A Dark Place

I realize I haven't published anything substantial in a while. Part of it is that this rotation at the Children's hospital has given me a lot of depressing things to think about. And it being the Christmas season, I didn't want to bring everyone else down. Actually, I didn't want to bring myself down. Some of the things that I have experienced, I just didn't want to rehash. I just wanted to come home and hang out with my kids and forget about the sadness of the hospital. But the other day was really bad.

It has been unusually warm here for December. I don't know if it's the warm weather or the holiday season, or both, but the crime rate spiked yesterday. Two traumas came in- one was in-operable. His siblings didn't even make it to the hospital after his father shot him, his mother, his siblings, then himself.

Later, a 2 week old came to the OR after she had been stabbed in the head several times, apparently by an uncle. I don't think I have ever worked so hard in my life to help keep this baby alive. It seemed like we were in the OR for 10 hours, but we really were there for about 1.5. We gave her several liters of blood products, while she continued to bleed from her head. The neurosurgeon had a tough time controlling all the bleeding because she wouldn't clot -probably DIC. Despite the very emotional circumstances surrounding this patient, the whole team -surgeons, scrubs techs, circulators, anesthesiologists- just focused on the job at hand -saving the baby. The baby made it through the surgery, but eventually died. Those of us involved were bonded by something so powerful that we couldn't really talk about it. I mean, what do you say? We later passed each other in the hallway, and asked each other how the other was doing- asked with that knowing look in our eyes, and the sadness furrowed in our brows. There was no easy response. Some were seasoned veterans, while others were newbies, like myself. All of us agreed that these were the worst traumas that we have experienced -the causes, the evil, the darkness that permeated each of these events. We couldn't begin to understand what was going through each of the perpetrators' minds, nor did we want to.

A Broken Heart

I had a patient today who was born with a bad heart. She is 4 years old and had to have surgery. Her cardiologist said that her heart was the worst he's ever seen. She is neurologically intact and appears healthy. Talking to her was like talking to every other 4 year old I have met. But she has been told that she cannot run or jump or exert herself in any way. Her heart would give out and she may die. CANNOT RUN OR JUMP! Anyone who has seen a 4 year old run and jump and play would probably agree that it is one of the happiest things ever. It is hard to imagine a child's life with those restrictions.

This evening I was sitting on the floor playing with my own children. We were laughing so hard, and then I thought of my patient. Tears suddenly welled up in my eyes as I thought that even laughing this hard might kill my patient. It just broke my heart as I cuddled my children a little harder.

Putting the Children to Sleep, Part 2

I am approaching the end of my first month at the children's hospital. It has been a very difficult month. I have seen children with minor procedures, like ear tubes, circumcisions, and repair of broken bones, but I have also seen some really sick kids. Really, really sick kids. My first case on my first call at the children's hospital was a 14 year old girl who came in with abdominal pain, nausea, and vomiting. She had eaten with her aunt, who was having the same symptoms. The girl was admitted to the hospital Friday evening, given some IV hydration, and had some tests run. Later that night, she was having more and more difficulty breathing, so they intubated her, transferred her to the ICU and placed her on the ventilator. The following morning, I started on duty. I was called by the Surgery fellow, who started the conversation by saying, "She may die if we do surgery; she may die if we don't." He proceeded to tell me that she was recently diagnosed with lymphoma, but had not yet started treatment. The surgeons wanted to do exploratory surgery to see what was going on. I went to the ICU to evaluate her. Her mother was there, tearful and puffy-eyed. I introduced myself and explained my role in her surgery, that I was to keep her daughter comfortable during surgery so that she wouldn't feel anything or remember anything from the surgery. The mother left, as if unable to deal with the reality of what was about to happen. I reviewed her chart. "Jen" was an otherwise a healthy teenager, who took Tae Kwon Do. She had one brother. Her parents were married. Her father was an EMT. Two weeks prior to her admission to the hospital, she was perfectly healthy. She had no idea how sick she was.

Later, her father returned. According the nurses, he had been "the rock," the one who would ask the questions, answer the questions, the one who proceeded with reason. As we were preparing to take "Jen" to the operating room, her father broke down in tears. His sobs were heartbreaking. He went to Jen's side and talked to her comfortingly, "Daddy loves you, baby. You're going to be fine. It's going to stop hurting. Daddy loves you so much." One by one, various family members entered her ICU room giving her hugs and kisses and prayers. Her brother couldn't even speak; he just cried and held his head. We were about to leave for the operating room when her best friend walked in and sobbed, "Oh my God, Jen!" Although sedated and intubated, Jen looked at her friend, and tears started to roll down Jen's face, the first expression of emotion that we had seen throughout her whole ICU stay.

