POLK COUNTY -- Holden Kunkle's kidneys weren't filtering. Pat Lewis' heart was barely pumping. Both needed specialized care they couldn't get near their homes in Polk County.
Both found it at Oregon Health & Science University in Portland.
On a clear day, people miles away to the east notice OHSU's main campus in the city's west hills. There, patients, students and staff can see Portland disappear into rolling hills and sky, with Mount Hood poking out of a haze.
At such a height, human forms are barely discernible. Yet the hospitals on the hill must bring their services to people of the metropolis below, to those past the mountain and across state lines.
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Three-year-old Holden Kunkle and his sister Christine, 9, play in Holden's room in Independence.
Ring." Christine picks up the toy phone. "Hello? Holden, it's for you. It's Kate."
She passes the phone to Holden, who quietly pretends to talk into the phone. He then says goodbye and returns the phone to his sister.
"You told Kate you love her!" says Christine.
Holden giggles and blushes.
Kate is Holden's favorite nurse from Doernbecher Children's Hospital at OHSU. He gets to see her once a month when he goes in for his checkups.
Holden was placed on dialysis when he was 7 months old. His parents, Debbie and Craig Kunkle, know a lot about waiting. They waited until Holden was big enough to receive an adult kidney transplant. They waited months more to find a donor.
On his second birthday, Holden got a new kidney.
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On a recent night, Pat Lewis woke up, got dressed, and headed down to the kitchen. There he stopped, amazed at what he could now take for granted: for so long, his heart made him too weak to dress himself. Besides, his lack of appetite might have ruled out a late-night snack.
Lewis had seen his health deteriorate over the course of 20 years and two surgeries for failing heart valves. By June 19, when OHSU Hospital called him in for a transplant, Lewis had less than 90 days left to live with his own heart.
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Kunkle and Lewis are just two among thousands of Polk County patients who come to OHSU. Last year, the university's hospitals -- OHSU Hospital and Doernbecher Children's Hospital -- had 4,384 patient visits from Polk County.
Oregon's only academic health center, OHSU includes schools of medicine, dentistry and nursing, research centers and institutes, along with clinics around the state.
Portland's Marquam Hill campus fits 31 major buildings into a wooded, 100-acre maze. A huge glass walkway, suspended above the city, connects the hospitals to the nearby veterans hospital.
But immobile structures don't hint at OHSU's efforts to promote health throughout Oregon. Students from OHSU's dentistry school provide dental screenings at several locations in Grand Ronde, Monmouth and Independence.
Pediatric cardiologist Mark Reller comes to Salem twice a month as part of an OHSU outreach program in operation all over the state.
There are no children's heart facilities outside the Portland metro area, Reller said, so a visiting specialist brings that service to the Polk County area.
"We offer the very same service that we give in Portland, so families don't have to drive all the way up and find us," Reller said. "We level the playing field so everyone gets the same level of care."
OHSU benefits from a healthy referral system at Valley Community Hospital, Polk County's only hospital. The two hospitals' operations are tightly interwoven, said Kelley Anderson, manager of obstetrics at Valley Community. "[OHSU is] like a spider web of technology, knowledge and sharing."
VCH doctors help OHSU in its outreach programs and the two hospitals' nursing staffs share information. "We're so interconnected, it's like we're an extension of each other," Anderson said.
Valley may use OHSU for any number of things, including testing specimens and providing a higher level of care for newborns, patients with severe hypertension or heart trouble. OHSU does "everything from a simple lab test that would cost us too much here to educating our nursing staff.
"They're a big part of any hospital in the state," Anderson said. "You don't function without having some contact with OHSU -- it's how you keep up."
Polk County helps OHSU keep up as well. Nancy Prouser manages an OHSU breast exam training program that might not exist without a $45,000 grant from the Spirit Mountain Community Fund in Grand Ronde.
The training helps clinicians examine a woman's breast in a more comprehensive and complete way, Prouser said. "Not only are we increasing the ability to detect breast lumps," she said, "we are helping them gain more confidence in determining if what they find is abnormal or not."
In October 1999, James Molloy, medical director of the Grand Ronde Health and Wellness Center, came to Prouser's demonstration course in Portland. The technique involves examining breasts at three different pressure levels, in vertical strips.
