Impact Stories

Twins Adam and Aaron keep mom Mayra and dad Giovanni on their toes. Adam is into all things cars and Hot Wheels. Aaron enjoys fidget spinners. They love watching Miss Rachel and light up when mom sings “The Wheels on the Bus.” A favorite pastime: racing up and down the hallway with their parents a step behind. These simple joys of daily life are a sharp contrast to their fragile beginnings.

Born too small and too soon, the twins spent the first eight months of their life under the comprehensive care of Children’s Hospital Los Angeles (CHLA) – three months in its NICCU (Newborn and Infant Critical Care Unit), and five months on the in-patient floor.

Born at 26 weeks gestational age weighing just two pounds and 14 ounces, the twins required specialized, multidisciplinary care because their brains, eyes, hearts, lungs, and kidneys were still growing and developing. Beginning in their very first days of life, the twins had five pediatric specialists at CHLA: a neonatologist, a neurologist, a cardiologist, a pulmonologist, and a urologist.

Meanwhile, mom Mayra and dad Giovanni spent long days at the twins’ bedside experiencing the good days and the challenging ones. It was three months before the new parents could hold Adam and Aaron. 

When it was time for Adam and Aaron to go home, the AltaMed clinic located on the first floor of the Children’s Hospital Los Angeles campus was there at the ready to help. The expert care teams at CHLA and AltaMed worked together to ensure a seamless experience for the family, from discharge at CHLA to establishing a medical home at AltaMed. “For AltaMed patients like Adam and Aaron, having easy access to pediatric specialists means timely diagnosis and timely treatment,” says Dr. Yvonne “Bonnie” Gutierrez, M.D., FAAP, Chief of Pediatric Services AltaMed CHLA Partnership. “It’s all about the right care at the right time, a hallmark of value-based care.”

Mayra and Giovanni were not just going home with two babies. They had to carry oxygen supplies, gastrostomy tubes (feeding tubes), medication, and the know-how to care for the twins alone for the first time. With a mixture of joy and nervous energy, and careful guidance from Lindsey Nicholson, N.P., they succeeded.

Nurse Practitioner Nicholson is part of AltaMed’s Bridge Clinic Program, where medical providers help pediatric patients with complex conditions, such as Adam and Aaron, transition their care and establish a medical home at AltaMed.

The collaboration between AltaMed and CHLA began more than two decades ago. CHLA invited AltaMed to open a general pediatrics clinic and an urgent care center within the main hospital building. AltaMed was a trailblazer in fully embedding an outpatient federally qualified health center (FQHC) at a leading academic pediatric hospital to better manage patients with Medi-Cal, California’s Medicaid program. “The partnership is innovative, too, because residents rotate within the AltaMed clinic, providing primary care and receiving their education at an FQHC,” says Dr. Gutierrez.

Having the AltaMed clinic within an acute hospital building has allowed patients easy access to specialists at CHLA. “Our patients come from throughout Los Angeles County. Many travel by bus,” says de la Rocha. “A patient family finds that a primary care visit and a specialty care visit can be done in one day, in one facility, with one team of people servicing the patient family.”

“When we think about how the Medi-Cal population is so underserved, the fact that AltaMed and CHLA are so devoted to this population, and together provide the world-class care, better access, patient sensitivity, patient- and family-centered care, is really very unique,” says Paul Viviano, President and CEO of CHLA. “When you walk down to the AltaMed clinic and you see the looks of relief on parents’ faces. It's a wonderful joy to work in a place where two great organizations can come together and provide that level of comfort to families in their hour of need.”

While CHLA helped the twins survive and thrive, the AltaMed clinic was a constant in helping Mayra and Giovanni navigate the journey at home. The AltaMed clinic was more than a pediatrician’s office, it was the first place the boys’ parents called when they had questions about feeding, breathing, medications, specialists, and developmental milestones.

“The biggest thing for Mayra, Giovanni, and the boys was extremely close follow-up care after they left CHLA,” says Nicholson. From her first appointment with Lindsey Nicholson to the present-day Mayra remains deeply grateful for her support. “Lindsey goes way above and beyond her job,” says Mayra. “She helps me a lot emotionally, giving me medical advice, and giving me mother advice. She's amazing. I am so grateful that she came into my life, into the life of my boys.”

“Mayra very openly shared how isolating it was in the beginning and just feeling somewhat alone, going from having all these people there to help the twins, then to it being her and Giovanni, but mostly her, because he was working,” says Nicholson.

For the first two months, Nicholson or another Bridge provider, were doing weekly outreach, either having in-person visits or telehealth visits. “The twins were feisty since day one and would pull out their feeding tubes,” says Nicholson, who worked closely with CHLA specialists as the boys navigated complex medical issues, including around-the-clock oxygen and brain bleeds.

“With NICCU grads, caring for a family extends beyond plugging them in to the right appointments,” says Nicholson. She helped Mayra understand how to manage the twins’ needs at home and recognize when they needed additional medical care, helping prevent unnecessary hospitalizations and emergency department visits. Nicholson also connected the family with developmental, financial, in-home nursing, and social work support through community resources and programs, including the Regional Center and Healthy Steps.

Mayra’s words echoed a similar sentiment. “Lindsey, to me, she's like my extended family, and she's like already an aunt," says Mayra.

Adam and Aaron are a dynamic, high-spirited duo, who keep everyone smiling. Today, the three-year-olds are using oxygen at night only. They love munching on chicken nuggets and rice. They say mom, dada, and papa. “They’re like photocopies,” Mayra says. “They are exactly alike. They've been so brave about everything they have experienced. They are my heroes.”

Mayra and Giovanni are deeply appreciative of the care they have received. “Every single doctor that I have seen at AltaMed, I have always gotten the best care, the best services, and the best advice,” says Mayra. “I'm so grateful that Lindsey, AltaMed, and Children’s Hospital Los Angeles came into the lives of Adam and Aaron.”