Once in the operating room, we assured her that we would take good care of her, then drifted her off to sleep with our potions. The surgery and anesthesia went just fine. She looked better. But the prognosis remained grim. The oncologist and surgeon had a long discussion about what to do. Her belly needed several months to heal, but her cancer needed to be treated sooner than that. Starting chemotherapy too soon might kill her, but not starting may kill her, as well. Apparently, they had a conference with the family, who decided to take Jen off of life support. When I heard the news that same day, my heart broke. I swallowed my tears and continued with the rest of my work day. I went home after call, and cried and cried and cried. Someone's little girl was gone.

There is little else that makes me appreciate my own children than seeing the struggles of other parents and other children. Many of the children I see were born with congenital anomalies and syndromes. Others are diagnosed with some form of cancer. Commonly, we see the victims of accidents. Some of their conditions are treatable, while others are not. These children and their parents are an amazingly strong group. Watching just a slice of their journey -the struggles, the triumphs, the attitudes with which they face both - makes me appreciate what is important in life. I thank God that my children were born healthy, and I continue to pray that they remain healthy and safe.

The other impressionable thing I see at the children's hospital are the neglected and abused children -the 2 year old whose mother's boyfriend fractured the kid's skull because he was crying too much. Or the 1 year old who has to get ear tubes for chronic ear infections because mom can't quit smoking. Or the crack baby who has to undergo repeated heart surgeries because he was born with holes in his heart. Sometimes I wonder if people should fill out applications before they are allowed to conceive children.

The hospital itself is an amazing facility. When I first walked in, it was like being at a toy store or a children's museum. I looked around in awe at how much fun it looked. It is colorful and festive. There are games and displays and toys. Everyone is so nice, too. I mean, people who decide to make it their career to work with children are usually pretty kind, fun people. I initially thought to myself, "My kids would enjoy playing with that train. Or they might like to take a ride in the wagons. And they would just Ooh and Ahh over the sparkly display in the lobby." Then I thought, "Lord, I pray that we never have to bring them here."

Putting the Children to Sleep

This is my first week on my new rotation at the Children's Hospital. I have a 3 month rotation here, and I must admit that I AM TERRIFIED. The responsibility of anesthetizing kiddos is enormous. I mean, one minute they are jumping off the table, and the next, they are not breathing. Somehow we are supposed to find the happy medium between these two extremes. While children are very resilient in so many ways, their new, little bodies have little reserve for trauma, blood loss, dehydration, hypothermia, and other stressors, that giving them "sleepy medicine" is not something to be taken lightly. I'll stop there so that I don't freak out all the parents out there whose children may have surgery in the near or distance future. Rest assured, the children are so well taken care of, and that every single person whom I have encountered at this hospital has been extremely kind and attentive to the children. It is a very pleasant atmosphere- a nice change of pace from the other OR that I had been working, where people were generally obnoxious and sarcastic.

My last rotation was Neurosurgery. It, too, was a stressful rotation. It was not rocket science, but IT WAS BRAIN SURGERY, literally. Tumors were removed, aneurysms were clipped, and blood clots were evacuated, all from the brain. Yikes. So, I was so very stressed out during those cases, but now the newness is behind me, and I actually feel more comfortable with these cases. Not that they are not still stressful, just less unfamiliar. I can deal with the stressful situations more methodically now. I just hope that I feel this way about the Pediatric cases soon.

Putting my own children to sleep is yet another stressor in my life. Actually our 6 year old son is pretty easy to put to bed. It is the 3 year old daughter who is more challenging. Our nighttime routine consists of a video, timed so that it would end at 8:00. Then we all go upstairs. Here is where the inconsistencies are. We usually read books all together in our bedroom, say prayers, then bring the kids to each of their own rooms to go to sleep. But we don't always take the kids to their rooms. Sometimes, we let them sleep in our bed, usually when only one of us is home (ie, the other is working). We know that the inconsistency makes it difficult for our daughter to readily agree to sleep by herself, so we are working on routinely making her sleep in her own bed. It is just so tempting, for me particularly, to snuggle up to my babies when my husband is working late. I rationalize by telling myself that they are not going to be this small forever, and one day, they will not want to cuddle in bed with me. But at 2:30 in the morning, two hours before my alarm is going to go off, when I have cute little feet kicking me in the side, waking me up, I am reminded of why we want the children to sleep in their own beds. So for now, we send them to their own beds with much protesting, and save the snuggling for right before bed.

All the bedtime angst has also made it difficult for me to keep up with "Survivor: Cook Island." I watched the first episode, and half of last night's, and have just read the recaps of the other 2 episodes. I just realized last night that the groups were reshuffled, and no longer divided by race, which has made me lose some interest.

Getting ready for Halloween. Our son wants to be a dinosaur, which we are still looking for. Our daughter wants to be Spider Man -this from the little girl who insisted on buying the pink, sparkly princess shoes the other day, and whose favorite outfit is her Dora princess dress. Well, I can't complain that she is too girly, nor can I complain that she is a tomboy, can I?