The cases that break your heart

[KelRN215]

Heartbreaking cases are not uncommon in pediatrics... especially in pediatric oncology. I have seen some of the worst of the worst in my 5+ years of pediatric nursing. I've seen kids present with a few days of headache, be diagnosed with a whopping brain tumor and leave the hospital in a body bag several months later. In my current job, doing pediatric home visits, I pretty much believe that every child in my city has cancer.

But every now and then a case comes along that is just that heartbreaking that it really gets to me. That case came to me last week. It was not an oncology case. It was a child who was normal until he was almost 3 but developed an anoxic brain injury after his teenage sister (later diagnosed with schizophrenia and currently institutionalized) tried to strangle him. He is now total care.

I generally don't get overly emotional about my cases. Pediatric cancer is awful but I can talk about it and be realistic about my patients' prognoses. This case is just one that is particularly getting to me... abuse cases are always the worst, IMO, because you know that the child's situation was 100% preventable. With pediatric cancer, you pretty much know that it wasn't caused by anything someone did.

Have you all had these kinds of cases that just tug at your heartstrings?

[anon456, BSN, RN]

I work on a unit where we have lots of hard cases. We specialize in trach/vent kids who are very often total care and have hard stories on how they got that way. The hardest for me are the SNATS or NATS (suspected non-accidental trauma-- aka child abuse). We have near drownings, hypoxic events, super preemies that survive in body but not so much in mind, cardiac kids that have coded and had anoxic brain injuries, broken necks and quadraplegia from freak accidents or car accidents, and lots of very unique and rare birth/chromosomal defects. Sometimes these kids bounce back and forth between long-term care to our unit, with no visits from family ever. Sometimes we have kids who could go home but the family is not interested or capable. Other times we have families who go the other way and let the care of the child completely take over their lives at the cost of other children in the family, their jobs, church, and social needs.

How do I handle it? I allow myself to feel compassion, but I also know I don't own the problem and it's out of my control. What is in my control is caring for the patient in the condition they are in now, and I try very hard not to take it home with me. That Serenity Prayer is very helpful.

[smurfynursey]

I had a kid once born with a preventable disease (to an extent). She was discharged as a newborn with follow up care all lined up...parents were homeless, and a whole lot of stuff happened. Last I knew she had a severe brain injury and had every complication known to man from all her problems. Parents continued to want her a full code despite obvious decline.

I worked at that facility for 6 months, she prob spent 7-8 weeks of my time there in PICU. I think about her often.

I know this is all very vague, but HIPAA is my friend...

smurfynursey

[BeenThereDoneThat74, MSN, RN]

Wow, there are so many stories, I can't keep track anymore.

But there are always things that's trigger some of the memories of the most emotional ones. Like, the other day, my daughter mentioned how the kids who were killed in CT would have unopened presents under their trees at home. It reminded me of a 16 yr old girl who came into the PICU, s/p MVA, bloody, unconscious and intubated. It was on December 23rd. When the shift finally ended at 7am, and the day shift nurses all came in decked out in Christmas gear, it hit me: this is where this girl and her family are spending Christmas. She held on for a few weeks, then passed. Every Christmas, the family comes in with a Santa, and brings presents to the kids on the Peds floor and PICU.

I've also worked in Peds oncology. The stories where no one listened to the parents complaints about their kids are the ones that always upset me the most.

I've also worked in peds long term/rehab. The ones that upset me a lot were the actual accidents. The ones where the stories appeared legitimate. I was a brand new parent at the time, so I couldn't say for sure that these things were unbelievable. Of course, some people did judge, and say "how can a parent let that happen?" Twelve years later, having been a parent, Peds nurse, aunt, girl scout leader, camp nurse, and friend to many mommies with young children, I can honestly say you never know what can happen under your watch. So,e of these things could happen to any one of us.

[chicagonurse89]

Pediatric cases are really heartbreaking. As a nurse, I love to take care of children who are sick especially those that are in Neonatal ICU, they are so fragile yet their heels need to be pricked many times. It's not easy to look at them experiencing such situation at an early age. Sometime, I got carried away that I can even think of them even If you are already at home.

[smurfynursey]

ProfRN4, I have worked in peds LTC/rehab for a few years now, and I thought the same thing. It's scary how fast something can happen...

[canned_bread]

4 year old received a trampoline for his birthday, and fell off it same day, hitting head on metal side (pre-mandatory-walled-trampolines). Went to local doctor straight away, and doctor did neuro tests and said kid fine. Kid fell asleep in car on the way home. They put the kid to bed when they got home (thinking the shock of it all had got to him). Kid was checked on a little while later, unconscious, shallow breathing. Ambulance called. Child had a massive haemorrhage and passed away.

Another case was first-time parents (with very minimal social support), and their newborn had a cold for 2/52, and they kept going back to the local doctor. The local doctor gave antibiotics and said she will be fine, she will be fine... They eventually took her to our paeds hospital and she was in full respiratory arrest. Came in, we vented her but she had sustained such massive brain damage the decision was made to terminate life support. The parents were so hysterical (mum bashing her head against the wall and dad walking around in circles in shock) they had to be sedated.

I don't blame the local doctors since I am sure they did their job, they just didn't know. Both times I went home and cried for those kids myself. Preventable? Maybe.

[4chun_cookie]

I once took care of a little boy in our PICU. 16 months old. Mom thought he was inside the house playing with his siblings. she went to move the family car out of the driveway. He was behind the car and his head ended up under the tires. This boy was in our PICU for a week. He never woke up, became a donor. I took care of this child daily and every day, I see the guilt in his mother's eyes, the tears streaming down her face. They are such a beautiful family and he was a beautiful child. It really broke my heart to see this family go through this. I'll never forget them.

Non-Accidental Traumas always breaks my heart too. Perfectly healthy kids, never the same again after. Always brings tears to my eyes... =*(

[JeanettePNP, MSN, RN, NP]

One of the first cases I saw as a student during our pediatric rotation was an 8mo baby who was thrown against the wall by his mother's significant other. The baby survived but with extensive neurological damage. He was transferred to LTC and after I graduated, I started to volunteer at that LTC. By then he was about a year and a half, able to breathe and eat on his own but had not achieved any gross motor milestones. Not crawling, not sitting up. He was also completely blind but able to respond to sounds and enjoyed being sung to or listening to music. A beautiful little boy who could have been a normal, happy child if not for some creep who I hope is still locked up.

There was another case that was on the news while I was in school, a 4yo child was brought in with severe injuries after being beaten by her parents and died in the emergency room. It was in the same hospital where I was doing my peds rotation and my preceptor was in the ER at the time. She was sobbing when she told us the story.

[amygarside]

Yes, several cases but I always look at the lighter side, everything happens for a reason and that I did my best so I dont have anything to regret about.

[meanmaryjean, DNP, RN]

Every single co-sleeping death. 100% preventable cause of death. But then, it would never happen to me............ makes me want to puke.

[uRNmyway, ASN, RN]

Every single co-sleeping death. 100% preventable cause of death. But then, it would never happen to me............ makes me want to puke.

I was called a judgmental b-word for mentioning the risks of co-sleeping to a so-called friend. Well, not to my face of course. She told OTHER so-called friends that I was being judgmental of her parenting choices. SMH....

[meanmaryjean, DNP, RN]

I was called a judgmental b-word for mentioning the risks of co-sleeping to a so-called friend. Well, not to my face of course. She told OTHER so-called friends that I was being judgmental of her parenting choices. SMH....

Tell me about it! For a while last year, Indiana was averaging one a WEEK. Disgusting.

But then, we live in a society where telling someone 'NO' is considered the ultimate offense.