What happened should have been a non-event; our daughter caught a cold. 4. Board certified, board eligible: what’s the difference? If they would have won, it w…. If your pediatrician suggests that your child receive care from a pediatric critical care specialist, you can be assured that your child will receive the best possible medical care. And now your cold is pneumonia and now your airway is blocked and now you are intubated. The Pediatric Intensive Care Unit (PICU) is a world unto itself -- separate from the time and space that gives order to our routine lives. But when you have an underlying mitochondrial disease such as our daughter's, there's actually nothing common about a cold. Nice post. For them, all of their problems overlap in constantly changing ways. I have often been asked by such parents: “Doctor, can’t you DO anything to help?”. The rooms are dim throughout the day, but the lights are turned off and on throughout the night as numbers are recorded, … They see only the limitations of supportive care, and are frustrated by those limitations. However, in spite of this array of twenty … After all, comforting the sick, giving pain-relieving remedies when needed, feeding the patient properly, and ultimately waiting out the course of an illness at a patient’s bedside with a concerned family are traditions of care that date back to the time of Hippocrates, the founder of Western medicine in ancient Greece thousands of years ago. I practice a new medical specialty – pediatric critical care medicine – and I do my work in the pediatric intensive care unit, or PICU. How To Talk To Your Child's Doctor A Handbook for Parents "A great read for any parent. 5. Who would care for these children? I believe that this is because the ancient practice of waiting patiently at the bedside until recovery either happens or does not happen restores a measure of control to parents, who often feel quite powerless in the PICU environment. The doctors may be in charge, but the nurses are running the show. You need to speak up. Enter the password to open this PDF file: Cancel OK. Intensive care unit doctor talks to students about a “day in the life” BU alumnus Dr. Adam Fox tracks his journey from sub-par student to accomplished surgeon. I learn something new and challenging on sites I stumbleupon every This is as old as the practice of medicine itself. What happened should have been a non-event; our daughter caught a cold. We also have a wide variety of medicines that can cure many things. This teaches us a key truth about PICU: nowhere is humanistic medical practice more important than in the intensive care unit, medicine’s most technologically sophisticated setting. The example of sepsis bundles. 8. Please don't wait to be asked. And even if I'd let my imagination wander, for sure it wouldn't have occurred to me that she'd be intubated the next day and that one week later we'd be flown back to Boston in a tiny medical plane -- where we'd remain in ICU for more than a month. The hissing of ventilators and the beeping of monitors sometimes tend to obscure that reality. day. Close. So, when I calmly took my daughter to the emergency room in Florida, having told my husband to save us a good spot by the pool, it never crossed my mind that we'd be immediately transferred and admitted to the intensive care unite at the local children's hospital -- I'd been expecting a prescription for some antibiotics. Most critically ill or injured children, however, cannot have their problems neatly categorized and placed in an organ-specific box. Bring a healthy meal to the hospital or some comfort food to the house; take the siblings to a movie; read a book to our daughter so we can leave the room for three minutes. How many calories does your child need to grow? Does it matter? Parents such as these are sometimes more than frustrated by this state of affairs; some are even angry about it. Although there had long been specialized units for premature and critically ill newborn infants – neonatal intensive care units, or NICUs – few hospitals had special intensive care units to care for children who were beyond the newborn age. It really helps you get inside the mind of your child's doctor and figure out how best to communicate.". And that is a lesson I hope I can hold onto even when we leave the PICU for good. Weak muscles can make coughing nearly impossible, and if you can't cough you can't clear your secretions. These are things that are best provided by a child’s family, not by the doctors and nurses. It's eerily quiet and deafeningly loud at the same time -- with people talking in hushed voices amidst the cacophony of beeps and alarms that never stop. Before intensivists appeared on the medical scene, the primary physicians for children like these had generally been those who were expert in whatever a child’s main problem was, such as failure of one bodily organ or another. Supportive care and watchful waiting leave substantial room for non-medical measures to work their wonders, such as hope, love, and prayer. Rewards of the Job Each workday as a NICU neonatologist is a day filled with emotional exertion. If a doctor at a community hospital calls us to let us know a premature baby is getting ready to be delivered, our team will travel to that destination so that they can take over as soon as the baby is born. The rooms are dim throughout the day, but the lights are turned off and on throughout the night as numbers are recorded, medication is administered and vitals are checked. The term "ICU psychosis" is a real one... and I'm beginning to see why. With nowhere else to go, all of the goo that healthy people cough and sneeze out of their bodies stays inside and can end up in the lungs. What they need is a new species of doctor, one best described as a general practitioner for the extremely ill child. However, in spite of this array of twenty-first century technology, a large portion of what we do in the PICU is to provide supportive care – maintaining children as best we can until they can heal themselves. Wheezing in infants and toddlers — what to do? 2. Nothing anybody could have done to prevent that. Once PICUs appeared, the many medical advances in life-support technology, heart surgery, cancer therapy, and organ transplantation soon filled them with extremely sick children with complicated medical problems. Once more with feeling: Don’t let patient care interfere with documentation! Some parents are surprised by this state of affairs.