Peds: How do you handle it?

umcRN, BSN, RN · Jul 10, 2013

I work in a pediatric cardiac icu. As one of our more senior charge nurses put it recently, every one of our kids is already dying when they come in the door (that's more specific to my unit of course). They are born with sick and broken hearts and if we don't fix them they will die. And some of them do die, some die quickly and some die after long battles, multiple surgeries, transplants, rejection etc. But MOST of them LIVE and when a kid survives they know it and they don't take it for granted, because they are children and what they want more than anything is to be a kid. Unlike in the adult cardiac world where the 67 year old morbidly obese patient s/p quadruple bypass might survive surgery but then go home, sit on the couch, smoke a cigarette and eat a burger and probably wind up back in the hospital a week later, kids really want to live, and when they do get out of the hospital they run and they play and they don't realize that they just had open heart surgery and should be taking it easy, they are just so happy to be out of the hospital living a "normal" life. Children' have a will to live that is rarely seen in adults, they are stronger than adults and put up with far more cr*p than many adults would ever be able to, and at the end of the day you can make things better for them just by being silly, reading a book, blowing up a glove balloon and putting a face on it.

I have had many losses of special children to me in the past 4 years. I have attended funerals of the ones I am closest to and vented about it with coworkers about the others. We support each other and get through it, and then we look at the pictures of the survivors. We have a wall as you walk into our unit, filled with pictures that parents have sent us. Some of them are of kiddos who didn't make it but many are of kiddos who did and who are home and thriving after their battles, whether long or short. Those kiddos are what get me back out there after a rough shift or loss.

It's not easy, and there are many tough, emotionally exhausting days. I have a primary right now who was dying the day he came through our doors 7 months ago and 7 months later he's not faring much better. Will he ever leave? I don't know but the days I can get a smile out of him, make him laugh, or see him put a smile on his moms face instead of the constant worry, those days are beautiful. That kid is the strongest person I know, and the fact that he CAN still smile, and laugh and enjoy life makes him my hero. He is three years old.

brownbook · Jul 10, 2013

I have only floated to peds and that was a "general" peds unit, we did not have severely ill kids.

I have had (fortunately not too frequent) experiences of dealing with dying children from newborns, to SIDS, to trauma's brought into ER, and am very peripherally involved in pre-op getting kids ready for chemo therapy.

Any area of medicine dealing with death and dying can affect the health care provider, but of course children are the worse.

It sounds selfish and egotistical but honestly I seem to be more worried about my ability to perform in front of other health care professionals, do my job right, get the IV in, draw up and meds correctly and give it correctly, etc., than get to emotional about what is actually happening with the kid.

When you look at a photo album your mind can focus on the photos and you look as long and slowly as you want. When you are day to day dealing with sick kids in a hospital your mind is to busy to "stop, look, and wonder" about the child.

Some health care givers can turn the "this is awful, this child is dying, I am too sad" off. Some cannot and cannot work peds or areas where dying, death, is a frequent visitor.

You don't really know until you are exposed to it.

mmcc26 · Jul 11, 2013

I work in a pediatric cardiac icu. As one of our more senior charge nurses put it recently, every one of our kids is already dying when they come in the door (that's more specific to my unit of course). They are born with sick and broken hearts and if we don't fix them they will die. And some of them do die, some die quickly and some die after long battles, multiple surgeries, transplants, rejection etc. But MOST of them LIVE and when a kid survives they know it and they don't take it for granted, because they are children and what they want more than anything is to be a kid. Unlike in the adult cardiac world where the 67 year old morbidly obese patient s/p quadruple bypass might survive surgery but then go home, sit on the couch, smoke a cigarette and eat a burger and probably wind up back in the hospital a week later, kids really want to live, and when they do get out of the hospital they run and they play and they don't realize that they just had open heart surgery and should be taking it easy, they are just so happy to be out of the hospital living a "normal" life. Children' have a will to live that is rarely seen in adults, they are stronger than adults and put up with far more cr*p than many adults would ever be able to, and at the end of the day you can make things better for them just by being silly, reading a book, blowing up a glove balloon and putting a face on it.
I have had many losses of special children to me in the past 4 years. I have attended funerals of the ones I am closest to and vented about it with coworkers about the others. We support each other and get through it, and then we look at the pictures of the survivors. We have a wall as you walk into our unit, filled with pictures that parents have sent us. Some of them are of kiddos who didn't make it but many are of kiddos who did and who are home and thriving after their battles, whether long or short. Those kiddos are what get me back out there after a rough shift or loss.
It's not easy, and there are many tough, emotionally exhausting days. I have a primary right now who was dying the day he came through our doors 7 months ago and 7 months later he's not faring much better. Will he ever leave? I don't know but the days I can get a smile out of him, make him laugh, or see him put a smile on his moms face instead of the constant worry, those days are beautiful. That kid is the strongest person I know, and the fact that he CAN still smile, and laugh and enjoy life makes him my hero. He is three years old.

