It happened again last week. Among the hustle and bustle of a crazy shift. A pre-hospital radio call from an ambulance team that nobody ever wants to receive.
"We're bringing you a child in cardiac arrest."
Noooooooo. Word traveled quickly through our staff, and the mood immediately got very somber as everyone prepared the resuscitation room for this child. We could only pray that the child being brought to us would respond to our life-saving measures.
Nurses ran to get the intubation and IV trays, pharmacists ran to get the resuscitation cart with all the emergent medications, techs ran to get the EKG and ultrasound machines, and respiratory therapists ran to get a ventilator. Two of us physicians were working with a slew of residents, and we all reviewed our mental checklists and tried to enter our objective frames of mind. Organized frenzy.
My partner requested to be the lead physician during the resuscitation. Being young and recently-trained, he wants to save the world. We all want to save the world, I guess, but for now we'd focus our energy on saving this child. I assured him that I would stay in the room and help with the resuscitation efforts.
The ambulance arrived. With a sad nod of his head, a trusted paramedic gave answer to our searching faces. No response. Yet. We all caught our breath as our hearts plummeted.
We transferred this child to our hospital cot. We emergently intubated this child, checked for any pulses, and continued CPR when we found none. IVs were hard to establish, so I started an intraosseous line by sticking a needle into this child's left tibia. Aggressive fluids were given. Medications were administered. Ventilations were forced into uncooperative lungs.
Efforts continued. My partner followed the life-saving protocols but didn't get any response from this child. Prayers were whispered. Seconds were watched as they ticked on the clock. Slowly, as slow as any time had ever passed, a heartbreaking realization permeated the room. We might not succeed.
My partner ran to the family room to discuss options with this child's parents, while I continued to follow all the resuscitation protocols. We had nearly maximized all of our medications. And still...nothing. CPR was continued, ventilations were continued, more medications and hydration were given.
My partner returned to the treatment room. He looked at me expectantly, and I shook my head "no." My partner shared his conversation with me. Dad was still at work, and Mom was in the family room with our social workers, waiting for family to arrive. She had been invited back to watch the resuscitation efforts, but declined. Her child had been through this once before, because of chronic, ongoing medical problems, and had survived. Surely, she thought, her child could survive again.
After almost an hour of failed heroics, with absolutely no response to any of our interventions, we confirmed what we were most afraid of. There were no palpable pulses. There was no cardiac activity, confirmed on monitor and with our bedside ultrasound. There were no spontaneous respirations. There were no signs of life from this child.
There would be no miracle.
My partner asked if anyone in the room objected to his prounouncing this child's death. Nobody objected, since we had all been involved in trying to save this child's life. We knew the efforts that had been put forth were monumental. No attempt had been spared by our team to bring this child back. Unfortunately, and for unexplained reasons, the fates held different plans. My partner announced the time of death.
I requested a nurse to clip some of this patient's hair for the family. I crossed myself after my silent prayer. I fought my tears. Hell, we all fought our tears. I consoled my partner, who, like me, has three young kids of his own. Slowly, a wave of profound sadness and nothingness swept across us. What good are any of us if we can't save a child's life? My partner went out to the family room to deliver the awful news.
Then, time stood still. From two hallways away, I heard the haunting sound. A sound that I knew was coming. A sound that is played over and over in my mind for days after an event like this. A sound of profound anguish. A sound of utter disbelief. A sound of infinite pain.
A mother's cry.
Slowly, as we all knew would happen, the mournful wails of crying crescendoed, and our emergency department came to a stand-still as Mom was escorted through our halls into her little child's room.
Despite our best attempts at maintaining our objectivity, and despite the fact that there were many more patients waiting to be treated, our ER staff cried collectively and gave consoling hugs to one another. We are mothers. We are fathers. We are brothers and sisters. We are sons and daughters. We are friends. We are human. And, we were broken.
Dad arrived just minutes after Mom was escorted to the room, and the cries of desperation were repeated. This time, husky and deep. Slowly, though, his cries softened and dissipated, until there was but one lone cry that began again. Higher-pitched. Guttural. Primitive. Emanating from the womb. A cry that conveyed the raw anguish and helplessness that only such a profound loss as losing your child could bring.
God Bless this mother. God Bless this father. God Bless this child. And may God Bless and watch over this family. And all of us.
If only life were filled with just happy moments...As always, thanks for reading. Next post will be either Friday, February 19, or Monday, February 22. See you then...