Many children present to the hospital so late in the course of their disease that even with the most advanced care, they would not survive.
After I do my initial assessment on these patients, I usually tell the family what I think about the prognosis. It is usually one of three responses: Good, Unsure or Potentially Death.
Yesterday we had a child arrive in heart failure because of a severe, prolonged infection. After a quick assessment, I told the family I thought the child would die. Immediately 10 people burst into a dramatic grief response. There was crying, yelling, wailing on the ground, throwing items and hitting walls.
Then, as I vigorously worked on the patient, the family became hopeful. When the patient had a brief lucid moment, they surround the bed and jubilantly prayed.
Unfortunately, after a few hours of desperate attempts to pull the child from the grave, she died. And the grief response started all over again.
Rather than putting the family through “two deaths”, I will change my practice. After my initial assessment, I will simply say, “I am unsure how he/she will do. I will do my best.”
I hope this will work better.