d be speeding down the road at a very high rate of speed,” he said.
The ambulance wasn’t permitted to go out of town, so Shaffer used a hearse from a funeral home. “I didn’t have a choice,” he said. “Before we got that Jimmy, it was hard. We couldn’t turn the passenger seat backwards so we’d set the isolette between the front and back seats,” he said.
One night as they sped to Ord, a bridge was out. They feared the detour would cost precious time, “so we tried to go through a cornfield to get around that bridge, but it was dark, and we didn’t know where we were going. My nurse said, ‘We’re going the wrong way,’” and sure enough, we were headed back to Kearney, so we had to turn around and take the detour,” he said.
Another time, when he headed out in a blizzard, the highway patrol sent a snowplow out in front of the ambulance. Sick babies initially were transported to Omaha in a van, but by the late 1980s, the hospital launched a helicopter service. Initially, only the pediatrician flew with the pilot, but now, the neonatal nurse practitioner also makes those trips.
Gasseling: First hour of life can make all the difference
Gasseling, 66, has memories like that, too. A native of Hemingford, he fondly remembers his one-room schoolhouse and the hard work he and his six siblings did on the family farm. He helped migrant workers hoe beets. He unloaded cement sacks from railroad cars. He helped clean out service station bays. He worked outside for 14 hours on hot summer days.
“When I hired a nurse, I wanted one who has milked cows. She’s had to get up early and work in tough conditions and put something in front of her own comfort. If she did that, she can do anything,” he said.
After graduating from the University of Nebraska College of Medicine, Gasseling arrived in Kearney in 1976 and never left. He never wanted to go elsewhere. “I’m a Nebraska guy,” he smiled.
There were no obstetricians in Kearney back then. There was no good way to stop labor once it started, either. “Preemies were born at 30 or 38 weeks, and at rural hospitals, there was no way to save them,” he said. “Back then, small babies just died. We had to convince people that a small baby was salvageable. There was a lot we could do to keep them from having brain damage.”
In his residency, he had learned to use ventilators, new at that time. He put that knowledge to work on the new job.
He did 36 transports in his first six months in Kearney. He especially remembers early days using the helicopter. “Our arrival in rural areas was an event,” he said. One night, he landed in the middle of a grassy knoll, with a landing pad created by headlights from a circle of cars. He also remembers flying in a converted crop flier.
Sometimes, his wife Linda, a registered nurse, would fly with him. “Nurses were trained to handle a critically ill child,” he said. “We knew all the area physicians very well. The doctor would wait for us. We took a huge burden off their hands,” he said.
He remembers pagers “as big as an old two-way radio.” Babies could be treated at Good Sam, but those who needed surgery were taken by van, and then flown, to Lincoln or Omaha.
“One time we were flying back from Omaha and a warning light came on, and we had to land in the middle of an alfalfa field. The farmer came out to help, but the pilot determined it was just a faulty alarm, so we took off again, but I was nervous,” Gasseling said. On a flight to Valentine, a goose flew into the windshield, causing a “moment of panic.”
“The real thing we did was teach hospitals and physicians how to resuscitate children early to avoid low oxygen levels. That first hour of life can make all the difference,” Gasseling said.
Gasseling, Shaffer awed by the technology that is saving lives
Now, as they hang up their stethoscopes, both men remain awed by the revolution in pediatrics over the past 40 years. Its focus now is illness prevention. Once-common childhood diseases like measles, mumps and chicken pox and polio have been eradicated.
Gasseling calls the trend “the dawning of interventional pediatrics. Our new partners have never seen some of those common diseases. Some things children died from aren’t even seen now,” Gasseling said.
Shaffer used to see between eight and 12 cases of bacterial meningitis every year. Two or three of those children suffered permanent damage, and two or three would die. “We’ve wiped that off the map,” he said. “Babies used to die of prematurity or congenital deformities or genetic diseases.”
Now, they said, diagnostic tools such as CT scans can diagnose and monitor diseases. Bigger ventilators and cardiac monitors care for tiny preemies. There is surfactant to treat preemies with lung disease. Kearney now has eight pediatricians,
“We are on the cutting edge in genetics, where we’ll be able to diagnose some conditions in the womb and be able to intervene with a missing enzyme or protein,” Shaffer said. “If there’s a genetic basis for a disease, we can manipulate the gene and the protein it does or does not produce. Our understanding of disease is changing. More data is available online, and we’ll be able to ascertain the cost and quality of care.”
Gasseling, however, is troubled that some parents don’t see a need to get their children vaccinated. “Go to an old cemetery and see the babies who died because there were no immunizations,” he said.
Both men note progress of treating HIV, autism and other conditions. Today, doctors can save babies as tiny as one pound, six ounces “on the edge of survivability,” Gasseling said. “And I can’t say enough about nurses. We’ve also learned that mothers remain the best transport system for little ones.”
This spring, Gasseling and his wife will move to Minnesota to be closer to their three daughters and their seven grandchildren. Shaffer and his wife Lynda, who have two children and five grandchildren, will remain in Kearney. Shaffer has been the medical director of UniNet for 18 months and is working with Buffalo County Community Partners to develop the HelpCare Clinic, the free clinic set to open in 2015.