Sorry its been a while, i've been in the trenches being eaten alive by rat ..er I mean kids...

So... I'm on pediatrics right now. and I'm actually really loving it! Hours are from 6am-5pmish (or later), so I'm pretty tired, but it's all a lot of fun. I had a GREAT time on the Wards, but right now Pediatric ICU is kicking my butt. It's 4am, and that's because I went to bed at 3pm after not sleeping on my night on call [every 4th night!]. (That means you start the work day at 6am, and you continue to work through the night until around noon or so the next day, except we illegally worked an extra hour till 1pm yesterday).

I actually didn't like my attending at first, and I don't think he's the greatest teacher for students, but I think he's a great doctor, and its been fun to observe his interactions with other people. PICU is a really really tough place. Half the kids are dying, half the kids have a tenous fighting chance. I guess the goal is to prolong life and to fight for those last few percentage points of survival so they can make it to through their next chemo, or their transplant without dying.

And then there are the parents who go kind of crazy (understandably) when their kid is in the ICU. I don't think there is a more scary place that exists in the hospital, and the scarier thing is, I think I could really like it (but we shall see).

There is a little girl in the PICU who is dying right now. The doctors and nurses all want to place her in hospice care. A family meeting was held with her doctor in the PICU (called an intensivist), her oncologist, and the parents. The parents decided they wanted to go through another round of chemotherapy. Essentially everyone in the PICU has been recoiling, and angry, because they have to take care of her, and she's in quite a bit of pain. I actually poke my head in when she was having an episode of breakthrough pain, and her little face was all scrunched up trying to scream.

What was most interesting to me was the conversation that I sort of overheard between the attending (the doctor) and the nurses afterward, and it made me thing of how much pediatrics is all about treating the family, not just the child. And while this next round of chemo is unlikely to do anything for her cancer, we still have to ponder what it means to have a good death. I think a good death means one without pain and a comfortable acceptance of death, and I still think that's what it means in adults. But it is truly complicated when you bring in the parents and families who also have to go through that process as well. And so, in the end, I think while we wish that the family had decided hospice, they made the best decision for themselves as a family. How can you not give your child that last chance, no matter how slim? But at the same time, the doctor's job is to aggressively go after pain and control it. The parents need a sense that they did everything they could, and the child will hopefully go as painlessly as possible. It seems in pediatrics, although the child comes first, it's also a lot more about treating the family.

I'm sorry this blog is so terribly long and depressing, but I think death and our view of it is a pretty important thing to think about, and I'm just starting to process through some of it. I wrote about this b/c I'm not doing very well in my own personal journaling, and I am moving on to a much happier place after this coming week (newborn nursery!) but I didn't want to forget the lessons learned here. There's a lot of love in the PICU, I think more than you'll ever see in other parts of the hospital, as a student I have a lot of downtime just because everyone is too busy to teach me stuff, and so its a great place to wax philosophical and think about some of these things.

It's now 5am, if I were on surgery, I would have already prerounded (4am), and we'd already be starting rounds, ah such things to look forward to!