The hospital

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Children who are diagnosed with leukemia are usually sent to the nearest academic medical center or children's hospital. The multidisciplinary teams needed for state-of-the-art treatment are found in these large centers, Most combine their efforts by participating in clinical studies with other institutions across the country.

After admission to the hospital, a steady parade of anonymous faces enters the life of a child with leukemia. To understand who is responsible for the child's treatment, an explanation of hospital pecking order is necessary.

The doctors

A medical student is a college graduate who is attending medical school. Medical students often wear white coats, but do not have MD after the name on their name tags. They are not doctors.

An intern (also called a first-year resident) is a graduate of medical school who is in her first year of postgraduate training.

A resident is a graduate of medical school in his second or third year of postgraduate training. Most of the residents at pediatric hospitals will be pediatricians upon completion of their residencies.

After residency, if the pediatric resident wishes to further specialize in oncology (the study of cancer), she applies for a fellowship in pediatric oncology. Fellows work only at academic centers with fellowship programs, not all of which are pediatric oncology centers. A fellow who treats children with cancer is a doctor who has completed four years of medical school, one year of internship, and two to three years of residency in pediatrics, and is taking additional specialty training in pediatric oncology. In the US, pediatric residency is three years. In Canada it is four years; however, there is no internship.

Above fellows in the hospital hierarchy are attending physicians (called simply "attendings"). These well-established doctors are hired by the medical center to provide and oversee medical care and to train interns, residents, and fellows. They are frequently also professors on the staff of the medical school.

Our medical team was wonderful. They always answered our questions and spent the time with us that we needed. We had a group of doctors who were all working together for the patients. I always felt that we were known by each doctor, and that they were on top of Paige's treatment.

When a child arrives at a teaching hospital, he is assigned an attending. These physicians provide continuous care throughout treatment. The physician in charge of your childs care should be "board-certified" or have equivalent medical credentials. This means that he has taken rigorous written and oral tests by a board of examiners in his specialty, and meets a high standard of competence. You can call the American Board of Medical Specialties at (800) ASK-ABMS or (800) 275-2267 to find out if your child's physician is board-certified.

While an inpatient, your child will see a large number of other doctors. Residents usually rotate to different services every four weeks, so they are an ever-changing group. If questions arise about your child's treatment or illness that the resident cannot answer, you should ask the fellow or attending assigned to your child.

If your family is insured by a health maintenance organization (HMO), you probably will be sent to the affiliated hospital, which will have one or more pediatric oncologists on staff. If this is not a regional center of excellence or affilliated with the Children's Oncology Group, advocate to go elsewhere to get state-of-the-art care.

The nurses

An essential part of the hospital hierarchy is the nursing staff. The following explanations will help you understand which type of nurse is caring for your child.

An LPN is a licensed practical nurse. LPNs complete a vocational training program and have a narrow scope of practice; for example, they usually do not start IVs or give IV medications.

An RN is a registered nurse who obtained an associate degree or a bachelor's degree in nursing, and then passed a licensing examination. These medical professionals give medicines, take vital signs (heart rate, breathing rate, blood pressure), monitor IV machines, change bandages, and care for patients in hospitals, clinics, and doctors' offices.

At our hospital, each of our nurses is different, but each is wonderful. They simply love the kids. They throw parties, set up dream trips, act as counselors, best friends, stern parents. They hug moms and dads. They cry. I have come to respect them so much because they have such a hard job to do, and they do it so well.

The head or charge nurse is the supervisor of all the nurses on the floor for one shift. If you have any problems with a nurse, your first step in resolving them should be to talk to the nurse involved. If this does not work, a discussion with the charge nurse is necessary.

The clinical nurse manager is the administrator for an entire unit, such as a surgical or medical floor or outpatient clinic. She is in charge of all of the nurses on the unit.

A nurse practitioner or clinical nurse specialist is a registered nurse who has completed an educational program that has taught him advanced skills. For example, in some hospitals and clinics, nurse practitioners perform procedures such as spinal taps. Nurse practitioners or clinical nurse specialists are often the liaison between the medical teams and patients and families. They help parents keep all the different multidisciplinary team "players" straight and help interpret medical jargon.

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