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Journal of Nursing

Care of the Pediatric Patient

Leah Toms [email protected]


Clinical Exemplar

After working in Interventional Radiology for two years, I had developed a rapport with some of our repeat patients. We had a group of patients with chronic diseases who would come in repeatedly for various procedures such as fistulagrams, catheter exchanges, etc. They would ask us about our families, we would ask about theirs, and though we never wanted them to have to come to the hospital, it was always nice to see them.

One such family had twin two-year-old boys. The twins had been born with multiple chronic medical issues, including dystonia and short gut syndrome. They had come in on a regular basis for their entire lives for feeding tube exchanges, so we had watched them grow up. They were adorable, very well mannered, and their parents were always involved in their care. They brightened our day whenever they came in.

One day I was assigned to the room where we did all our pediatric cases. I saw W.L. on the schedule for a feeding tube exchange, so I pulled up his chart to see if anything had changed since the last time I'd seen him. As I read through his history, I noticed that he'd been an inpatient for a few days, when normally he came in the morning of his procedure. He had a diagnosis of the flu virus, and had come in through the ER one evening several days prior. I worried a bit because I knew his respiratory muscles were already weakened from his dystonia; he always took a bit longer to wake up from anesthesia than the other pediatric patients.

I went out to meet him and speak with his grandmother, who had accompanied him today while mom stayed home with her other son. He seemed tired, tossing and turning in his crib and whimpering a little. After a few minutes with his grandmother, I picked him up and carried him into the procedure room. He clung tightly to me, not wanting to be set down on the procedure table. I held him in my arms and rocked him, trying to soothe and comfort him. He clung tighter to me every time I shifted my weight or moved, afraid that I would put him down. I continued to hold him while we placed him on the monitor, started his IV, and began his anesthesia induction. Only after he was asleep did I lay him down on the table.

The procedure went off without a hitch, as did the anesthesia. He took a little longer to wake up than the average patient did, but this was normal for him. When we were finished I placed him in his crib and wheeled him to the recovery room with his grandmother in tow. As I walked away I said a silent prayer for him and his family, hoping that his frail little body would be able to fight the flu and return home soon.

I didn't think too much about it the rest of that week; we were busy and had lots of other patients to focus on. But the following week a coworker was flipping through the paper over breakfast and ran across his obituary. Apparently he'd died only a few days after his procedure with us, from respiratory failure. She came and told me with tears in her eyes, and I had to wipe away my own.

It's never easy when a patient dies, but especially one so young. I thought of his mother, and his twin brother, and all the love his family had lavished on him during his short, troubled life. I felt good about the care I had provided to him the previous week. I'd promised his grandmother that I would take care of him as if he was my own, and that day what he needed most was someone to hold him and comfort him. He was first and foremost a child, and a patient second.

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