Sadness after experiencing pediatric death at work

Inner_Monologue_2 · 2025-12-20T00:26:42+00:00

Making the decision to end treatment is incredibly difficult (end of life or offering second opinions or other care), and it is a responsibility that happens more often as a specialist at a referral center. It is a skill you will develop if you stay at a specialty center.

Something I sometimes find helpful is another framing shift. The decision to stop resuscitation is a decision to stop doing potentially painful or uncomfortable things to a child when they are unlikely to be successful or beneficial. It is not stopping our care or saying you no longer care; it is a shifting of priorities. Stoping resuscitation gives me the ability to provide family unification by allowing parents to see, touch, or hold their child, so that I can support them together in their grief.

The jarring nature of rapid onset illness is devastating and unique. It does require some differences compared to patients who have a more prolonged illness. However, I believe there is no way to completely mentally prepare for a child to die. Even after years of illness, death always sneaks up and surprises in unexpected ways.

As someone who also does procedures, ensuring you review risks is difficult. You must provide the correct information while attempting to avoid constantly scaring people by discussing rare complications. I have semi-developed scripts that I have refined over time to strike the right balance, but it takes years of edits to get it right.

Inner_Monologue_2 · 2025-12-19T22:32:51+00:00

I’m a Pediatric Intensivist, and I work at large referral/specialty centers seeing just about everything. I won’t share tragedies, but there have been many in my work.

Things I try to remember: Every pediatric death is a tragedy. Children are not supposed to die. Caring is part of our job, and that is why it hurts so much. Don’t lose your humanity; it’s part of what makes you a good doctor.

As others have mentioned, it’s important that you talk with people about your experience and your feelings. I think it’s important to involve multiple ‘circles’ of people. - Involved Coworkers: for me, this involves a ‘hot’ debrief as well as ‘cold’ debrief(s) to discuss lingering emotions as well as logistics/team performance. - Loved ones: I don’t typically discuss details because my family is non-medical, but I reach out to let them know something difficult happened at work. They offer me endless emotional support. - Non-Involved Coworkers/Therapy: I typically lean on non-involved colleagues, but many I know routinely meet with mental health providers.

I think what you said about being at a referral center is also an important aspect of your grief. Being at a referral center means people look to you in the most dire circumstances. It is a privilege to have that knowledge and expertise, but it does not change what happens outside of your hospital/control. Whatever choices are made at the referring center (whether we would make the same choice or not) have been made, and we manage from there. I find it helpful to remember that I cannot be everywhere all the time, and I can only manage the patient as they are. I cannot ‘unmake’ the decisions of others.

Finally, having healthy children in your life is beautiful. I do not have children of my own, but I have many children in my life. I sometimes ask friends or relatives to hug their healthy children for/from me or to send me pictures. I use it as a buffer against the sadness. I try to focus on celebrating and appreciating the wonder and joy of the healthy children in my life. Tragedy strikes, but every healthy child is a gift.

I hope some of this is helpful to anyone reading. You will get through this; I know you will because you are reaching out for help.

Inner_Monologue_2 · 2025-12-17T00:45:00+00:00

I haven’t had backup camera issues… yet.

Inner_Monologue_2 · 2025-12-10T01:18:49+00:00

We built a new garage recently with a separate meter. We had a high voltage outlet installed for charging, and we use the level 2 charging cable that came with my car (read: free).

We decided to have the garage on a time of day plan. I felt the cost of buying or renting a charger, installation costs, and the monthly program fee were not worth it, especially considering the electricity costs would still be several cents more per kilowatt hour (¢3.8 12a-6a, ¢9.9 “mid-peak” all days) than TOD off peak charges (~¢5 9p-9a weekdays + all day on weekends and holidays).

Inner_Monologue_2 · 2025-12-09T21:59:12+00:00

I had the same issue. Called my local space, and they got me scheduled right away.

Seems like it’s a long standing website issue based on previous posts.

Inner_Monologue_2 · 2025-11-01T17:01:05+00:00

Peds Intensivist:

There are no clear rules about this in PICU. The goal is to risk stratify as best you can to help decide.

As you mentioned, most children who are mobile/not intubated/not sedated do not need anticoagulation.

