Sunday, May 4, 2008

Blue

They wheel around the corner to the trauma bay, where the three of us are waiting. Bright yellow Stryker with a black mattress, blue and black Zoll at the foot, O2 tank with the green canvas cover.

Mabel is standing on the side of the gurney as they wheel in, doing compressions as the medic squeezes the ambu-bag. I meet her eyes across our patient.

"Ready?" she says.

I nod.

She lets go and steps back. I reach over and wrap my hands around the tiny body, continuing CPR with my thumbs as I lift him from the gurney to the infant warmer.

I know immediately that our efforts will be in vain. He is too cold, too stiff, too blue.

But we do it anyway. Because he's only 6 weeks old.

Lucy takes his temp. "Core temp of 89.6, doc," she says.

Doc shakes his head. They've got an IO established, but we need an airway. He's holding the miniaturized laryngoscope in one hand as he looks for the chords. In the other is an equally miniature ET tube.

He and his wife will be having a baby next weekend. I wonder what he's thinking. If he's thinking.

"Tube's in." RT connects the BVM and starts ventilating again. She puffs his little lungs for him as I pump his little heart for him.

I feel the cold of his skin under my hands and the warmth of the heat lamp on my arms. I try to will some of my heat into him.

"Another round of Epi," says Doc. Mabel reaches for one of the syringes she made up when we heard they were coming.

I squeeze my thumbs and fingers together over and over, circulating the drug as she flushes it through the line.

My forearms are cramping. I ignore it. An alarm sounds and a robotic voice intones, "Check patient." I can see the monitor over Lucy's shoulder. It looks like we have a rhythm.

"Hold CPR," says Doc.

The deflections turn to a straight line. It was just me. I was only fooling myself.

"Resume CPR."

I start to feel a burning behind my eyes. Reality is rearing its ugly head.

Doc squirts the ultrasound gel on the tiny chest. The transluscent blue shines on his pale, pale skin. I do compressions in between each look at his tiny heart. The gel squishes around my thumbs.

"Stop CPR."

We all wait for the words. We know they are coming.

"No cardiac activity on the monitor. No cardiac activity on ultrasound. There's nothing else we can do. Time of death: 0316."

We stand there for a minute looking at the tiny body in front of us. Then we start disconnecting leads and lines.

We swaddle him in blanket, leaving only his face showing. I think to myself that our blankets aren't soft enough to wrap a baby in. The tube sticks out of his mouth, reminding us that there will not be a happy ending to this story.

Sometimes you know that there was nothing you could have done.

It doesn't make it any better.

29 comments:

ernurse said...

Heart breaking.

Medic 61 said...

It's not often that a post makes me hold back tears. This was really hard to read.

I'm glad to be reminded that there are people like you in medicine who care as much as you do.

Thank you.

Babs said...

Hugs...

Sarah said...

Last weekend I had a 3 month old. blue. Practically same situation. It was heartbreaking. Especially since my husband and I are currently trying for a baby ourselves.

Devorrah said...

This post even made me cry. Thanks for being there to save the ones that can be saved.

Mom In Scrubs said...

Tears in my eyes. It's so hard, but it's an unfortunate reality.

You told it tenderly.

And a big one-finger salute to those who lurk here and think you have no heart...

Kirsten said...

I have not yet had to experience this. I'm sure eventually I will. I don't ever want to.

A few years back, we had a "frequent flyer" baby with serious brain deformities... family had just had her 1 year birthday party, had the Christmas photo shoot, whole 9 yards. 2 weeks later, baby was back in hospital with another round of aspiration pneumonia and seizures... and we lost her. Right before I came on shift. I cried for hours that night. I still have her Christmas picture that the familiy gave me.

LadyBugCrossing said...

I'm so sorry you had to endure that. It's a real bummer.

Hugs.
xo
LBC

CrankyProf said...

Jeeezus H. Fuckbuckets. My nightmare. I'm still gun-shy about the Biscuit, and she's nine months old.

This post will ensure that i get no sleep for the next few days.

I sent a big, fat donation to the volunteer crew that brought Butter Biscuit back up when we found her blue in September.

This one was rough, MG. Hugs to you.

ERP said...

I had a very similar case to this about a month ago. Very very sad.

Lonestar Gal said...

How completely heartbreaking for your team, and for that family.
Sending heart healing thoughts your way.

WhiteCoat said...

This sucks every time it happens.
Shows you how precious life really is.
Just heard WhiteCoat daughter get home from preschool. She gets extra hugs and kisses from dad because of this story.

tyro said...

Tough. Poignantly written, thanks. Hope it was therapeutic.

With three, I've already spent years worrying; in medical school my anxiety dreams would always take the form of something happening to the kids and I would wake in a sweat. You may have known it was futile, but you helped the family by trying, believe me.

911DOC said...

pediatric deaths are the worst thing about emergency medicine, and when you combine them with having to tell the parents it makes me want to quit and run away every time. bless you MG.

radioactive girl said...

I read this in the morning and was so sad I couldn't even comment. I'm back now and still can't think of anything. I really appreciate what you do. I do not think I could do it.

CountyRat said...

I am so sorry, MG. What a terrible loss. Thank you for being on the little one's side all the way. He had people with him who cared about him, right to the end. That doesn't help you feel better, but it does matter. What you did for him does matter.

Aidan's mom said...

Ugh. This gave me chills. My son was a 28 weeker preemie and we knew that this fact put him at an increased risk for SIDS. He came home on an apnea monitor for a few months and everytime that thing had a false alarm, I think I almost had a heart attack.

So sorry you had to endure this.

EE said...

*sobs*

MY OWN WOMAN... said...

It never gets easier....and yet some of our patients call us cold and careless bastards. If they only knew how much we ache.

Mellee said...

How sad I am so sorry. Brings back alot of memories, of my son :( Thankyou for showing such compassion as it must have been very hard for you to write about this.

muffinrn said...

Thank you for sharing such a sad and touching story. I hope getting it out helped. Thank you for caring and trying so hard. Two years ago, on May 12th, my 3 month old niece died in a similar fashion. I'm thankful there were nurses like you to care for her at the end.

Bernice said...

I'm so sorry. It is never easy.

CountyRat said...

"It never gets easier....and yet some of our patients call us cold and careless bastards. If they only knew how much we ache."

Those of us who have been there know. Those who haven't, can't. Best to just ignore them.

And yes, each one hurts as much as the first one. It never gets easier. But then, maybe it isn't supposed to get easier.

Jenny said...

How depressing. I will give my 3 month old son extra cuddles. I am so thankful for you and your colleagues. You have the strength that I do not.

"Mabel" said...

Wiping away tears, again. Luv ya MG

mojitogirl said...

Can life and work suck more than at that moment?

BIG HUG FOR YOU MISSY!!!

I hope you at least get some decompression time when stuff like this happens. It's not business as usual. Sometimes it takes TIME to shake the feelings off.

I choke up just thinking about it. And you know what? It's just a matter of time before it's MY turn.....

MOJO

fuzzys dad said...

God Bless you and all of the hard working people in our hospitals.
This story makes me glad my two little girls are healthy. This is so heart breaking.

Jet said...

perhaps we in the NICU are spared a lot of these by those in ER. it's always too much to see these little ones go. Thank you.

hiraethin said...

*cries*

Thank you for trying. There's no way for this to be anything other than tragic... but at least competent, caring people were there to do what could be done. Even wrap him in a blanket.