0919 - "Rapid response, resus room, 5 minutes, pediatric."
And with that the previously relaxed atmosphere of that Sunday morning was over.
Almost before the announcement is finished the team is halfway to the resusitation room; the glaringly lit, cold room with two stretchers where we fight with death, sometimes sucessfully, and others not. Things must be prepared for the arrival of an unknown child. Machines whir into calibration, monitors are switched on, equipment is placed within reach, medication trays are opened, and the team rushes to preassigned positions. Nurses, a respiratory therapist, several ER techs, and x-ray techs all scrambling to their posts to prepare. The ER doc makes his way down to the room as well.
0927
"They're here!"
The doors at the end of the hall swing open.
"Looks bad, they're moving fast!" A voice calls out to no one in particular.
We all know what that means. You get an early gauge on the prognosis of an injured person coming at you by the body language of the paramedics. The crew rushes toward us, two of them guiding the gourney, and two more hunched over their burden on either side, one manually compressing the chest up and down to curculate blood, the other administering live-giving oxygen. The only sound heard is the thud of their feet, almost running, and the scattered beep of the monitor as the artificial compressions being administered mimic the activity that the heart should be producing. They've almost reached us now, soon it will be our turn to grasp the baton and finish the race. We will either win, or lose.
They rush through the door. A small boy lies lifeless on the gourney, almost lost among the machines and tubes. We all strain to see; visualize what we're up against. Curly blonde hair lies wet against his pale blue face, eyes closed, mouth open with a breathing tube placed into his windpipe. Arms that should be alive with activity, lie limp at his sides.
The paramedics push the gourney up alongeide the ER stretcher. Four sets of hands grasp the sheet under the boy.
"One, two, three-lift"
He is now in our hands. Untangle the tubes and wires. Disconnect from the portable monitor and reconnect to our life-support monitors.
The thought in everyone's mind is "Do something!"
Paramedics and firefighters who brought the boy in stand helplessly to one side against the back wall. One struggles to be heard above the machines and movement to give a brief report.
3-years-old....found floating in a pool....unknown how long...unresponsive on the scene...no pulse....not breathing...
We begin the last leg of the race, our leg, still not sure of the final outcome, each trying to conceal their own private misgivings: that there may already be answer to the question that everyone is asking themselves.
"What are our vital signs?" The doc yells out. Numbers are what sanitize a medical professional, they allow the medical emergency to addressed objectively rather than subjectivly. Cardiac arrest can be treated more effectivly than this precious little boy's cardiac arrest. We must treat the symptoms, detach ourselves from the person lying beneath out hands, until we know the outcome and can begin to let out hearts feel.
We look at the arithmetic, heart rate, blood pressure, respirations. Spontanious respirations: none, movement: none, heartbeat: none, palpable pulses:none. Already the outcome looks grim. We have come so far in the medical profession, yet still there are times when we are forced to admit defeat. We will do all within our power for him-relying on breakthroughs in medical knowlegde, science, and protocols-then either it's in him, or it isn't.
On the left someone is compressing his small chest, up-and-down -already his rib cage is slightly sunken from the pressure-trying to stir his lifeless heart to beating.
At the head of the table life-giving oxygen is pumped into his lungs, supplying his brain and heart in the hopes that the damage that we all know has occured will be stopped, and if possible somewhat reversed.
New IV lines are started to deliver the "rounds" of drugs in the hopes of reaching his still heart. Medications are drawn into syringes, then handed to another who will deliver them through the IVs in an attempt to charge his empty circut and spur it back into action. In another moment support will be withheld to determine the effects of our efforts; to see if he still has it in him to somehow pull back out.
"Hold resuscitation-"
Everyone freezes-suspended for a moment in time-everyone with eyes fixed on the monitors. Nothing. Not even the smallest blip across the screen, no beep heard, lifeless.
"Continue efforts."
The cycle begins again. Compression, veintilation, then another round of medications.
"Hold resuscitation."
Again all eyes watch the screen. Still nothing.
We begin again, this time the dose of adrenaline is increased, trying to reach his still heart and jolt it into activity. Compressions. We stop again. Still nothing. We are still nowhere.
1009
For nearly an hour we have been fighting. Fighting hard to bring this precious life back; this little blond-haired boy, who has barely begun to live. No one wants to admit defeat. To admit that despite all our efforts we must relinquish him to death. And his family is on the way here.
Blood tests have long since comfirmed what we all suspected to be true from the start- his system was shut down far too long. After 5 rounds of drugs there is still no sign of a heart beat, or gasp of breath. As we pause yet again from our efforts the monitor again traces the all too familiar horizontal line.
Resignation sets in silently- individually, collectively- there will be no resuscitation here.
But the question nags us. When. When do we let go. How long should we keep running this race despite knowing the outcome? What if in five minutes, in ten minutes something miraculous takes place? What if we keep pushing a little bit longer, and his small heart begins to pump its warm, red blood again?
Everything we have been taught. All of our knowledge says we have fought long and hard, and done all we can. Yet we are his advocates. Where do we draw the line?
Finally after more minutes pass, still without result, a voice is heard. Coming from the head of the table, the doctor says, more quietly than his previous orders:
"Does anyone have any suggestions that we may not have tried before we terminate efforts?"
The silence is deafening. No voice is heard. We try to avoid making eye contact with our co-workers. Each person rebeling against the idea of this outcome, yet knowing that we have done all we could do, and lost. The next words stab deep:
"Time of death 1021"
And with that the formal pronouncement of death is made. Legally, it is the moment when a licensed physician deems it futile to attempt any further physiological resuscitation. Yet it is merely a speck on the continuum of time, a speck that most will never know of.
Eyes stare at the monitors, daring that hauntingly familiar green line to tell us why. For a moment we are silent. Now the parts that we objectivly isolated to deal with seperatly, are converged back into the whole. When we reach this point no one looks at each other. We all try to steal our minds away. Yet the face of a brother, friend, nephew, son surfaces in our minds, what if this was them?
Then each member disperses. Monitors are put away, trash is cleaned off the floor, and tubes are removed so that the family members can have time to grieve with their loved-one.
Each person privatizes their own experience. Some have to take a moment to themselves. Many will call their own loved-ones, just to hear their voice, just to check. Others deal with their emotions by unleashing them on a task; restocking, paperwork-any kind of organized, directed activity that might make sense.
Then we must inevitably face the world again.
Yet as your mind replays the events, you can't help but see things in a new light. As people complain about the long wait to see a doctor you want to tell them "At least you are alive to wait!" As you look into the eyes of your patient who is here because she attempted to take her own life, as you listen to her words "why didn't you just let me do it?" You want to shake her and tell her "We fought hard, and long to try and save that young innocent life, a life that his family would give everything to get back! And now you are making us fight to keep you from ending your life?!"
If only others could see from a perspective so much bigger than the version of events that they call "reality" they might be suprised to see just how small their picture of life really is.
~Its the 9:00 nightly news. The newscastor tells a 20 second story about a drowning that took place earilier today. A 3-year-old little boy fell into a pool when nobody was looking. Then its on to sports....~
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