The dark side of peds

Don't get me wrong, I still love pediatrics, but today was kind of a downer from a medical perspective.  One patient I saw is a wrestler, really good at it, been doing it for a while, and loves it.  But he came in with a concussion -- and a history of previous severe concussions.  He was out of it -- first time I've been able to use the word "lethargic" legitimately to describe one of my own patients -- but his parents understood what we were saying.  They know that some time not too long from now, when his head has cleared up some, they're most likely going to have to tell him that for the sake of his health he can no longer do something he loves.  That's gotta be a pretty terrible feeling.

Of course, that kid had a pretty good day compared to another one I saw -- this one just a few days old.  She was born with a congenital diaphragmatic hernia (CDH); that is, part of her diaphragm failed to form properly and so a big chunk of what's supposed to be in her abdomen (stomach, bowel, etc.) is up in her chest.  Sometimes this is fixable.  The danger, though, is that this can prevent the lungs from forming properly ("hypoplastic" lungs) and the child can be unable to breathe well enough to supply oxygen to the rest of the body.  And that's what happened to this baby girl.  For the moment she's on ECMO (ExtraCorporeal Membrane Oxygenation; they basically run her blood through a machine that artificially oxygenates it and sends it back to her), but it sounds increasingly like it's a short-term fix for a bigtime problem.  The last child I saw in a similar situation didn't make it, and it looks like this little one may be headed along the same trajectory.  And I stood there watching her, sedated and intubated, with wires and lines and monitors attached to every part of her tiny little body and realized that, for all our knowledge and expertise, she was beyond the capabilities of modern medicine to fix.  And so, helpless to aid, all I could offer was a simple prayer: in manus Tuas, Domine.  Into Thy hands, O Lord.

I think that regardless of how long I do this I will never come to terms with a child dying.  I think that feeling will only intensify as the care of these children becomes increasingly my responsibility.  And already, only being involved around the periphery, the feeling of helplessness and uselessness SUCKS.  I only hope that God will grant me the grace to take those feelings as reminders to trust in Him.  I don't think this job would be possible if not for faith.

Anyway, that's all for me tonight...back Wednesday with more updates.  Till then, peace and God bless!