Broken bones can be mended, and 104-degree fevers can be lowered. But when a child is born with a birth defect, the course of the illness is not always obvious. Neither is the course of the treatment. Children's Hospital has been treating a teen-aged spina bifida victim for several years. His case is typical and unusual at the same time. My associate in this year's fund-raising campaign, Deborah Schwartz, has the story:

Shortly after Mark Sabadie was born on Jan. 13, 1974, doctors informed his parents Suzy and Patrick that their son had a bubble on his back.

"I really thought that it was a bubble that cosmetically you removed and that was the end of it," Suzy recalled.

But when Mark was 12 days old, the Sabadies were given much more serious news. Mark had myelomeningocele, a fancy term for spina bifida.

Spina bifida occurs when the spine fails to form properly and part of it is exposed at birth, resulting in the bubble. Surgery is necessary to close the back. Further surgery for related problems often follows.

"All we saw was this thing that looked like half an egg and {we were told} it had to be removed," said Patrick. He remembers making "some flip remark about when {Mark} plays football and we had a doctor with the bedside manner of a rock. He said this kid may die. And that was our initial exposure to spina bifida."

After that meeting, Suzy Sabadie looked up spina bifida in the family's medical guide. She learned that as recently as 20 years before Mark was born, 90 percent of newborns with spina bifida died.

"I read after two years he'd be dead," said Suzy.

Now 90 percent of newborn spina bifida victims live, because of medical advances and aggressive treatment by doctors such as Dr. Gil Rushton Jr., a pediatric urologist who has seen Mark at Children's for more than a year.

Mark has had many more operations than birthdays -- 22, to be exact.

After the first of those operations, to close his back, Mark underwent another procedure to implant a shunt. He needed that operation because he was born with hydrocephalus (fluid on the brain).

A shunt is a thin tube inserted into the brain. It runs under the skin into the abdomen, which reabsorbs the fluid. Most spina bifida patients are born with this condition.

Mark has had many orthopedic operations. Spina bifida patients tend to have bones that do not form correctly. Bones often need to be broken and pins need to be inserted.

Mark's most persistent problem, however, has been urological. Because of his condition, he could not have controlled his bladder without surgical help.

Mark had an artificial sphincter implanted when he was 4 years old. At that time, doctors said the only other feasible option was to reroute Mark's urinary tract. But if the Sabadies had chosen that course, Mark would have had to wear a urine collection bag for the rest of his life.

The artificial sphincter keeps Mark dry. But until the surgery to implant it, urine had been backing up into his kidneys. That had caused extensive kidney damage. Mark's right kidney functions at only 20 percent, his left kidney at 80 percent.

The Sabadies credit Children's Hospital with helping to save Mark's kidneys.

When Mark became a regular patient at Children's in October 1986, tests were conducted to discover how severe the damage to his kidneys had been. "We realized in Mark's case that we were going to have to be more aggressive. And we subsequently performed a major operation on Mark -- an augmentation cystoplasty, which has really saved the kidneys and the bladders in a lot of these patients," Rushton said.

In an augmentation cystoplasty, a piece of the intestine is used to construct a pouch, which is attached to the bladder. The pouch increases the bladder's capacity. More important, the pouch allows the bladder to fill up at lower pressure. In Mark's case, his bladder was putting so much pressure on his kidneys that infections were occurring regularly.

Still, the cystoplasty is no miracle cure. Rushton said he may have prevented Mark's kidneys from getting any worse, but he can't make them any better.

The Sabadies' attitude is very positive and upbeat, and it has obviously rubbed off on Mark.

Mark is a freshman at Oakton High School, with blond hair and a perpetual smile. He can walk with the aid of crutches, but must use a wheelchair to get to and from classes.

"He's just a normal kid whose legs don't work. {He's} irresponsible. {He'll} forget his homework or sweet-talk the teacher," Patrick said.

"He gets all over the neighborhood. He can get to the shopping center a mile away without going on the main drag. We don't know where he is half the afternoon."

Recently, the Sabadies were faced with the possibility of being transferred to Chile by the Navy, in which Patrick serves as a commander. Mark took the situation into his own hands. He lightheartedly passed a petition around Oakton to help "Keep Mark in America." He got about 100 signatures.

He also got his way -- for now.

"My concern was, 'What did Dr. Rushton foresee for him and his kidneys in the coming years?' " said Suzy Sabadie. "Is it a dangerous thing to take him down {to Chile}, or what? So we had a lot of conversations back and forth and Dr. Rushton was just sort of coming around to the idea that, 'Well, maybe you could do it.'

"He offered to talk to the people down there, if Mark ran into a problem, over the telephone." But just as the Sabadies were leaning toward saying yes to Chile, Mark's kidneys flared up.

So, for the time being, the Sabadies are staying in their Herndon home, although they plan to retire to Jacksonville, Fla., in the summer of 1989. Until then, Mark remains under the watchful eye of Dr. Rushton and the spina bifida nurse coordinator at Children's, Sue Leibold.

Children's "feels like a family," Suzy said. "They feel like they really care about you ofter there. At Children's, they really have the family in mind and the children in mind. They really take care of you like a big family."

More group donations to our campaign:

Members of the Science & Technology Division of the Institute for Defense Analyses ($181, the 16th consecutive year we've gotten a donation from this group).

Treasurer's Office, National Association of Securities Dealers ($100).

Classic Construction of Northern Virginia Inc. ($50).

Konstantinoff Dental Ceramics, McLean ($100).

Greenbelt Unit No. 136, American Legion Auxiliary ($25 in memory of Frank Charles Comploier).

Porten Sullivan Corp., Bethesda, and its employees ($436 from a raffle).

Long & Foster, McLean ($700).

Employees at W.J. Schafer Associates Inc., Arlington ($1,400, and a hearty salute to this bunch for their ninth consecutive contribution).

Oakview Ladies Tuesday Bridge Club ($45).

Employees of Downey Communications Inc. ($111).

Great work, all! Thank you very much.


Make a check or money order payable to Children's Hospital and mail it to Bob Levey, The Washington Post, Washington, D.C., 20071.