This new method finds 30 percent more cancers than the one Molloy had been using, he said.
Molloy was so impressed, he asked Prouser to train all of his clinicians.
Molloy wrote a letter of support to the Spirit Mountain fund on Prouser's behalf and they awarded her the grant.
Now, thanks in part to the Grand Ronde community, clinicians from around the state have received the training, including two in Monmouth and one in Dallas in addition to the eight in Grand Ronde.
"If Spirit Mountain Community Fund had not funded the program, I don't think it would be going today," Prouser said. "They were the ones who believed in us, and as our first major donor, getting their money enabled us to get other money."
In total, gifts, grants and contracts made up 30 percent of OHSU's total budget last year. Polk County donors alone gave OHSU $82,500 last year, said Pete Sommerfeld of the OHSU foundation.
Doernbecher Children's Hospital benefits from vigorous fund raising in Polk County. The Dallas Kiwanis Club raised more than $4,300 for the hospital last year, said Kiwanis Doernbecher fundraising chair Nick Nichols.
The local Kiwanis raised more than $10,000 in the last three years, Nichols said, mostly from selling raffle tickets for a classic car and its first ever golf tournament held earlier this summer.
The money Nichols raises has more significance to him than mere dollars and cents. "I was standing in front of Safeway, selling tickets," Nichols recalled. "A lady bought $20 worth
"She was in tears. She said her son had been at Doernbecher, and even though he had died, she wanted to support Doernbecher for all they had done for her child.
"That's why I'm involved," Nichols said.
The children's hospital also gets enthusiastic support from Polk County students. In a week of fund-raisers named "Doernbecher Week" at Dallas High School, students raised $3,355 from benefit basketball games, dances and the annual Mr. Dallas competition this year alone. They got a helping hand from LaCreole Middle School in that effort.
Central High School students earned $1,000 for Doernbecher with a Spring Fling Week this year that included a battle of the bands, drive-in movie night, and barn dance. The Mr. Central pageant itself brought in $600.
Students raised the money, for the faceless children throughout the state as well as in support of Polk County students receiving treatment at the hospital.
Dallas High student Mason Tichinin lent a public face to the fund-raising in 2000. Tichinin, 16, underwent chemotherapy for Hodgkin's disease at Doernbecher, starting in February of last year.
This June, Tichinin returned to Doernbecher, but not for treatment. His cancer in remission for two months, hospital administrators chose Tichinin to test a new computer link at the hospital. Connected with his friends at Dallas High from a hospital room, the technology allowed Tichinin to see his friends smile on a monitor as they sang him "Happy Birthday" in real time.
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Craig Kunkle appreciates the way his neighbors in the county came together to help little Holden. Members of various local clubs, Central High School and Faith Lutheran Church raised thousands of dollars for Holden. "People do things for Doernbecher," Craig said, "but they also do it for the families.
"There's a lot of heart in the community," Craig said. "If not for the kindhearted folks, it would have been more of a hardship for us."
Today, Holden plays like a happy, healthy 3-year-old, though he still needs special care. After Gullian-Bare syndrome paralyzed him from the waist down, Holden has struggled to walk, using braces and a walker. He's had eye problems and tubes put in his ears. He still needs to be fed every two hours through another tube.
And he gets dried out, needing intravenous treatment. "He has an adult-sized kidney in his little body," Craig said. "It's hard to keep him hydrated."
Craig Kunkle sees Doernbecher Children's Hospital as a profound place, one of inspiring breakthroughs and great disappointments. "It's definitely a place where miracles happen," Kunkle said. "For a 2-year-old to have a kidney transplant" is amazing.
"But it's a hard place to visit," Kunkle continued. "We've been up there when children don't make it; parents have had to make the choice to take their brain-dead kid off machines.
"There are some tragedies, and that's heartbreaking."
Kunkle has been lucky. As a manager at Mendi's Pizza in Independence, he has flexibility to spend time caring for Holden. "It's too bad some employers can't give time for people to be with their child" at Doernbecher, he said.
"Sometimes children cry for their dad and mom -- you just want to go and hug the kid," Kunkle explained. "The nurses try, but they're just so busy.
"They need more nurses."
