Health
Thursday, September 18, 2014
 
Doctor's Perspective
The hardest part of being a pediatrician

By Dr. Anthony Policastro
People sometimes ask me what the hardest thing is about being a doctor. People might think it is dealing with a difficult diagnostic case or doing a difficult technical procedure. They might also think it is keeping current with medical advances. They would be wrong. For pediatricians there is one task that is more difficult than all others. Pediatric patients have an entire life ahead of them and they are not supposed to die. When that happens, it is devastating for the family. It is no less devastating for the physician who has to tell them that news. I have been in a position to do that many times over the years and it never gets easier. Every situation is different and every family reacts differently. In most cases, the pediatrician has taken care of the child in the past so the pediatrician knows the family. There is a sense of familiarity that might affect the interaction. This familiarity might make it easier or harder if the death is sudden. When I first started as a pediatrician, I knew most of the families whose children died. I took care of many cardiac patients and they had a high mortality rate in those days. I needed to be the one that the parents were with when the time came. One weekend, I went away on a retreat with my church. While I was away, I got a call that one of my cardiac patients had passed away. Unfortunately, I could not be there for the parents, which bothered me all weekend. Things changed when I became an Air Force Hospital commanding officer which I did for nine years. I was then the medical director at Nanticoke for 12 years. For that 21 year period, I was hospital based during the day and I lived on Air Force bases which meant I was the closest one to the hospital after hours so I was usually the first one on the scene when there was a newborn or a child code. That also meant I was the first one who communicated with the family so I was often the one that communicated their loss. Here is a good example. When I was at Shaw Air Force Base I got a call one afternoon that an 8-year-old had been brought to the ER in a code situation. I was the closest pediatrician so I hopped into my car and rushed to the hospital. We worked on the child for an extended period of time. The girl had been playing with her friends in a junkyard and an old stove had fallen on top of her. When I saw that we were not having any success, I went out to talk to the mother. She was clearly in the denial and anger stage of mourning. She screamed at me to go back in and save her daughter. I had no relationship with her. She did not know me. She knew what results she wanted. I was simply the messenger, however, I still had to provide the comfort she needed. Ultimately, the autopsy showed that the stove had ruptured her heart in three different places. There was no way to save her. The discussion with that mother was not easy. Unfortunately, there have been many other discussions like this one and they are never easy. Children are not supposed to die and when it happens someone, usually the pediatrician, has to tell the family. This is far and away the hardest thing about being a pediatrician. If you have comments about this column or suggestions for other topics, send an email to Dr. Anthony Policastro at editor@mspublications.com.

Respiratory illness affecting children The Delaware Division of Public Health (DPH) has announced that 12 children have been hospitalized in Delaware with a respiratory illness caused by a yet to be identified virus. Further testing will be needed to determine if the virus is the same Human Enterovirus 68 (EV-D68) virus that has sickened over 1,000 people, especially children, across the country. "While the test results will be helpful, it is most important to stop the spread of this illness, whether or not it is EV-D68," said Dr. Karyl Rattay, DPH Director. To prevent the spread of viruses that cause respiratory illness:
  • Wash hands with soap and water frequently for 20 seconds, especially after changing diapers.
  • Avoid touching eyes, nose and mouth with unwashed hands, especially after you cough or sneeze.

  • Cover coughs and sneezes with a tissue and dispose of the tissue immediately. If a tissue is not available, cough or sneeze into your inner elbow. Droplets from a sneeze can travel up to six feet.
  • Stay home from work or school when sick and do not return until 24 hours after a fever is gone.
  • Avoid kissing, hugging, and sharing cups or eating utensils with people who are sick.
  • Disinfect frequently touched surfaces, such as toys and doorknobs, especially if someone is sick.
  • Get your annual influenza vaccine to protect yourself from influenza, which is the most common virus causing severe respiratory illness. At this time, there is no vaccine against EV-D68 infection and it is generally an uncommon virus except during outbreaks.
Adults and children with asthma and allergies are particularly vulnerable to respiratory illness. If someone with existing breathing issues begins to show symptoms of a respiratory illness, it is particularly important to reach out to your health care provider. Most people infected with enteroviruses have no symptoms or only mild symptoms, but some infections can be serious. Infants, children and teenagers are most likely to get infected with enteroviruses and become sick. Most enterovirus infections in the United States occur seasonally during the summer and fall.

Nanticoke welcomes Dr. Asija Nanticoke Health Services and the Nanticoke Physician Network welcome Amit Asija, MD. Dr. Asija graduated from M.P. Shah Medical College in Jamnagar, India in 2003. He completed his internship at Hindurao Hospital of Delhi in 2005 and his residency in Internal Medicine at Westchester Medical Center in Valhalla, N.Y. Dr. Asija completed a fellowship in geriatrics at Temple University of Philadelphia in 2011 and a fellowship in pulmonary and critical care at New York Medical Center in Valhalla. He is board certified in internal medicine and geriatrics. Dr. Asija is accepting new patients at Nanticoke Pulmonary and Critical Care located at 613 High St., Seaford. Appointments can be made by calling 629-5766.

DBCC offers peer mentor training The Delaware Breast Cancer Coalition (DBCC) announces a Peer Mentor Support Training for breast cancer survivors in the Allen Room at the Seaford Library and Cultural Center on Tuesday, Sept. 23. DBCC peer mentors are trained survivors who provide free one-on-one support and education to those newly diagnosed with breast cancer. The session will take place on Tuesday, Sept. 23 from 3:30 to 7 p.m. and a light dinner will be provided. Training is free and experience is not necessary. Registration is required and space is limited. Topics include listening skills, the mentorship role, confidentiality, problem solving, handling difficult situations, and reporting requirements. Trainees learn through lecture, interactive activities and role plays. To register, contact Connie Holdridge at 302-644-6844 or choldridge@debreastcancer.org.

Sleep apnea support group offered Nanticoke Memorial Hospital in Seaford is hosting the A.W.A.K.E. - Alert, Well, and Keeping Energetic, sleep apnea support group. A.W.A.K.E. is a free support group for people with sleep problems including sleep apnea, insomnia, excessive daytime sleepiness, restless legs and narcolepsy. The support group also focuses on the impact medications may be having on your sleep. Family and friends are welcome to attend. Meetings will be held from 2:30 to 4 p.m. on: Wednesday, Oct. 22 at the ground floor Nurse's Conference Room; Wednesday, Nov. 19 at the ground floor Nurse's Conference Room. There is no meeting in December. For more information about the group, call the Sleep Disorders Center at 629-6611, ext. 3815.