Pediatric extubation: 'pulling the tube'
| Autor: | Delaney Gracy, David Sine, Lizabeth Sumner, Charles F. von Gunten |
|---|---|
| Rok vydání: | 2002 |
| Předmět: |
Patient Transfer
Neonatal intensive care unit Heart malformation Decision Making Pediatrics Patient Care Planning Intensive Care Units Neonatal Intubation Intratracheal Medicine Humans General Nursing business.industry Cardiothoracic surgeons Delivery room Infant Newborn Extended family General Medicine medicine.disease Euthanasia Passive humanities Anesthesiology and Pain Medicine Hospice Care Cardiac defects Medical emergency Heart repair business Case discussion |
| Zdroj: | Journal of palliative medicine. 4(4) |
| ISSN: | 1096-6218 |
| Popis: | “What’s the point?” the nurse asked me quietly. I tried not to look uncomfortable, but she pressed on. “I mean, we’re pulling the tube either way. Why transfer the baby to the hospice center?” She paused, searching for the most diplomatic way to express what was bothering her. She finally added, “I mean, not to be crude, but he’s going to die, no matter where he is.” I am a doctor—technically. But more accurately, I am a second-year pediatrics resident. As a new resident on the hospice team, I was embarrassed to realize that I did not have enough experience to really answer her. I knew the hospice rooms were bigger and nicer, that the hours, space, and the environment were more suited to extended family involvement, and that there wouldn’t be so many monitors. Beyond that . . . well, part of me wondered the same thing. What was the point? We were preparing to transfer a 5-day-old baby, Reymundo, from the neonatal intensive care unit (ICU) to the inpatient hospice facility, located a couple of miles away. The baby had been born with severe heart defects and had required intubation in the delivery room. In addition to heart malformations, prenatal ultrasounds had shown that the baby had too much fluid around his brain. In his first days of life, his heart and brain defects turned out to be even worse than anticipated. He depended on a ventilator to breathe, medications to keep his lungs from flooding, and was receiving nutrition through a large catheter going directly into the vein of his umbilical cord. The neonatologists saw him. The cardiologists, cardiothoracic surgeons, and the neurosurgeons evaluated him. Finally they all sat down with the mother and father of the baby. The doctors explained that there was a series of operations that could theoretically correct some of the cardiac defects, but even if each step went perfectly, the baby already had a severely damaged brain. After a long discussion of options and potential outcomes, the family decided that the most compassionate thing that they could do for their son was to let him die. I remembered another baby, the first dead baby that I had ever held. After an unsuccessful heart repair, and 4 days of artificially pumped circulation, the baby had been removed from the machines. The mom wailed as she held him and then rushed out after he died, a few moments later. The father left with her. They did not come back. As the surgery residents were removing the tubes from his chest, the charge nurse poked her head in the door and told them to hurry up because another patient needed the room. Pediatric ICU rooms were hard to come by. I helped the baby’s nurse put the baby into the body bag, so that he could be taken to the morgue. She was afraid to do it alone. So was I. We both cried. So, as I drove to the hospice to meet Reymundo and his family, I wondered how this one would be. And how I would be. I arrived before the family, and found the hospice nurse preparing the room. She had opened the blinds, and the afternoon sunlight reflected warmly on the polished wooden floors. The room was large and comfortable, with chairs, a bed, a sofa, and a balcony. The nurse had put on a quiet CD, and was preparing a small crib for the baby Case Discussion in Palliative Medicine |
| Databáze: | OpenAIRE |
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