Friday, December 31, 2010

Pediatric vs. Hospice Social Work

Can you believe I've been at this for 6 months now? Sometimes my pediatric hem/onc world doesn't seem that far from what I used to do in hospice. And yet, there are some noticeable differences!

In hospice, most of my patients were over 70 yo, with a few being in the 40-69 range. I rarely had a pediatric patient. In pediatrics, all my patients are about 20 yo and younger.

In hospice, I saw a variety of diagnoses. In pediatrics, my specialities are brain tumors, sickle cell, and benign hematology. Whereas in hospice, I knew a little about a lot, in peds, I know a lot about a little.

In hospice, my desk was my dining room table and whatever I could fit in the trunk of my car. In pediatrics, I share an office with a view. I have my own desk. I have two drawers of a large filing cabinet. Space, space, space!

In hospice, I was on the road all day doing home visits. I had the largest territory of the social workers so I did a lot of driving. In pediatrics, I come to work in the morning and I stay in the same place. I vary between the clinic and the hospital. It's really nice to be in the same place.

In hospice, I worked primarily with the patient and their family. In pediatrics, that's still true. The older the patient, the more I'll work directly with them, instead of just their parents.

In hospice, I had a cell phone, a laptop, and landline voicemail. In pediatrics, I have a pager, landline phone and voicemail, and a desktop computer.

In hospice, I was on-call an average 72 hours per month over a weekend. We didn't get any time off for being on-call. In pediatrics, I have one day and one night call per month and 2 or 3 weekends per year, plus a rotating holiday every few years. We get one post-call day after weekend call or holiday call.

In hospice, I provided emotional support, counseling, and prebereavement. In pediatrics, I still do the same thing!

In hospice, I had to all sorts of case management. In pediatrics, we have case managers that take care of that stuff. I still educate families about resources, however.

In hospice, I worked with 3 other social workers. In pediatrics, I work with a billion! (Maybe not quite that many but the support is phenomenal.)

There are many more comparisons I could make but I think you've got the picture!

Monday, December 20, 2010

The First One

You don't go into hematology/oncology without knowing that at some point, one of your patients will die. You hope they won't, to be sure. However, statistics don't lie and no cancer center can completely beat the odds. I didn't know how long I would be at my new job before I lost my first patient. I wasn't sure if the death of a patient here would be different from the death of one of my former hospice patients.

Recently I lost my first patient, after almost 6 months working here. You might think that it was one of my brain tumor patients. That's who I thought the first loss would be. We're both wrong.

A teenager with sickle cell disease. It makes me so angry because this death could have been prevented. People with sickle cell can grow up to have healthy, productive lives. The operative word is CAN.

If you take your medications daily. If you keep your routine doctor appointments. If you take complications and side effects, from fevers to pain crises, seriously.

This teenager did not. There was a long history of non-compliance, some of which was the parent's fault, some of which could be explained by poverty, and some of which was completely this patient's choice. Even when struggling to breathe during what turned out to be the last few months of their life, this patient still did not take their hydroxyurea and other important medications. Yes, it was too late to reverse the lung damage and heart failure but their life could have been prolonged and they could have been so much more comfortable.

That's why I'm angry. This death should not have happened. If you have sickle cell and are reading this, I implore you to take your medications as prescribed and to keep in regular touch with your sickle cell provider. It can make a world of difference.

This teenager was so sweet, so polite, and deserved so much more. I'm glad that there was time for the patient to express their final wishes, for us to have a good palliative care discussion. They were able to go home and celebrate one last birthday with the family. They died in their mother's arms. As far as hospice goes, everything worked out beautifully.

If only it could have been prevented.