Amiee Stanton provided exemplary care for a child and his family who were forced to make end-of-life decisions in the emergency department. 

The child, who we will call Jay, was a teenager with terminal cancer. He had come with his parents to the pediatric emergency department late at night because he had been having some trouble breathing. His workup eventually showed that he had clots in his lungs, which is what was causing his breathing problems. The hematology service was also involved in determining how best to manage these clots. He also had bruising on his body and low platelets, which is concerning for easy bleeding. 

Throughout this time, Amiee was continuing to help keep the family updated on the behind-the-scenes discussions and coordination of Jay’s care. She was especially helpful in support the family with the understanding that they were going through a very difficult time. 

A decision was made that since treating the lung clots would be complicated and risky, it was safest to initiate this in the ICU. Amiee brought him and his family up to obtain an additional scan before going to the ICU. In the scan, Amiee was watching him very closely and noted that his heart rate dropped very low for a brief period. She quickly communicated this to the physician team in the emergency department and continued to monitor him closely before bringing him next-door to the ICU. 

Sadly, Jay’s scan was concerning for small bleeding so Amiee was asked to bring him back down to the emergency department to better understand the care that was possible for the clots in his lungs. Amiee was forced to explain to the family why they were coming back down to the Emergency Department. However awkward it was for her, she was able to communicate a calm and unified voice to the family from the hospital health care team, that we were trying to work through options to be able to deliver the best care to Jay. 

Once in the ED, the oncology service came down to discuss with the family the options of being admitted to the ICU, coming into the oncology floor to get limited treatment, and the possibility of going home with no new treatment for the clots. Amiee stayed present by the family's side as these options were discussed. She continued to offer them support as the family wept, strained by the decision that they were being asked to make. 

The oncology service and Amiee left the room to give the family time to think and talk before making a decision. The father came out and found Amiee to let her know that they were ready to talk to Oncology again. At that at that time they confided in Amiee that they had chosen to go home. Although Amiee was feeling sadness for the family, she had space of mind to notify the ED physician, so that the coordination could begin to allow the family to go home from the pediatric ED as seamlessly as possible. 

As the ED team waited for the oncology service to complete tasks on their end, Amiee’s shift had ended. Yet she stayed by the family's side for a few more hours so that she could be assured that the family would not experience any bumps on their way home. 

Through this sad story, Amiee remained a rock, never losing sight of what was best for the family, always being a bridge between a complex medical system, and a family losing their child. She maintained emotional strength, anticipated the family’s needs, and facilitated the coordination of the whole healthcare team to make that happen seamlessly for Jay and his family.