The World of Pediatrics

My clinical rotation in pediatrics draws to a close next week. While I’m looking forward to getting into my next rotation of mother/baby nursing, I’m admittedly a little sad to leave. I love the world of pediatrics. Kids are honest, funny, resilient, and affectionate. It was pretty awesome to do our clinicals at a world-renowed children’s hospital with it’s beautiful structure and incredible resources. But I’m okay with leaving, because I am hopeful that I will return to the Children’s Hospital of Philadelphia as a registered nurse after finishing school. If you know me at all, you probably already know this. As tends to occur when I get excited about things, I’ve talked a lot about it The two areas I’m looking to interview in, are the Emergency Dept. and Oncology. The more I talk to people about this, the more I realize just how rare it is to want to work with really sick kids. The response I usually get is, “I could never do that,” followed by one of the following three questions:

1. …how can you handle seeing all those kids sick/dying?

2. …how with you deal with all the abusive horrible parents?

3. …how can you handle watching the parents of sick and dying children?

I’ve thought a lot about these questions as I’ve looked at my desire to enter pediatric medicine. They are valid and challenging. So after consideration, here are my answers.

1. How can you handle seeing kids sick/dying?

I don’t want to downplay the gravity or the challenges of this field, because they are very real and very difficult. But I think if there is anyone in this world who deserves healing and restoration, it is our children. I know going into pediatrics means some pain and grief, especially because I enjoy critical care nursing situations. But I am also entering into an arena with a lot of joy. For all of those we lose, there are so many we can save. And when we save children, we a really giving the opportunity for life, not just a few extra years chalked onto the end. If you have the power to help save someone’s baby, whether 18 days, or 18 years, that is a pretty amazing experience. I find that I can handle the children themselves without difficulty, but children are only part of the equation in peds. With every child there is a family, or a place where a family should be.

2. How do you deal with all the abuse and ways parents mistreat their children?

The contrast seen in families here at CHOP can be striking.

With a large number of infants on the floor I’ve done my clinicals on, I’ve had the chance to see an abundance of brand new parents, who jump and run with every sound that escapes their little bundle of joy. They are at the bedside every moment, questioning every asessment and procedure.

But I’ve also seen a lot of patients who come in because they haven’t been properly cared for at home. Last week I cared for a patient who came in to the hospital with bronchiolitis (airway inflammation) secondary to RSV (a super common respiratory virus that mainly affects infants). This is actually a somewhat boring diagnosis. The patients admitted with bronchiolitis require suctioning and chest PT, but it usually resolves within a few days and the patients don’t tend to require much in the way of medication, or intense levels of care. But my patient had been born at 31 weeks to a cocaine using mother and was just 6 weeks old when he came to me. He had just left the NICU a week before and was having frequent periods of apnea where he would just forget to breathe on his own. He came in with signs of neglect and social work was being consulted to determine the aqequacy of his care. During my entire shift, no one was there with him.

I sometimes marvel that you need a license to catch a fish, shoot a deer, give an injection, or drive a car, but anyone can have a child. As I cradled this 6 lb miracle, I wondered at the responsibility of the act. What gravity to have the life of another person completely in your hands. No wonder new parents freak out. And the truth of the matter is, some people really can’t handle it.

And yet even with the significant amounts of abuse and neglect I’ve encountered during my time in peds (and there has been much more than I had prepared myself for), I’ve also come to recognize that most parents really do love their children. This is how I start to deal with situations of abuse. I NEED to believe that parents love their kids. They may not understand how to fully care for them, and they may resort to violent tactics, but even abusive parents love their kids. Yes, there are some people who are definitely better at the job than others, but I think if we recognize that most parents want to do right by their children, we can begin a family-centered process to recovery.  I don’t want to sound naive here or say we can turn everyone into a good parent.  We can’t and more often than not find myself wanting to take the abused and neglected children home.  But I’ve seen families listen to nurses in ways they would never listen to anyone else.  Studies have ranked nurses consisently (alternating with firefighters) as the most trusted professionals.  That gives us the ability to speak into people’s lives and educate them in ways that can help them better care for their children.  We also have the opportunity to be advocates for children and help those who need it to get out of abusive situations. Seeing widespread abuse and neglect will undoubtedly be difficult, but that’s hardly been a reason for me to avoid circumstances thus far in my life.

3. How can you handle watching the parents of sick and dying children?

Honestly, I’m not really sure how I will handle it. This is the area that I think will challenge me most. I can only hope that I will have the strength to help these families through their grief….and then I’ll probably go home and crumble.

Ultimately, God has placed this desire in me and I know he will guide me through it….And let’s be real, I never do anything the easy way.