The cases that break your heart

  1. 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?
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    About KelRN215, BSN, RN

    Joined: Oct '10; Posts: 6,956; Likes: 15,179


  3. by   realnursealso/LPN
    Yes................Sometimes You Just Don't See It Coming It broke my heart when this happened.
  4. by   umcRN
    1 year old previously healthy. Hx of few days low grade fever, parents brought to PMD and were sent home to let it run it's course. Next day kiddo didn't wake up, 911 called, taken to ER, respiratory failure, coded multiple times, placed on full VA ecmo for over a month, seized, renal failure, CVVH. Patient is now trach/vent/gtube dependent. Has no cough/gag, does not track, is neurologically devastated.

    It was "just" a virus.
  5. by   amygarside
    I have not experienced this yet, but I can emphatize. This kind of case is really difficult.
  6. by   7feetunder
    1.When a boy died on his birthday...
  7. by   AtivanIM
    On my normally scheduled days, I work with children ages 5-17 in an acute care psych ward.
    Every day I hear stories that could break your heart. When I first began working there, I had a pre-psychotic break! Talking in my sleep, texing in my sleep complete word-salad. This was when I was actually able to sleep because I took my work home with me.

    The vast majority of my patients have been abused, usually to extreme levels, and oftentimes the abusive parents or CPS are involved. VERY recently I had an older teen that had begun being prostituted out by her mother at the age of 8. How could I even process that pain if I took it home? Admittedly, sometimes it's impossible. I hear stories that are beyond belief on a daily basis. I can't count how many times I have teared up while a child tells me their story.

    My job has shaken any religious beliefs I had, regardless of how small they were. I advocate for my kids as much as humanly possible. I will debate with social workers and MD's if I know that child could be going back to an abusive situation and explain my rationale. The only reason I do this type of nursing is because I can SEE the difference I have made. When a kiddo draws me a picture to say thank you or says "you're the coolest nurse I've ever had," or just a simple "Thank You" as I walk them out the door, it makes all of my emotional turmoil, to some extent, worth it if I've made a positive difference in their life. I always make sure to give the kids that had a connection with me a big hug as they go out the door, because I don't know when will be the next time they will get a genuine hug.
  8. by   nursel56
    A two year old who was conceived after years of infertility. Parents were both professionals . . .one in neurology the other in psychology. They made instructional videos with their child to show normal developmental milestones. Then he developed a brain tumor. That was one cancer case that got to me.

    Six year old girl with full-thickness burns from waist to toes from being dunked in a scalding-hot bathtub, "accidentally". Many other findings in the investigation but parents put on a good show. In the end they gave her back and they moved out of state within the week. I still wonder what that little girl's life turned out like but it haunts me.

    Several cases of children rejected by parents for congenital defects who died for reasons not adequately explained by their physical conditions at the time of the death. Meaning they passed away in the hospital unexpectedly, not at home.
    Last edit by nursel56 on Nov 23, '12 : Reason: clarify something
  9. by   SunshineDaisy
    I am still in school, in Peds and OB this semester. This past week for my Peds clinical I was in the PICU and discovered real quick I can't work there. there were 2 clients, both babies. one was a 3 month old who was being prepared to be taken off life support and his organs harvested. He had been there 2 weeks after he was brought into the ER from being suffocated by one of his parents who had rolled over on him while sleeping And the other, a sweet 7 week old baby who was there for shaken baby syndrome. The baby showed no signs of life but mom refuses to let her go because the boyfriend will be charged with murder! WTH?! He did kill your baby, let him pay!!! Ugh. I can not work in Peds. I can't handle so many sick children. it made my heart so sad to see these precious babies this way :'(
  10. by   dirtyhippiegirl
    Get a lot of them working PPD. The saddest was an older couple who had remarried later in life. They wanted a kiddo together and she finally got pregnant, not super older but maybe very late 30s-early 40s? Anyway. Mom goes into early labor and strokes out. Dies in a nursing home a few months later. They take the baby at the same time and she has a massive hypoxic event, is in a persistent vegetative state. No hope for much.

    Another kiddo in PVS. Was normal until 22-months or so. Mom put her to bed with a cold. She never woke up.


    My own mom lost a child (my brother) at around two months. I was told for years that it was SIDS. Late learned that she had taken the baby wading in our swimming pool about a week before he died, and that the docs later cultured an unidentifiable bacteria from his spinal fluid upon autopsy. She always blamed herself.
  11. by   sunny3811
    When I was a CNA about 12 years ago, I was working at a Community hospital on the medical floor, and I got called down to the ER to sit with a baby. I had no idea why I had to sit with a 5 month old baby. Well it turns out the mother had brought her child in because her child had uncontrollable screaming. The mother was very young maybe 19 or 20.

    It turned out that her boyfriend(the father of the baby) had squeezed the 5 month old's right arm so bad he broke the arm. At first the mother was suspected(that is why they needed a sitter to keep mom away). The reason the "father" squeezed the baby was because it was the middle of the night and the baby was crying.

    I was disturbed by that abuse as well as the rest of the ER staff. The mother did not want the father prosecuted for child abuse! By this time Social Services and the Police were already involved. I do know the baby had to be transferred to the Children's Hospital in the city. The break was not on a joint right in the middle of the upper arm. I saw the x-ray. It looked like the humerus was literally snapped in two. that poor baby!!

    The mother also had a 3 yr old at home, and she did not want to scare her son. After I spoke with her for a little while. I came to believe the boyfriend was abusing her too. She had no job and was estranged from her family(because of the boyfriend). I stayed with that baby until he was transferred to the Children's hospital. That child should be about 12 or 13 yrs old now. I hope he is okay and has no permanent scarring from that abuse as well as his mother.

    I remember going home from work that night and hugging my child and also thanking my husband for not being an abusive a@@hole.
  12. by   sharpeimom
    I was a second semester senior and I was so traumatized that I very nearly quit. A tiny five year old girl was carried into the ER by her father. She only weighed about 20 pounds. She had been vomiting several times
    a day and in severe pain for a month or longer. Her parents were very very poor and were illiterate.

    They kept saying over and over just how much they "loved our girl." They were migrant farmers who were terribly afraid of any authority figure and had been afraid if they had brought her in sooner and were unable
    to pay that either she would be taken from them or that they would go to jail.

    She was rushed to the OR, where her ruptured appendix, her reproductive organs, plus a few feet of intestine,
    and her bladder were removed, due to the overwhelming infection.

    She died shortly thereafter.
  13. by   ~PedsRN~
    I have patients that I will always carry around with me.
    What gets me the most are the patients who are alone. Dropped off at the hospital to deal with all of it on their own.... kids dealing with chronic illnesses, sometimes due to the neglect of their home situations.... these are the kids that take up residence in my heart.

    One little boy in particular, 6 years old..... stayed in the hospital with us for months and I couldn't have picked his momma out of a line up. But I sure remember the sounds of his little voice as he would lie in the bed on the phone with her begging for her to come to visit him.

    These are the children I go out of my way for, who I spend more time with than I really should, who I tiptoe the line with. It helps knowing that if even for just a moment, when they were with me, they knew that they were loved.
  14. by   anon456
    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.