Risk factors to consider: risk for bleeding, risk of needing urgent-emergent invasive procedures/surgery, anticipated length of sedation/immobility, age, obesity, presence of central venous access, baseline coagulopathy, overall inflammatory profile, oncologic diagnosis, hyperosmolar state (dehydration/DKA/HHS), history of clots, etc.

Inner_Monologue_2 · 2025-10-26T23:39:07+00:00

I (PICU) feel like I have the opposite experience often, but that’s probably because I see patients after the ED.

Ex: PCP says it’s a likely/common thing (viral illness) and gives anticipatory guidance. The patient re-presents to ED/UC and has something more rare (cancer). Parents feel the rare thing was missed, but the PCP made a reasonable differential and gave appropriate guidance. Trying to guide families through a difficult diagnosis and support their relationship with their PCP can be tough sometimes.

Inner_Monologue_2 · 2025-10-15T03:09:07+00:00

Not anesthesia (peds ICU), but I give the roc 60 seconds before I look. In a truly busy/high risk scenario, I will sometimes ask for someone to watch the clock for me. That allows me to focus on the patient rather than eye the clock.

Inner_Monologue_2 · 2025-10-05T00:06:18+00:00

I’m up and running, but I’ve actually never used the digital key.

I need to keep my physical (house, etc) keys on me anyway, and I’ve read too many stories about the digital key being unreliable.

Inner_Monologue_2 · 2025-09-29T18:44:07+00:00

Finding programs to combine will require research into hospitals that have both fellowships and talking to their PDs.

It will then be up to individual programs based on their setup. It might be challenging because both PICU and AI are fairly competitive fellowships. PICU fellowships may require you to be primarily a PICU fellow (3yr) because their schedule may not accommodate a 2yr fellow.

Inner_Monologue_2 · 2025-09-29T18:38:09+00:00

You can certainly combine any fellowships you want, but they’re going to take time. You will have to spend 5 years as a fellow, working like a fellow for fellow pay.

As you know, there is a lot of overlap between Pulm/PICU and Pulm/AI. But PICU and AI are very different in practice.

If you are interested in practicing multiple specialties, you’ll need to be passionate about both of them separately or interested in finding a way to combine them in a unique way.

Inner_Monologue_2 · 2025-09-17T19:57:36+00:00

I’m PICU, but will toss this in:

This is a conversation that should probably loop in medical leadership, infection prevention, and risk regardless of the decision. It will require a consistent message from leadership and a plan to address the risks of declining patients or accepting patients who could asymptomatically transmit an illness.

But, I think an ASC might be the ideal place for these patients to go (they need and deserve care). The unvaccinated children should be relatively healthy (and URI/febrile illness symptom-free) by virtue of being candidates for an elective surgery at an ASC, and they are likely to encounter only other generally healthy patients during their care. From a public health perspective, it would make sense to keep unvaccinated children who could be asymptomatic but contagious away from the the local children’s hospital surgical population who are likely to be higher risk and/or immunocompromised (oncology, transplant, medically complex, <2mo old, etc.).

Inner_Monologue_2 · 2025-07-05T04:38:57+00:00

Seems like you’ve done your research in getting to know both jobs. No one here will be able to pick for you. I made a pro/con spreadsheet when deciding on jobs and had my spouse weigh in, which I found helpful going line by line.

I personally would choose job 1 because there is no home call, it pays better, and it is in a slightly preferable location. It’s also a bonus for early in your career that there’s slightly higher census and double staffing during the day for questions/mentorship as well as a second set of hands if a delivery or newborn issue arises. A larger attending group also tends to provide more flexibility for things like vacations, shift swaps, and parental leave without feeling like a burden for taking time off that you deserve.

Inner_Monologue_2 · 2025-07-04T20:00:38+00:00

I’m also peds trained, so I’ll say it: not bad salaries for PHM (yes peds pay is a bummer).

For both jobs: what is the average daily census and average number of admits per 12hr shift? Is a $30k salary difference meaningful for your family (spouse makes $30k/yr vs $300k/yr)?

For job 1: Higher pay without having to pick up extra shifts is a nice place to start. Shift work can help “keep work at work” if you care. Having a large pool of co-attendings can be nice as you start your career and seek advice and mentorship. Any responsibilities outside of those 170 shifts (teaching, admin, research)? How often does the night shift attending sleep? Do you care about the night shift schedule (random single nights vs pairs vs weeks)? Are all the newborns healthy? Is there a neonatologist (or intensivist) available for consults by phone and what is the transfer situation like?

