The heart of the PICU: A social worker’s role in supporting families
The pediatric intensive care unit (PICU) at M Health Fairview Masonic Children’s Hospital is the scene of many extraordinary moments. Social worker Lauren Paget is there for many of them.
She watches as children recover from infections. They go from tired and lethargic to energetic and playful. She also sits with families who have to make the difficult decision to pursue comfort care after learning their child will not recover.
“We see a lot of hard stuff,” Paget said of social workers. “When a family is grieving, we are grieving in our own ways and just holding space for what is important.”
Paget shares what it’s like to work in the PICU.
Each family has their own challenges.
Behind each patient room door is a family having their own experience and going through something that might be very different from what the family next door is experiencing.
Some kids need intensive care for a few days while they recover from a severe case of RSV or the flu. Others will be in the PICU for months because they have complex medical conditions or are on extracorporeal membrane oxygenation (ECMO) machines because the their heart and lungs need more support.
“It can be scary and isolating because your kid is the sickest they've ever been and you're in a room by yourself,” Paget said. “Sometimes families don't have social support or informal support outside of the hospital. But they have that here and in various forms. It’s not just me, but all the other interdisciplinary team members that I work with, too.”
She advocates for families.
For many families, it’s their first time navigating a high level of medical care with their child. Paget likes to reassure them that they aren’t expected to know what they need or what to ask for. She encourages them to advocate for their children – and for themselves, too.
“A lot of families say they don't like to ask for things,” Paget said. “I remind them that they can. The resources are here for families, like you, who are experiencing something that's really difficult.”
Paget encourages parents to be open about their needs, whether it’s getting help paying their bills or someone to sit with them through a difficult moment. She also reminds them that they have a say in their child’s care and can ask questions and be advocates for their kids.
“You are your kid's biggest advocate, and you know your kid the best,” she tells parents. “We're seeing a very small picture of your child.”
The work is hard but also rewarding.
“In the ICU, you’re constantly waiting for the next day or waiting for medications to work. Sometimes if feels like all you do is wait,” Paget said. “But then you start to see little moments. He sat up for the first time. The tube came out. She opened her eyes. I think that's really cool.”
Paget also described watching kids who were once so sick that all they could do is sleep start feeling better and showing their silly or curious sides.
“I really enjoy working with families,” she said. “Their resilience is so encouraging and it’s inspiring seeing a family come in when their kid is the sickest that they have been or ever will be and then watching them through that process and standing by them and seeing them change and grow and then the kid is feeling better, so their personality comes out.”
The staff needs support, too.
Paget works closely with doctors, nurses, child life specialists, and more on the PICU floor. They go through challenging experiences together every day. Once a month, the team gathers to talk about it.
“It’s a space to share how it has been emotionally for them,” Paget said. “Each person on our interdisciplinary team has a different perspective and experience with a family.”
Sharing their different points of view can be refreshing for the team, including for Paget.
“I really appreciate my team,” she said. “They are some of the most incredible people I've worked with. They care a lot and try so hard to do the best for a family. I just get really inspired by working with them.”
She also makes sure to take time for her own self-care by exercising and spending time with her family, so she can recharge and bring her best self to the hospital each day.
She doesn’t stop thinking about kids when they leave her floor.
Once kids are stable, they leave the ICU for another floor in the hospital or go home. But that doesn’t mean they leave Paget’s thoughts.
Sometimes she hears updates from her colleagues on other floors of the hospital. She also enjoys running into families she knows when they’re back for an outpatient appointment. Sometimes she can barely recognize the child who is no longer sick and has grown so much since they left the hospital.
“I feel really grateful that families allow us to be a part of their experience,” Paget said.
