Palliative Care

If there is one job that I hands down never...ever...ever!!!...want to do, it's Palliative Care.

Throughout my orientation, I have the opportunity to "shadow" APNs from different services to see more in depth what they do.  While I see these APNs in the PICU, it's not their home base, so it's nice to see "what else" they do.

Yesterday I was with Palliative Care.  I left the hospital with full assurance, that under no circumstances should I ever do that again!

It may have been because our day started off in a dying teenagers room.  I cared for this girl all last week.  And she was getting better!  But, she took a turn for the worse over the weekend, and is just receiving palliation at this point.  Hearing her mumble that she was afraid to die while watching her parents try to stay strong for her in a situation I could never imagine to be in was too much.  I had to tune out some of the conversation at one point just so I could hold it together.

We then moved to a six week old who was born healthy.  His mom noticed that he would sometimes look a little bit blue around his lips, so she took him into her pediatrician.  The pediatrician found nothing wrong...other than an ear infection.  So the mother drove to the pharmacy to pick up a prescription and when she checked on the baby in the car seat he was not breathing and blue.  He was pulseless for about 45 minutes, and even though he now has a beating pulse, he does not have a functioning brain.  So here was this perfectly healthy baby who now has a very limited life.

Then we got to go sit in a Care Conference with a family who had to make the decision to withdraw care for their 3 year old daughter.  She has a rapidly progressing degenerative disease with no hope of getting better.  They have to decide whether to take her off the ventilator and let nature take its course, or if they want to put her through a surgery to have a trach and long term vent.  What huge decisions to make.  What horrible decisions to have to make.

There were other patients that we had to follow-up with.  Then there was the phone conference with a hospice center discussing patients who were dying at home.

And then I left.  Feeling sad for these families.  And feeling discouraged that as health care professionals sometimes there is just nothing more we can do.

I don't know how Palliative Care APNs do their job day after day.  To be able to help kids pass away with peace and dignity is a privilege.  And we get some of that in the PICU.  But to ONLY do that is overwhelming to me.

Parents in the PICU ask me all the time how I can work in such an environment.  And every time I tell them that I can do this because I truly do see so much more good than the bad.  A majority of our patients go home happy and healthy.  Only a few in the grand scheme of things do not.

But for Palliative Care, 100% of their patients are not going to go home healthy.  So I give my full respect to the men and women that can make this their specialty!  It is something that I could never do.