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Pediatric Critical Care:
What Would You Do?
Just imagine that one day your child is severely ill. The problem appears to be
frightening enough that you call 911 and rush him to the Emergency Room at JFK Medical
Center. There you report to the physician that your child has been having trouble with
coordination and balance for several weeks and today has been having severe headaches and
vomiting. He had trouble breathing at home and was responding poorly. With the help of the
pediatric intensivists, the Emergency Room physician stabilizes your child, places him on
the respirator and sends him to the Radiology Department to obtain a CT scan of the head.
Your child is then transferred to the Pediatric Special Care Unit for monitoring and
further management. In the flurry of activity around your child, you hear that his blood
pressure is unstable and the pressure around his brain is very high. At the conference
with a team of physicians your worst fears are realized - your child has a brain tumor.
There is inflammation around the tumor and the swelling in his brain is threatening his
life. The physicians and nurses tell you what to expect in the near future - your child
will need several bedside procedures, blood tests and medications and then he will need
brain surgery.
You watch helplessly as the EKG monitor quietly beeps with a steady rhythm and the blood
pressure waves and oxygen levels sweep by seamlessly. Your child appears to be sleeping
quietly despite the activity around him, the rhythmic rise and fall of his chest
synchronous with the machine helping him to breathe. Time moves slowly. MRI scans and EEGs
come and go. At last, you are told that he is ready for surgery.
With your family around you and the pediatric nurses and physicians providing emotional
support, you anxiously await the return of your son. After seemingly countless hours, he
returns, accompanied by the pediatric anesthesiologist. The pediatric neurosurgeon tells
you that he removed the entire tumor and that the neuro-pathologist reported that the
tumor was malignant. Although you were previously prepared, the news is devastating.
Recovery from surgery, stabilization of his vital functions and removal from the
respirator occupy the following days. Follow-up scans reveal that the tumor is gone and
the child is allowed to go home. The neurological deficits disappear after intensive work
with the physical, occupational and rehabilitation therapists, as well as the
neuropsychologists. A permanent central venous catheter is inserted for the chemotherapy
recommended by the neuro-oncologist. The combination of radiation and chemotherapy causes
your child to be sick and for his hair to fall out. He returns to the Pediatric Special
Care Unit several times following the surgery because of complications from his cancer and
for conscious sedation for various procedures.
Finally, after the last dose of chemotherapy and radiation, your son is cancer-free. He
sees the pediatric neurologists, neuro-oncologist and rehabilitation therapists for
routine care and you are told that the prognosis for good health is excellent. Thanks to
the physicians and staff at the Children's Neurological Center, your child can look
forward to a normal life.