Pat Southard has a different assessment. "That's not a complaint I hear very often," said Southard, interim director for OHSU and Doernbecher hospitals.
"The nurses are busy, but staffing is what it should be," she said. "We have a better nurse-to-patient ratio than we did three or four years ago."
Christine Decker is communications coordinator for OHSU news and publications. "`Nursing shortage' are the big buzzwords right now, but it's not a problem here yet," Decker said. "Our nursing school has been graduating the same amount of people."
But Kunkle doesn't question the level of care the nurses give. He related the story of Stephany Pelky, a pediatric nurse who gave her own kidney to help a child. "That's just the love up there," he said. "But they've got the good, the bad and the ugly."
Pat Lewis has enjoyed his interactions with OHSU hospital. And he's thrilled with the results. "At this point, they tell me I'm a poster child," Lewis said. His new heart functions well and his body has showed a "close to zero" rate of rejection of the organ.
Lewis describes life after the transplant as if it were a second childhood. "I feel things I haven't felt for years," he said. "I have good circulation, more energy, my appetite's better, I eat better.
"How do you explain feeling good?"
Lewis also had the community looking out for him. Friends started the Pat Lewis Heart Transplant Fund to help Lewis offset costs associated with the transplant. The fund has benefited from ongoing fund-raisers, including a silent auction in May and a yard sale in June.
Lewis felt comfortable going to OHSU for his transplant. "They've been doing it the longest in the Northwest," Lewis said. "I was heart transplant number 385."
While 20,000 people in the country wait for heart transplants, Lewis said, fewer than 1,500 will receive one. But OHSU leads in research on a new device that might make the difference by keeping one's original heart going, Lewis said. "Getting a heart is a precious gift, so it's nice to see devices that help people wait.
"OHSU has excellent people. They did everything they could and did their best to get me home as soon as possible," Lewis said.
His one concern: "It would be nice to see support groups before or after the surgery so I can ask questions and find out information." Other transplant recipients have helped Lewis the most by telling him what to expect. "The doctors are so busy," Lewis said, that they might not have the time to explain.
Kunkle would like to see the doctors and specialists slow down and pay closer attention to the patients and their families. "They need to listen to parents with open ears," he said. "They're not with the children 24/7 like we are."
Southard said she appreciates patient input and will share these concerns with the hospital administrators. "We welcome that kind of thing," she said, noting "I've worked for a lot of different hospitals and I have been the most impressed with the care I see delivered at OHSU."
Christine Decker walks from the Casey Eye Institute to Doernbecher hospital, passing grand views of the city and the Willamette River. Cutting from building to elevator to parking lot, she says that OHSU is Portland's largest employer, the fourth-largest in the state. And growing -- OHSU has plans for a new site along the river.
As it expands its services, OHSU will continue to draw people from Polk and other Oregon counties. The hospitals see 151,000 patients annually, coming from every county in the state and beyond. "We don't turn anyone away," Decker said proudly. "Other hospitals can't say that."
Pat Lewis didn't come to Dallas to live near a state-of-the-art medical facility, but he's thankful now. "It's a godsend," Lewis said.
"It's divine intervention that I moved here. Many people move to Portland and the Northwest because your chances of getting a heart are greater here than anywhere else in the country."
OHSU has performed heart, kidney, liver, lung and pancreas transplants longer than any other hospital in Oregon. No other hospital performs bone marrow or lung transplants, and OHSU patients do better after all these transplants than the national average.
But the story never ends with the transplant. Both Lewis and Kunkle must take medicines to suppress their immune systems. In addition to side effects such as mood swings, the medication leaves them open to diseases.
"His immune system is cut in half, so he picks up all kinds of viruses," Craig Kunkle said of Holden. "And then too many antibiotics kill too many good germs.
"We constantly have to deal with those issues."
Craig speculated that if he couldn't take Holden to Doernbecher, he'd need to find a similar hospital, even one states away, like Children's Hospital at the University of Nebraska. As it is, Holden can get to his checkups in just over an hour.
"It means a lot," Craig said. "You make life decisions based around the fact that you have the availability to get there.
"If I relocate, I'd do so within the distance from Doernbecher I am now. I wouldn't go further away because I can't get there fast enough.
"It's a nice feeling to be so close to something like that."