Thursday 14 May 2009

Futile

I look across at MikePara, and in his eyes are reflected the same thoughts as in mine. The scars on his tiny body tell us that this boy has spent his short life suffering, and that the cardiac arrest we are called to is just the final chapter in his story. As I pass a tiny tube into his trachea, as I thread a miniscule needle into a vein, I think how futile this is. And then I look across at the mother, sitting in the ambulance with us, watching our every move, silent tears running down her face, I realise who we are treating.

So we continue our last, futile battle to save this poor boy's life, a life that has only just begun, yet has seen him go through far more than any of us. We we give him drugs, we give him fluids, we massage his heart and ventilate his lungs, for his mother.

This battle is lost, the war is over.

9 comments:

  1. You gave that child a fighting chance against everything they were put through. I have nothing but respect and admiration for people like you.

    Thank you for doing a job that so many could not do, especially for free!

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  2. Remember, that battle was sadly lost, but the war Isnt over, you must keep fighting!

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  3. Wow, that was very powerful.

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  4. futile? never... your patient may not recover, but the family need to know that everything possible was done... "promoting recovery", one of the ambulance service's aims, doesn't always mean just prescribing the right medication,and isn't always aimed just at the patient...

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  5. Thank you for your comments. Ben, the whole point of the post was to say that, despite the futility of the resuscitation, there are others, surviving, who need to know that everything possible was done. MikePara and I were going through the motions, for the mother, not the child. But, the resuscitation attempt was futile, from the moment we arrived.

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  6. doc - first, what an incredible post. all that emotion conveyed in so few words. second, apologies... i guess i worded what i wrote earlier very badly... i only meant to refer to the word "futile" itself. i just feel that what we all do, even if the result is a negative and forgone conclusion, is never futile. thankless sometimes, heartrending sometimes, but never futile!

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  7. A very good post and a job that we really never want to end up doing, but do unfortunately get. RRD, I was interested in your thoughts re. doing paed rescus on patients that clearly do not have conditions compatable with life? Its just that we have basically been told in our trust that we are attempting ALS on too many paed patients that (if they were an adult) we would be recognising death and not performing ALS on. I can see both sides of the argument i.e. getting mothers hope up and bleeping a paed team in A/E unnecessarily. But I also believe that seeing everything possible being done is hugely beneficial to the parents! So just wondered what your thoughts were on ambo crews bringing in paeds that have been asystolic for prolonged periods and don't fit our normal indications to commence ALS? Its a difficult situation and I have personally found it very difficult to not at least give it a go! Thanks :-)

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  8. I have very strict rules for ambo and BASICS crews in my area - NEVEr call a paed resus in the field. Always take it in to an A&E Department, so that due process can take place in an appropriate environment. What do yo do with the child otherwise? Yu can't just leave them. I do suggest that they make sure that we in the hospital are aware of the situation, so that the final calling is just a formality.

    If your Trust are being a bit difficult, have a look at the Children Act. I am sure there is something in there about ensuring that all paed deaths are taken to a hospital, rathe than left on scene, so that all the necessary tests can be performed, to rule out any child protection issues.

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  9. Thanks for the comment RRD. And I completely agree with you. No I think the concern with my trust was not regarding taking them to hospital (that always happens for the reasons you mention). What we have been questioned on is actually starting rescus in the first place, i.e if it had been an adult we may not have done? Basically saying that conditions incompatible with life is the same whatever the age (fair enough!). What generally happens in my experience is that unless it is very obviously deceased, the crews tend to continue rescus regardless (quite rightly in my opinion). I think our coroner has highlighted a few incidents where they do not think it should have been commenced in the first place. Like I said its very difficult and to be honest I'd like to meet someone who has the guts to withhold rescus on a baby put into your arms as you walk through the door. I find it very difficult indeed! Anyway not sure if I've explained myself very well.

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