How do you deal with this?

Rayray, I really don't know how to articulate how I cope with child death. It isn't something I've learned to do, it is just the way I am.

I prefer working with terminal kids over adults, they don't have the baggage and unfinished business that adults usually have.

My experience has been with kids with chronic conditions who have spent most, if not all of their lives experiencing invasive and sometimes painful medical treatments.

For them death has been a long time in coming and it is hard for me not to see it as a blessing. I think that is what gives me the strength to deal with the parents. I also think that most of the parents (of the kids I've worked with) have had a long period of anticipatory grief. When the end finally comes they react as intensely as a parent who experiences the sudden loss of a child but they seem to move through the stages of grief more quickly and is there is such a thing, more easily.

Thank you for sharing your insights on this difficult issue with all of us.

Our hospital just had 2 very young, chronic patients die within 24 hours of each other. I hadn't taken a lot of care of either of them, but one had spent a whole lot of their life on our floor and we all knew him and his family relatively well. They had both been through a whole lot in their short lives and I KNOW they are "happier" being with God, but I'm still having some trouble dealing with it... the deaths, the effect on their parents, why they had to deal with so much suffering in their short lives anyway... how do you all deal with this? Especially those of you who have been in peds for a long time, how do you keep from getting bitter or angry or just giving up? Thanks for any insight...

I'm sorry for your pain, Rayrae. I could never, ever do your job. Bless you for the work you do.

Hi Rayrae

Each nurse handles the death of a child in his or her own way. I've been a pediatric nurse for 6 years and I've seen the death of a child from the result of a trauma to the long-term chronics. It isn't easy, especially with the chronics because you know them for so long..you know them almost as well or better than their parents sometimes.

What gets me are the chronics who have never been home and the parents pretty much step away/abandon them to the hospital; ones who are no longer involved. We become their family, it's all they ever know and when they die..it hits everyone who was involved in their care hard. For me when it looks like its coming to that end, I prepare myself for that final moment so the impact isnt as great when the time comes. I know that they are going to a better place and its best to let them go. You still feel great sadness and grief because those children you saw everyday and makes you wish the parents made the proper decision before placing them in so much pain and misery (which is why I don't do NICU..yuck).

You'll shed tears and cry. It takes time to get over that hurdle, but once you've been in this situation long enough you know what works best for you in dealing with death. I've cried at work in front of colleagues and there is no shame in doing that because they are more than likely crying along beside you and parents. I've gone home after a shift and cried myself to sleep or while taking a shower..it kind of releases all of the energy and stress you've kept inside. Then I go back to work like before and go on with working like before but sometimes with a heavy heart because you know what occurred previously. Over time you'll feel that you did what you could while they were alive to make their short life as worthwhile as possible. You will think about them at odd moments, remembering

something about them that was unique about them.

It's hard not to feel bitter and angry because a child dies, but death is something we expect at some point in our patients, whether we like it or not, and no one expects a child to die before and adult. Those who give up are those who cannot handle the death of a child and need to move into a different area. When people ask me how can I take care of a sick child or isn't it hard to take care of a sick child, I tell them I've gotten use to it. I don't elaborate how or what I do, because I don't really know. I know what works for me taking care of sick children.

Just take each experience and learn from it. See what works for you in handling the death of a patient. Don't let it discourage you into making you leave, unless it's something you can't handle any longer; then I would suggest you move to a different specialty and come back to pediatrics in the future.

Thank you all for your insights. It is not an easy topic to talk about so I really really appreciate it. I guess some will come with experience and maybe growing a deeper faith. I can see the relief for many kids but it's hard to reconcile the pain on the families left behind. I guess that happens with any patient death, though, no matter the age. Last night as we came on shift a 3-month-old was dying and died in the first few minutes as we were getting report. We were all somber but supporting each other and it is one of the hardest things I've ever seen- the family, the grandmother. This is not the usual run of things... it's not an ICU... but that's just been how it's going lately.

Hey Rayrae,

I am still dealing with the same thing. Our unit doesn't normally see alot of deaths either but in the past year I've been there we've unfortunately seen quite a few. I just wanted you to know that your coping skills will get better and you will find your own way of dealing with the childs passing. I know for myself I had to do some serious soul searching and figure out whether I could handle this, it is incredibly, indescribably heartbreaking.

On the other hand, I think there is something so sacred about being able to touch the life of a child so close to God. Even though we don't always win the tug of war with the angels, we know we have done all we can and hopefully that brings some peace to ourselves and the families.

Someone on these boards suggested to me that our unit have a debriefing shortly after the traumatic death of one of our sweet babies. I made the suggestion to our supervisor and we did it. It really turned out to be a positive experience as well as a way to bring some closure to the situation. I would suggest the same to you.

Please feel free to PM or email me anytime. I know how difficult it is to find someone who really understands how you are feeling about this. And to quote your quote, siempre, tu puedes!