“I don’t feel a pulse.” Instantly, I feel my own double. I know what I have to do, but only if I can focus on what matters the most right now: keep the blood flowing enough to keep the heart and brain alive. I glance at the monitor and take a deep breath, trying to block out the mother’s terrified screams while swallowing my own horror at the unsightly shade of purple my patient is turning. I look directly at the nurse practitioner standing opposite me and say, “Start compressions.” Then I turn to the bedside nurse and say, “Call a code, and get the crash cart and defibrillator.” I put my finger on the child’s femoral pulse and feel the steady thump-thump-thump of blood flow with each compression, three times the rate of the push-pause-push rhythm of the mechanical ventilator.
This is the job: facing the worst of situations with the calmest of demeanors. Forcing your brain to remember what you know when all your body wants to do is stay frozen. We are trained, through endless repetition, to overcome the urge to succumb to the panic of adrenaline, and instead channel its rush into productivity.
Seconds later, the room is filled with people rushing in to help. Someone helps me get a backboard under the child. Someone cracks open the emergency drug box and begins drawing up code doses. Someone disconnects the ventilator and takes over the child’s breathing. Someone sets up the defibrillator and places the pads on that little lifeless body. Someone leads the mother outside and stays with her to give her updates. Then another wave of people floods the room; this time, an incredible team of pediatric critical care providers I work with on a daily basis. With one glance at the patient, one of my PICU nurses turns to me in dismay and gasps, “Oh my God, that’s our baby!”
Yes. That’s our baby. They are all our babies. We may not share their DNA, but we know what music makes them happy, what position they find most comfortable and how they like to be held. Even the older ones are our babies; we know which superhero they emulate, what food they get excited about and what books make them forget their pain. Yet somehow, in overwhelming moments like these, we must efficiently control our emotions to be able to save these babies we’ve spent countless hours caring for.
As our PICU attending takes over leading the code, I cycle into the short line of chest compressors and place my hands on that tiny chest: unnaturally cold against my fingertips, yet still soft enough to spark dread that I might break its bones if I use too much force. With every compression, I am acutely aware of the bruise my thumbs leave on that small sternum and the trickle of blood that has begun to blossom at one nostril. I choke back tears and remind myself of the goal of all our efforts: whatever it takes to keep the heart and brain alive. Several rounds of compressions and emergency drugs later, our efforts have proved to be in vain; there is clearly no heart or brain function left, and we are now left with the task of delivering this news to the distraught family sobbing outside the room.
How are we to do this? How do we grieve with our patients’ families without breaking down, but also without appearing to not care at all? How do we create the most comforting environment for families to share a few final private moments of grief on the worst day of their lives? How do we suppress our own emotions enough to be able to get on with our day but still acknowledge the loss we feel? And then there’s the next challenge to face: did we miss something? Could we have prevented this disaster? I am fortunate enough to be part of such a fantastic team of critical care providers that the answer to that question has always been “No” so far. And though this fact does provide some consolation, it doesn’t take away the pain. Not just because we’ve all spent countless hours of tireless physical and mental labor trying to keep them alive, but because, like I said, they are all our babies too, and we have loved each and every one of them.