[Kimbalou]

I am wondering what type of PICU pt. you find the hardest emotionally to deal with...is it trauma? Or brain tumors? Former premies?
Thanks for your input.

[Kimbalou]

Of course there are many more types of pts. than what I mentioned, just curious what is the most difficult for you to handle.

[janfrn]

I have the most trouble with the kids that we know are not going to survive who are forced, through one means or another, to continue to breathe... because someone is unable to face facts and be realistic, compassionate and courageous enough to say "Enough". Lately we've had more than a few of these. By the time the point of no return is obvious to everyone these kids have been subjected to untold indignities because the family has been filled with false hope by a surgeon or a family physician who isn't seeing the whole picture and lacks the understanding of the limits of what we do, or parents can't let go, or because a physician lacks the stones to call a halt. We have kept brain dead children breathing until their hearts have stopped, we have watched children die by inches, we have a five week old baby on ECMO after two prolonged arrests... a baby with previously undiagnosed TAPVD who is unresponsive and failed to meet brain death criteria only because of a single gasp... Those are the ones I have trouble thinking about.

Come on, GF... spill. What's got you in such a contemplative mood?

[Kimbalou]

I am finding PICU is harder emotionally than I expected. It's harder to wind down from a shift in PICU. I am usually ok at work, then after coming home I am thinking about these kids a lot and wanting to fix them! The hardest pt.'s for me so far have been the ones who were totally normal, then all of a sudden they are not communicating at all because of an illness that the doctors can't fix...yet. I just wish we could fix them all!
It's sad.

[janfrn]

If this persists for you, you're going to burn out fast. You haven't been there long enough to see the fruits of your success, the kids that do well after PICU and come back to visit. There are kids who leave PICU with significant deficits who return six months or a year later to shock and amaze with the amount of progress they've made with therapy... There's a boy here who has had a large part of his brain removed for intractable seizures, who has also had several strokes. By all rights he should be severely handicapped. But because of the expertise of the neurosurgeon, the excellent post-op nursing care and the early and intense therapy he receives after every intervention, he is an articulate, physically active young man who raises more than $25,000 a year for our Children's Miracle Network telethon. He lives in a small rural community and has overcome. Those of us who have stayed the course in PICU think about the kids like him when we have those bad days, and remember that we are the agents for a return to 'normal' life for the vast majority of children who come into our lives. We, personally, have no influence over what happens to children before we meet them, but we have a profound impact on them and their families when they enter our world. That's what keeps me going.

[Kimbalou]

Thank you for sharing. Yes, I'll have to stick it out to see good results.

[janfrn]

I really hope you do, Kim, because I think you have the potential to be a great PICU nurse. Part of that opinion is your human-ness... if you lose that part of yourself, then you might as well dig ditches, if you know what I mean.

[AliRae]

Toughest for me are hands-down the near-drownings. I'm a PICU nurse because I was a PICU family member first ... when I was 15, my 17-year old cousin drowned. He spent 2 days in PICU until his parents could get back from France and everything could be arranged for donation. Those PICU nurses had such a profound influence on my life. So much so that I'm considering moving up to Toronto to work at Sick Kids after spending next year in Africa! =)

At any rate, those are tough for me because of the personal aspect of things.

I also have a rough time when the end comes for one of our chronic kids. It tears me up to think of their families going home without them, when these kids have been the be-all and end-all for their parents for such a long time.


But I'll echo Jan- find the good and hang on to it. It's the only way. They discovered this summer that I'm "good" at death and dying, so I've gotten pretty much every end of life kid for the last few months. If those months hadn't included a couple extremely exciting and heartening visits from former patients (some who we had totally written off!), I don't know if I would have gotten through.

[janfrn]

Oh AliRae, come and work with me! Forget Toronto... it's too expensive to live there and we have mountains only a couple of hours away! All they have is smog.

You have a gift, being a helping presence at the end of life. Please make sure that your management knows not to exploit you. You'll learn so much about making do in Sierra Leone; I have a friend who has been on several missions and she manages to recruit at least one new face for every one she does. Stay safe over there...

[AliRae]

Originally Posted by janfrn

Oh AliRae, come and work with me! Forget Toronto... it's too expensive to live there

Not if there's a free basement apartment at my aunt's house with my name on it! =) But maybe I could work out a travel contract there...? I haven't been to western Canada enough!

I don't know though ... if current indicators are true, I'll probably end up in Africa for the rest of my life. Which I'm okay with. =)