Sunday, November 21, 2010

NaBloPoMo Day 21

A baby died today;  a very small infant.  One minute I'm excited by the end of my overnight shift quickly approaching, and the next I am hearing the words you never want to hear come over the radio, "En route to home for infant not breathing."  I think the whole ED staff stopped for a minute waiting for the next report.

Then we begin to organize.  Prepare a room, grab the pediatric resuscitation cart, where's the Broselow tape, get respiratory alerted.  The on-coming attending arrives, and I tell him what is going on.

The next report comes over the radio, "Attempted intubation, bagging via BVM, chest compressions ongoing, no IV access.  Five minutes out."  Ok.  Grab the ultrasound, do we have the right sized needle for the EZ IO, call an overhead infant code.

The infant arrives.  One, two, three, gently over to the gurney.  Let's take a look.  Intubation attempted.  Ultrasound shows no cardiac activity.  Temperature is 31 rectally.  The parents are hovering expectantly, holding onto each other tightly, watching our every move.  The other attending and I look at each other.  We know there is no hope.  We try to make our attempted resuscitation last as long as possible for the sake of the parents.  But soon the staff understands our motions.   We take one last look with the ultrasound.  Silent snow.

We turn to the parents.  They have a sense of what they're going to be told before a word is even said.  They look around at us and our staff and see our eyes looking down, looking sad, tearing up and looking at them wordlessly.  Cries of anguish fill the ED.  The infant is gently wrapped and the parents are brought to the bedside.  We file silently out to give them their last moments with their child.

I go to dictate my last patient's chart, stopping to hug the nurse who stepped into my work area to "get it together" before heading back out to the other waiting patient in the E.D.  She apologizes, and I tell her it's ok to show her emotion.  She starts to shake as tears run down both of our cheeks.  She quickly recovers and steps out.  I take a deep breath, dial the familiar number, and begin my dictation.


Nikki Bleu said...

Veronica - I am so sorry you have to go through days like this. But I also know that if there's anyone who I would trust with my life, it would be you. Thank you for being a wonderful friend and doctor.


betty said...

((((Veronica)))) I am so sorry for the parents and for all involved. I was just talking with my husband about this last week, that doctors have seen death/suffering/etc. How do they not harden their hearts and remain sensitized to remain compassionate, etc. I am sure it is a delicate balancing act for you all. I echo what Nikki Bleu said in her comment.

(and I know the person who got that final dictation of your day cried as they transcribed it)

hugs to you


Lori said...

Very sad. But how comforting to know, from the view you give us of the other side, that when we call with an emergency, even as the paramedics are on their way to us, emergency department staff are gearing up and suiting up to help us when we get there. My heart goes out to those parents, and to the staff that worked so hard to try to resuscitate the little one.

Julie said...

I think we all stop and listen when they call a pediatric code, and offer up a silent prayer it goes well, and all feel a deep sadness when it doesn't. I am happy I don't have to go to them anymore. Just the adults, which is sad enough as it is. Thanks for all you do.

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