the PICU

PICU stands for pediatric intensive care unit. It was pretty intense. I saw 2 month old girl that had been physically abused. A 5-year old boy was there for suffering a brain aneurysm; they actually went into his brain to drain cerebral spinal fluid from the ventricles (that's like dead center of the brain) in order to relieve intracranial pressure.

The patient I had is comatose and they really aren't sure why. He had some seizures, so he might have suffered some brain trauma, but they don't know why he had the seizures to begin with. They think it might be Acute Disseminated Encephalomyelenitis (ADEM), but they really aren't sure. Some doctors think it could be a "metabolic problem" which really just means they've eliminated all other possibilities and are ruling out a mitochondrial disorder. The ADEM is supported by a CT scan (computerized tomography), which shows what think is a distruction of the myelin sheath in the brain. Myelin is a coating that many neurons in the brain possess which increases the nerve impulse speed.

Currently, my patient doesn't have deep tendon reflexes. Like when you swipe the bottom of his feet (Babynski reflex), he doesn't respond to that. His pupils are round and reactive to light, but they don't react very quickly. I felt so bad for the patient's family too. I'd hate to be in their situation. But there was one patient who was a happy case and I didn't realize it. She was a 2 month old who was born with a congenital defect in her heart. She had a perforated septum between her ventricles. This actually not rare and is easily remedied. She is recovering nicely, will probably be off the the ventilator tomorrow and will be in mommy's arms in two days. If there are cases like this to look forward to, I just might be able to hang in there with the kids. If not, I don't know what I'll do, cuz they break my heart when I see them in those beds with all those tubes coming out of them.