Pediatric Palliative Care

Do you think there can be such a thing as a beautiful death?
Do you think there can be such a thing as a beautiful pediatric death?

These are questions that we do not normally discuss, even in nursing arenas but it needs to be discussed more.  We are very uncomfortable with talking about end of life issues, but you know what they say, the only two things that are certain are death and taxes.  It is a sad sad world where children die, but as tragic as that is, it still happens and I do believe we can orchestrate such a thing as a beautiful death for a family, if possible. 

 There are those situations due to trauma, accidental or non-accidental that there may be no time to prepare all concerned but there is certainly lots of follow up that can be done to help with the grieving process.

Yesterday in clinical I took my students to a brilliant lecture by the head of the Palliative Care Team at the hospital where I teach.  She spoke bravely but simply, challenging my students to examine how they felt about these difficult issues.  Some of the questions she asked.

• What is your attitude to death?
• What is your attitude to a child's death?
• What is your own experience with close family death?

The answers to these questions is the beginning of an attitude to end of life issues, and eventually you wear your attitude on the outside, don't you think?

It helps tremendously to be a part of a healthy team, where up:down communication freely flows, where you have an ability to debrief, to say you need a break without recriminations, where you have wonderful collaborative care with the family, physicians, pastor, rabbi whoever, child life, the patient (duh obvious!...not always).  It also helps if you have a dedicated palliative care team aimed at the population you are working with, even better if there is a pediatric hospice in and out patient facility with endless resources for these families.  

It can be unusual for all or any of these components to be present and as a result we are doing our children and families a huge disservice because at all costs I DO think we have an obligation to create a beautiful end of life experience for the child if we possibly can.

Our speaker ended with strong words about taking care of ourselves as nurses so we can be the best we can be, this seems to be a theme this semester and I am so glad my students are hearing it over and over again.  It does not work to run yourself into the ground emotionally and physically, nobody wins, least of all you!

Think I got my second wind this week, inspired by my students, the children we are seeing in the clinical area and the richness of the professionals I am coming across.

I think I can make it til Thanksgiving!!!!!