How to cope with peds deaths

[u/[deleted]]

I worked my first peds arrest yesterday. He was under a year old. I can hear his family’s screams echoing in my head and see the defeat in my team when we called it. I know it’s part of the job we do, but it sucks and I know they don’t get easier. Does anyone have any advice or coping skills to offer? I could use it.

[u/Consistent-Fox2523]

Hi. PEM physician here. Even if you do everything right they still hurt like hell, and you are correct, it doesn’t get easier.

Here are some things that help us process it in our department:

1) “The pause”. I think it’s fairly common practice at this point, we recently started doing it and it has been life changing for everyone. After declaring time of death, i ask the parents if we could say a few words for their child. I keep everyone in the room, including parents, people who helped resuscitate, EMTs and police who may have brought the kid to you.

Here’s how ours goes:

"Everyone let's pause as a team"

"Before we leave the care of this patient let's take a moment to stop as a team and honor the person we have been caring for. (name of patient) was loved and gave love and is important to others. Lets take a moment to recognize that and honor (Name of Patient) with a moment of silence" 30-45 seconds of silence

"Thank You"

"Know that as individuals and as a team we put froth our best effort to give (Name of patient) his/her/their best chance. Move forward in your day knowing that you were (Name of patient's best chance and that everyone here did their best. Thank you for everything that you do, today and every day"

Usually, everyone in the room cries and i have found that parents respond very well to it. It’s actually printed on our badges so that we dont go looking for it, and there’s a few on our crash carts.

2) warm debrief with nurses/docs/pcts. It helps to talk about what we could have done better, but vital that no one goes around blaming people. It’s ok to talk about these because you know everyone will go home and play it over and over again im their heads. I do it after i’m done with all the death documentation which takes a few hours, then page the entire ED to let them know that there will be a brief happening in a quiet room.

3) cold debriefs. We host these every month through palliative care, people can join voluntarily. Obviously, if you don’t see multiple pediatric deaths every week they can also be in an as needed basis, but it really helps.

4) go home and watch netflix until your brain gets really numb and you don’t hear the screams anymore. Crying is ok too.

[u/SolitudeWeeks → u/Consistent-Fox2523]

I’d just suggest a sooner warm debrief. A few hours could mean a shift change and staff turnover or staff is now tied up in catch-ups/new patients. The best ones I participated in were pretty immediate after leaving the code.

[u/youngdumbandhappy → u/SolitudeWeeks]

Right! I’ll never forget after a Peds code one time, our MD demanded the hospital house sup get nurses from other depts to cover the ER patients so the entire ER team involved in the code could debrief. We went around in a circle just sharing our thoughts out loud and one of the travel nurses there (who had been on the unit for a while, always very cold, stoic and detached) shared how he lost one of his kids to SIDS and witnessed an ER team code him. He shared how life altering and life changing it was, how it almost broke his marriage and family unit (losing their child) but how after years of counseling, they were finally able to cope and learn how to live again. It was heartbreaking but also- I can’t find the words to describe!- it really brought our team together and helped us see him in a different light. I’ll never forget that.

[u/platon20 → u/youngdumbandhappy]

Indeed, there was a study done a few years ago looking at the causes/triggers for divorce. Obviously the most common stuff was infidelity, money arguments, etc

But that wasn't the biggest risk factor for divorce, not by a long shot.

Infidelity issues increase risk of divorce by 70%, and money issues increase risk of divorce by 30%.

But the death of a child is devastasting, to a far higher degree than the other causes.

It turns out that the death of a child increases the risk fo divorce by a staggering 350%

Death of a child breaks families apart in ways that nothing else can.

[u/SolitudeWeeks → u/platon20]

As someone whose adult brother died unexpectedly and tragically, I absolutely believe that. My parents were already divorced but seeing the way we all dealt with it and responded in ways that were often very incompatible at minimum it makes so much sense to me that the death of a child puts that much strain on a marriage. I’d heard that fact before but not the specific percentages.