Sad series of peds hem-onc patient deaths

[Rhan24]

I have been an R.N. on my city’s pediatric hospital’s Hem-Onc/BMT unit for a little over a year now and recently I’ve been having a difficult time coping with patient deaths. Not that I didn’t care/feel sad before, but the deaths recently have been patients dying from secondary cancers/complications (GVHD) from treatment from their initial diagnoses. I think maybe it’s because in my first year of nursing I was so focused on getting my skills down (this is my first “big girl” job!) and building confidence that I didn’t understand all the facets of my patients’ medical histories and what relapses truly entail.

Has anyone else in this sub-specialty felt this way? I have cried out to my trusted loved ones, asking what’s the point in torturing these children and teens with horrible treatments if they’re “just going to die anyway” (absolutely horrible, I know, but it’s how I feel sometimes). This overarching sadness and despair makes the challenges of bedside nursing (short-staffing, for example) unbearable. I feel defeated and like I’m not making a meaningful difference and dread going to work. I try to focus on positives in my life (vacations, new house) but this is a big part of my life too and this sadness is overwhelming. Any words of encouragement or insight is appreciated. Thank you for reading this far.

[ruby_jane, BSN, RN]

I am not a hem/onc nurse but I thought I wanted to be...until I did my capstone at the Children's hospital. RJ Junior was seven at the time and I thought it would undo me. RJJ is leaving for college now and I think I'd actually like to work my way back there. I especially loved the kids with sickle cell. Can't tell you why.

You work in one of the most challenging specialties ever. Hem/onc units are filled with both hope and inevitable death. It is not unusual to become disoriented or have difficult feelings when you're happy and sad all day, every day.

In addition - I want to validate your feelings about heroic treatments that may or may not prolong life with quality. I had to get out of the ICU because of that. Your feeling is compounded by the fact that these are minors who are legally unable to give consent to treatment and whose feelings may or may not be considered.

Do you have an EAP? They may be able to provide some brief, solution-focused therapy. If not - you have a year's worth of experience in a super-challenging unit and you could probably go wherever you like. Best of luck to you!

[NotReady4PrimeTime, RN]

Ruby Jane makes some good points. But to put a little perspective on it, when my son was diagnosed in 1985, children with malignancies generally didn't survive. We were given a 5% probability that he'd be alive in a year. Next week, he turns 36 years old. The "system" has learned a lot about his disease, and so many of the others, and that has allowed thousands of kids to live longer with their families, a lot of that life GOOD time!

I can relate to your feelings about suffering and futility; it's true that we push the envelope with kids ... because they're kids. Kids are resilient and accepting; they don't think like adults do. What would be intolerable to us isn't necessarily so bad for them. Most parents reach a point where they recognize the advent of diminishing returns and are able to step back to let the disease win, but it's a devastating choice no one should ever have to make.

Instead of focusing on your distressing emotions, maybe you could instead think about how what you do for that child and that family might make the horrible-ness of it all just a little more bearable for them. Sometimes it's the simplest of things that mean the most - frequent oral care for the child who no longer can swallow, a gentle but thorough bath and clean gown for the older child whose skin is so fragile, administering analgesia and anti-emetics before they're requested, finding little jobs for the siblings to keep them involved and feel like they're helping, there are so many ways your nursing skills can turn a very awful day into one that isn't so bad. Those parents aren't going to remember much of the last hours or days, but they will remember who was there for them and who gave them those last moments with their child. And you know, sometimes hugs are therapeutic for the hugger too.

[Dacatster, ADN]

I worked BMT back in 2000 for a year. I liked it, the deaths were sad. the hardest part for me was stupid drama of the family, for example 1 family getting kicked out of the RMH for watching Media in the lobby of the place on a wide screen tv. I ended up going to PEDS ER at a level 1 trauma center, there we seen many deaths, most were traumatic, unexpected. I was able to brush most off my shoulder until 2008.

In 2005 my nephew was diagnosis with 2 brain tumors, he was 17 at the time. He under went 2 brain surgeries, chemo, 2 BMT, often being seen the ER I worked at in 2008 he died in the PICU just right above where I worked at. I had a horrible time with that. My first day back from his funeral, I had a new diagnosis brain tumor of a teen boy came through. His only complaint was headache. Ended up with same tumor as my nephew.

All I could think of is that poor kid is going to go thru something horrible and end up like my nephew. I later had a friend whose son died of a brain tumor at the age of 12. Can I just say I hate brain tumors?

I don't know how much this helped you. But me 11 years alter, I still feel the pain.

[sergel02, BSN]

Not a peds nurse but I am a heme-onc/BMT nurse, so I get what you're saying. The transplants and chemo themselves aren't usually that bad, but the after effects of chemo and the GVHD is absolutely awful. We've had some poor patients who are in their 20s die due complications.

The hard thing in this field is that we see them suffer and sometimes die, but we don't see all the ones who are flourishing and thriving because of the care and treatments we gave. We give them their last chemo or their transplant, and if everything goes well, we don't see them again. It's when they start getting complications or go into relapse that we see them again.

It's hard to remember all the good when the bad is so hard, but it is out there. Plus, every year research and medicine in cancer is improving.

[Ashley_SF, BSN]

I'm late to this post, but I wanted to say thank you for working in the area you do. My twin sister was diagnosed with stage 4 neuroblastoma back in the late 80's; she was given a 5% chance of survival. She endured total body radiation, a bmt, and chemo.

I am happy to report that because of the work of people like you she is alive and thriving today, almost 30 years later.

We can't save them all, but like others have mentioned, we can make the time they have left more comfortable. Sometimes our job is to ease the pain and suffering that our patients and their loved ones experience, no matter the prognosis.