Last week on peds

This week, my last on the peds floor for my clinical, was one that got me thinking. My patient was a 17 year old girl who had been diagnosed with a medulloblastoma (brain tumor) almost a year ago. What gets me most with these cancer kids, I think, is how they initially present. Bruised shins, headaches, nausea and vomiting-- things that kids just get, except this time, they ended up with cancer, too.

I've chosen mostly heme/onc (hematology/oncology) kids for my patients, and I've seen them all at different stages of the disease and treatment process. My first week on the unit, my patient was in the middle of her third round of chemo for ALL (acute lymphoblastic leukemia). A few weeks later, my patient, who's squamous cell carcinoma had been complicated by several intense cases of pneumonia and metastases to lung, liver, and bone, had just become a DNR/DNI (do not resuscitate/do not intubate) status, and was at the end of a very long battle. His dad was at the bedside, waiting for the snow to stop so that he could take his son home to die. A few weeks later, my patient was a toddler who had, that day, been diagnosed with neuroblastoma, and had a tumor the size of a football in his belly. This past week, I finally got to witness a little bit of success.

This adolescent girl had presented a year and a half ago to her primary care physician initially because of some vision changes. After being lost to follow up for nearly 6 months, she came back because one side of her face had started to droop, and she had headaches. After MRI showed a mass in her left parietal lobe, this young woman underwent surgical resection (yeah, we're talking brain surgery) and radiation, and then chemo. This week, she was hospitalized for her final round (of 6) of chemo. With her Mom at the bedside, she was hopeful and optimistic; this 17 year old was the friendliest patient I'd had all term, even being pumped full of poison. She was doing really well-- clear lungs, 0/10 pain all day, eating well, ready to go home and get back to school.

When a mishap with the shower (she somehow leaned on the curtain and knocked the pole--and the surrounding tile-- off of the wall) forced her to move rooms, she randomly ended up in the same room where her chemotherapy had first begun. As her nurse and I hooked her IVs back up and got her settled, her Mom stood at the window with tears streaming down her face. She remembered months before, watching snowflakes circle to the ground, wondering if her daughter would survive to see her 18th birthday.

She had come full circle. And for my very last day as a pediatric acute care nursing student, I couldn't have asked for anything better.