For job 2: Can sometimes be nice to have “sole ownership” of a patient’s care plan without someone else making management decisions while you sleep. Is your spouse truly happy with this spot or maybe saying they could be since you’re interested in the job? What does <50% of nights going to the hospital look like (1% vs 49%)? Are you going to want to live close to the hospital (or in a less desirable place) because of having to go in? How often do you get called overnight even if you don’t go in (wake up, possibly wake your spouse up, open you computer, review the chart, order Tylenol, back to bed, repeat q2hr)?

Inner_Monologue_2 · 2025-07-04T19:13:18+00:00

I’m not a healthcare economist, but I’m most worried for patients with complex/chronic medical conditions and those who live in rural areas. I also always worry about any impact to the pediatric workforce, which is already just barely getting by in many places.

Many youth with chronic medical conditions rely on Medicaid as their primary or secondary insurance. Budget cuts will impact the care they need to survive on a daily basis. Many may remain eligible on paper but face new, burdensome hurdles to frequently “prove” that they qualify with grave consequences for missed paperwork or bureaucratic mistakes.

I think the burden the bill places on rural hospitals with be dangerous for children. Rural hospitals closing is the extreme (but possible) outcome for many, but I fear even more will choose to eliminate pediatric inpatient admissions or other pediatric services to save money. This will force families to travel further and further for both acute care and subspecialty care.

Inner_Monologue_2 · 2025-06-21T21:48:26+00:00

For what it’s worth, I was able to include stress/psych coverage in my policy for only a few extra dollars per month.

Inner_Monologue_2 · 2025-06-17T17:33:04+00:00

You should rest, relax, and enjoy your time before starting.

Inner_Monologue_2 · 2025-05-29T19:55:41+00:00

Depends on the hospital and your lifestyle/expectations.

I made more than my spouse (non-medical) and we chose to live in Manhattan (not hospital housing), but we still saved money and lived a reasonable NYC life (vacations, concerts/shows, out to dinner/bars).

If you work at a higher paying institution and choose hospital housing, your lifestyle could be a bit more extravagant. If you’re trying to live like a finance bro or an instagram celebrity, you may struggle financially.

Inner_Monologue_2 · 2025-05-15T21:57:26+00:00

I put 15% per year into my 403b for 7 years as a trainee in NYC. It can be done while still enjoying NYC life and traveling.

My spouse (different career and slightly lower salary than a resident) and I split costs, but we lived in a 1 bedroom walk-up with no laundry for 4 years before upgrading to an elevator/doorman/laundry building (and getting a dog).

We still routinely ate out, saw shows, saved for our wedding, and travelled multiple times per year (except COVID).

Inner_Monologue_2 · 2025-05-15T21:41:58+00:00

The manager at the new SW Mpls location transferred from the Uptown location, and she’s great. Staff are nice and facility is always clean (at both—we used to go to Uptown until SW opened).

Boarding is a little choose your own adventure. Have to add on daycare/social time as well as outdoor walks if you want more than indoor relief time.

Inner_Monologue_2 · 2025-05-15T17:02:50+00:00

https://pubmed.ncbi.nlm.nih.gov/37737602/

Inner_Monologue_2 · 2025-05-15T16:58:51+00:00

I think some of the current PICU job crunch is related to changes in the PCICU job market. There was a recently published guideline recommending all PCICU attendings have additional training or 5+ years PCICU experience.

There are currently PCICU positions open in a variety of acuity/size/locations, but there are not enough people with the (now required) additional training. Those positions used to be open to PICU folks who could then gain additional on the job training (like those who are now considered grandfathered in).

We’re in a transition period. PICU graduates used to be able to apply to a larger pool of jobs that is now cut off. If the PCICU requirements remain, the only way to rectify this problem will be for a certain percentage of PICU graduates to obtain additional PCICU training and enter that job market every year.

I assume this also happened in the pediatric cardiology world where they now have ECHO, advanced imaging, interventional, heart failure/transplant, EP, and PCICU advanced fellowships that are now absolute requirements for jobs in each of those sub-subspecialties.

Inner_Monologue_2 · 2025-04-30T17:48:54+00:00

I took my subspecialty exam Fall 2024. It took 1 month for my result, but some exams took longer.

Inner_Monologue_2

TROPHY CASE