lunes, 15 de noviembre de 2010

The space of the hospital IV

I choose three key actors within the children's hospital landscape. When children experience lack of curative options or when the treatment is working children and families will develop relationships with these three groups of professionals. Palliativists, hematologists, and communicable diseases specialists are central to the experience of these children and families. But they are not the only one. This is an intricate space where different disciplines and sub-disciplines would interact with children and families at certain point during the diagnostic-prognostic-treatment process. After feeling bad for days, weeks, or months a child may be diagnosed at this children's hospital with a particular condition such as ALL (acute lymphoblastic leukemia) type L2 but this label may come after some days he or she was hospitalized and many different tests were run in order to confirm or discard other conditions. So diagnosis, prognosis, and treatment are entangled in many different ways. There are diagnostic tools and procedures (which some times can also work as therapeutic) for the 'main condition' like in this case leukemia but there are other moments during the treatment process in which they also need to diagnose a specific fungi or bacteria that is developing and growing inside the child's body. This means that children would interact with multiple teams, groups, units, and would be exposed to manifold diagnostic tools such as MRIs, X-Rays, Biopsies, Ultrasounds, Dopplers, etc (usually these techniques are meant to produce images, take a small sample from the body to test it, or visualize the speed and direction of a particular sample volume). Hence, diagnostic tools are continuously present in the experience of children, families, and health professionals. Especially, in tertiary care teaching hospital like this in which all kinds of specialists and biomedical technologies are available and "ready to be used".
But going back to children and families' experience at the children's hospital one could say that they relate more with specific units and groups of professionals than others. It is accurate to say that for the families there are a group of core professionals and satellite professionals. Particularly, children with leukemia have as their core professionals the hematology unit and the communicable diseases unit (where they go when hospitalized). Whereas children whose treatment seem not to be working (any condition not only leukemia) will have the palliative care team as one of their core professionals at certain moments during the treatment.
The relation between the hematology unit and the palliative care team is particular since they do not seem to interact so much. I guess this may occur for many reasons: 1) children with non-solid types of cancer have a different illness trajectory than children with solid tumours in which usually they may need palliative care early in the treatment, 2) according to the hematologists they themselves provide palliative care treatment to children when they need it, 3) it is not clear that a child might be experiencing end of life issues, some times their condition may change
very suddenly and dramatically in terms of hours .

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