Saturday, May 17, 2008

Lots of dispair lately

Haven't posted in quite some time, I kinda have been getting sick and tired of the human race. Sometimes I really think the earth would be much better off if we just just hurry up and off ourselves already.

Working in Peds has really opened my eyes to some of the suffering that can go on, as a parent I can't even imagine how I would feel if any of these kids were my own. Had a young teenage girl last week that had horrible NP all inside her left abdomen/chest, went to the OR to try and remove all the dead tissue and they kept calling up reports to the attending like every 20 min. about how much more they were finding. She went to the OR on PRVC because her lungs were starting to get stiff(her CXR was starting to look like ARDS, and we use Pressure SIMV almost exclusively to prevent volutrauma), and I got an oscillator ready for when she came back, just in case.
She ended up coming back after I had gone home, and conventional ventilation wasn't working, her BP was dropping like a stone and she couldn't be oxygentated or ventilated. After a brief stint on HFOV and a long drawn out code she passed away in the middle of the night.

Same room now(it must be haunted), we have another young teenage girl, had osteosarcoma with secondary AML, CMV, fungal balls and influenza. She was in the BMT unit on BiPAP 24/7 for a couple days before she got transferred to the PICU, and you can't live very well on BiPAP continuously. The morning she came over she actually asked to be intubated. Not literally, but she told me and her nurse that "I think I need that tube thing in my throat, I just can't breathe". Pretty sad moment when a kid tells you she needs a vent. Long story short we did electively intubate her vs wait for her to code. Personal opinion though is that she will never come off the vent and will go see baby Jeusus very soon. Apparently the parents were not aware that her condition was life threatening as they were shocked and angered when the MD's told them how dire her condition is.

It's not all bad all the time though, and that's why I can do this job and why I enjoy it. There are a few shining stars that actually get better or at least stable enough to go to stepdown and then transition to the floors and then go home. None of these kids would make it if we did nothing, so a handfull is better than 0 if you ask me.
I actually had a bit of a break and worked the floors yesterday and pushed nebs to my CF kids, saw some asthmatics and only had one rapid response to a baby on a home vent.