Wednesday, June 10, 2009

The sad part about Pediatrics

I'm working in the PICU this month.  It's at a trauma center, so we see quite a few serious injuries.  Mostly from car accidents.  But almost as frequently (or so it seems) we see children come in with injuries due to child abuse.  Last week a 12-month old baby boy came in unresponsive.  The parents reported he had been "out of it" and vomiting for a day.  They couldn't recall him falling or hitting his head, and there were no signs of trauma on exam.  There was no history of toxin ingestion.  The CT of his head showed intracranial bleeds and a very swollen brain.  What was the cause?  We weren't sure but we had our suspicions.  The next day, the eye doctor did an exam and found severe retinal hemorrhages - almost pathognomonic for child abuse.  This little boy had been shaken badly by someone, so much so that it caused bleeding in his brain and severe swelling.  His intracranial pressures got so high that he had to have emergent surgery to have part of his skull taken off so his brain could expand.

Despite these extreme measures, this patient went on to develop brain death.  His brain became so swollen that the blood flow had almost ceased completely.  Once he was declared brain dead, the parents and medical team decided to take him off life support.  His heart stopped 18 minutes later.

This is the second death I've seen this year.  The first one shook me up so badly that I cried for almost a week.  This time, I didn't shed a tear.  I don't know why.  Maybe because he came in and died so quickly.  I didn't have time to get attached.  Or maybe because I didn't actually code him.  Or maybe because I'm growing calloused?  I don't know.  I tried to say a prayer for him, but my heart wasn't in it.  I think I felt more angry than sad.  I'm not sure who abused him, but I sure hope he/she ends up in jail.  I don't understand how somebody could hurt a little child.  Children are so small and vulnerable.  They are completely dependent on adults.  They are so trusting and most of them just want to be loved.  It makes me SO angry to think of all of the children out there being abused, like my poor patient who died.  He left this world far too soon.

Anyway, that's just one of the reasons I don't think the PICU is my calling.  It can be really depressing!  Also, I don't like to have to think on my feet.  And I like my sleep.  But God bless the people who do choose to go into it.  They are definitely special people, and a blessing to all the sick children they take care of.

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