Thank you for your post. You answered just about every question I have.

mmcc26 · Jul 11, 2013

I have only floated to peds and that was a "general" peds unit, we did not have severely ill kids.
I have had (fortunately not too frequent) experiences of dealing with dying children from newborns, to SIDS, to trauma's brought into ER, and am very peripherally involved in pre-op getting kids ready for chemo therapy.
Any area of medicine dealing with death and dying can affect the health care provider, but of course children are the worse.
It sounds selfish and egotistical but honestly I seem to be more worried about my ability to perform in front of other health care professionals, do my job right, get the IV in, draw up and meds correctly and give it correctly, etc., than get to emotional about what is actually happening with the kid.
When you look at a photo album your mind can focus on the photos and you look as long and slowly as you want. When you are day to day dealing with sick kids in a hospital your mind is to busy to "stop, look, and wonder" about the child.
Some health care givers can turn the "this is awful, this child is dying, I am too sad" off. Some cannot and cannot work peds or areas where dying, death, is a frequent visitor.
You don't really know until you are exposed to it.

You're absolutely right, I won't know until I'm exposed. Thanks for you input, there were a lot of things in your response that I hadn't thought of.

meanmaryjean, DNP, RN · Jul 11, 2013

The thing I love about pediatric patients: They take NO enjoyment/ pleasure from the 'sick role'. They WANT to get better, and they want to get better NOW.

My take-away from PICU is this: 95-99% of the kids I care for get 'well' and go home to mom and dad. AND- when they go home, most of them have another 60-70 years ahead of them, which is VERY unlike the adult side.

kidzrn08 · Jul 12, 2013

The only nursing I have EVER done (besides clinicals in school) is Pediatrics. Sometimes it takes all I have to make it through my day without tears and some days there are tears but that's ok. People expect you to be upset when their child is sick. It shows them that you CARE about their child and that they are special to you. As the person above me posted...children want to get better, they want to run and play and be silly...this is what I go to work to see. I want to see my little 4 year old running up and down the halls thanking all the nurses because we finally let him have sips of clears...even if we didn't take the NG tube out. An appreciation for making them feel better that you will rarely see from an adult. If I have made the difference in the life of just 1 child in my entire career, I have done my job and that keeps me coming back for more.

~PedsRN~, BSN, RN · Jul 12, 2013

It is not the sickness and the injuries that bother me, although there are sometimes that I get mad at the preventable injuries (like gunshots, and ATV accidents, and lawnmowers) - but like the previous poster said, the majority of the children I take care of get better and go home. :) Kids are amazingly resilient, and they want to get better. I take care kids of kids after surgery and it's amazing how fast they bounce back after a surgery that would have put you or I out of commission for weeks. :) We do a lot of ortho surgery (lots of spinal fusions, scoli repairs, etc) and I can't imagine something more painful than having a rod implanted into your back - but these kids ROCK IT OUT.

The sadness, for me, comes from the neglected children. The ones that are left to fight their battles alone. The ones that end up with me because their parents were too stupid to take care of them properly. The abused children. The kids that come in literally starving because their parents just don't FEED them. These are the cases that make me cry on my way home from work.

There will always be a child that you carry with you. I think that everyone has one where I work.... it is just the nature of the job. But it helps to know that these special children get love when they are under your care. :)

ixchel · Jul 12, 2013

I'm not in peds yet, but I'm on my way there and I have kids. (I know, I know, that's not actually experience, but......) You know what draws me to peds? Children find joy and hope when adults don't. They have a resilience that is pure and inspiring, against all odds. Yes, that will be hard sometimes, I'm sure. But it is so beautiful! I want to be part of that.

The problem with adults is many times the problems you see will be self inflicted from poor habits over a lifetime that they may never change, but they will continue to struggle because of. I can see that burning me out way faster than the hardship of pediatric illnesses.

KelRN215, BSN, RN · Jul 13, 2013

I'm strongly considering pursuing pediatrics because I am very good with children and believe this could really be a good match for me. I also have my doubts, because I'm not sure how emotionally trying it can be. I was very confident until I saw a photo album online of a young boy and his journey with terminal cancer. So, pediatric nurses, how do you handle losses? What is your outlook on your specialization?

I work primarily oncology and there is a fair amount of loss, depending on the specific diagnosis. I have several patients on my service now who likely will die of their cancers. Usually once it gets to that point, they no longer have any quality of life. Their tumors take away their ability to walk, eat, speak and it often comes to a point where their dying is a relief. This is going to sound horrible but, it's been years since I cried from one of my patients dying. I know their prognoses from the moment I meet them and, subconsciously, I probably consider it when caring for them. If I hear "stage IV neuroblastoma in a 6 year old", I know that the odds of survival are only 30-50%. If I hear "DIPG" or "GBM", I know the odds of survival are close to zero. I do what I can to help these kids and their families in the hear and now despite the fact that no matter what I do, I am unlikely to influence their prognosis.

xoemmylouox, ASN, RN · Jul 14, 2013

The losses are tough. Some days it just honest to God breaks your heart, but there are SO many triumphs. They make it worth it.. Now if only we could do something about those parents..

umcRN, BSN, RN · Jul 17, 2013

Came across this today. An example of why kids (and those who take care of them) are awesome.