Nick Edwards - In Stitches

Two hours later the crying started. Back to sleep, and then up again at 2 a.m., then 4 a.m. and then 5.30 a.m. I wish I could invent a cure for colic and teething – something more ethical than ear plugs. But alas no … So, off to work at 7.30 a.m. and I was exhausted. I believe that the bastard who invented the term ‘sleeps like a baby’ never met anyone under five.

I arrived as the red phone went off. Information from the ambulance crew – paediatric arrest. Patient, six months, mottled and blue on arrival. The senior nurse called the paediatric resuscitation team down, but we all knew the probable outcome: this was a cot death and we were going to be going through the motions just in case and also to help the long-term grieving process.

The child came in with mother screaming. The thing I noticed was that he had the cutest little blue socks on which were the same colour as his skin. Our initial expectations were correct. We had all agreed our jobs, with the paediatric registrar being in charge of us all. My job was to get an interosseous line in (this is where a needle is quickly inserted into baby’s leg bone as a very quick way to give fluid and drugs – you do this when they are so ill they have no visible blood vessels). I got on with my job, but felt sick. I wasn’t in charge and could just concentrate on my job. Somehow I felt very detached from the whole situation. All the voices seemed distant. The mum’s cry was audible, as was the counting of the cardiac compressions, but it all felt surreal. I can’t explain why I felt like this but I did. I pushed the needle a little harder and felt the pop of the needle going through the baby’s bone. It was a huge sense of relief that I had done the part I was supposed to do. I attached the needle to fluids and gave drugs that others had drawn up.

The drugs were not helping – nothing was. We were keeping his blood pumping with the compressions and the anaesthetist was breathing for him – but he was dead and had been for a long time. We all knew it but nobody wanted to give up. Nobody wanted to stay ‘Stop’ in front of mum.

It felt like fruitless cruelty, but I rationalised it by knowing that the child would feel nothing and the grief would perhaps be easier in the long run for mum and dad if they knew we had tried everything.

I wanted to say ‘Stop’ but my colleague in charge murmured a suggestion of doubling the usual adrenaline dose – no-one really thought it would work, but no one said so. It is much easier to stop resuscitating an elderly adult than a child. No one wants to be the first to say stop. After about 15 minutes, one of the senior nurses first brought up stopping. No-one really responded – but a general agreement was made to continue for another cycle (2 minutes)

But then, thankfully, the (right) decision was taken out of our hands. ‘Please stop … Stop, STOP. STOP. He’s dead … My baby is dead.’ We all looked at each other, nodded and stopped. The barbaric-looking lines and tubes were removed and the senior nurse wrapped him in a blanket. He picked him up and took him to mum. She held him and sobbed, and sobbed and sobbed … and then started speaking to him, ‘I am so sorry I let you down today. I’ll make it up to you. Tomorrow, we can go to the zoo and see all those animals you like.’

At this point I couldn’t stay in the resuscitation room any longer. The consultant paediatrician was coming in from home to talk with the mother about what had happened. I was so glad it wasn’t my job, because all I wanted to do was cry and have a cup of tea.

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