Case Continuation

You were post-call so you chose option A.

• The test is performed and it shows multiple apneic spells of both obstructive and central etiology. Your consultant recommends tracheostomy and chronic ventilation. You call the family to let them know the medical plan. The mother is caring for this child alone as well as two others in a rural area. Currently she has no other family support and does not speak English. She arranges to come in to discuss the results with a translator. She rapidly agrees to the recommended procedures, which are then performed. Unfortunately, there are no home nursing services in the county the child lives in and his mother fails to make progress in learning to manage the tracheostomy and home ventilator. The child becomes a long-term resident of a pediatric chronic care facility. The mother expresses anger at the care team there, repeatedly asking, “Why can’t I just take him home?”