For the Handover Carnival, hosted by my friend and colleague, Ben Yatzbaz, at http://insomniacmedic.blogspot.com/. Well worth a visit...
He's 13, and waiting for a bus to school. It's cold. He's running late. How fab, then, when he sees his sister's boyfriend drive up to the bus stop. Who wouldn't accept an offer like that?
5 minutes later, he is deeply unconscious, lying in the unrecognisable wreckage of the car.
10 minutes later, I am in the ambulance, vainly struggling to get IV access, to pass a tube into his windpipe, essentially to save his life. IV line in, tube is passed with difficulty. He makes no response, despite the fact that I have given him no anaesthetic drugs. This is bad news. His pulse slows, down to 30. There is no pupillary response to light. He has a severe head wound, and his neck feels as if it broken.
The monitor shows a heart rate of 20; wide, very abberant waves. I can feel no pulse in his neck or groin. I open up the giving set, and push through another 500mls of saline. None of us are talking much in the ambulance; we all know where this is going.
Asystole: flat line. I consider making a cut in his chest, to decompress any tension pneumothorax, but I know it will be to no avail. One of the paras begins CPR, and I tap her on the shoulder, and silently shake my head.
I ring the local hospital - it's not mine, but I know the team well there, having worked there a number of years before. I let them know the situation: that we are bringing in a young lad, injured in a serious RTA, and who I have pronounced on scene. It is not usual practice to take someone to hospital after you have pronounced life extinct, but I can't leave him here, and I know the family have been informed. For their sake, he needs to go to the hospital.
I travel with him, a silent journey, no sirens, no blue lights.
At the hospital, we are met by a paediatric trauma team - my message clearly did not get through properly. I tell them what has happened, and they disperse, until I am left, alone with the paramedics and the A&E nurse and .. Oh no! I don't even know this child's name.
"The aunt has arrived, will you talk to her?" I look around. The receptionist stares back at me, tears glistening in her eyes. "I know him," she whispers, as she leaves the room, without a backward glance. I remember how difficult it is, working so close to where you live, when any one of the thousands of patients you see could be a friend or a relative.
The aunt had been on scene, had seen the car, knew her worst fears had been realised the moment I walked in to the relatives room. We sit there quietly for a few moments, she just telling me isolated snippets of his lfe; things he got up to, what he was like.
And then, it is time for me to leave, to drive to my own place of work. All day long I am not my usual self, thinking about how every single decision can have such far-reaching effects.
A month or so later, I am sitting in my office, dreading the arrival of his mother, a lady I haven't yet met, but who wants to talk to me. She enters, and I rise to greet her. She looks around my office, at the many photgraphs of my five children, and a wistful smile flickers on and off her face.
She wants to know what happened at the scene, and I tell her, sparing her no detail. It is my impression that what is imagined is always worse than reality. She asks me if he said anything to me, and I shake my head, and tell her that, based on what I had seen, he had been deeply unconscious from the moment of impact. She frowns. "But I was told he was talking initially," she tells me. I probe a little deeper. It turns out that her sister, the aunt whom I met on the day, had 'phoned her and told her that her son was talking, possibly so as not to unduly distress her initially, before the worst was known. The mother had never discussed that with anyone since, yet had lived with the thought that her son must have suffered terribly before he died. I assure her that that was definitely not the case. She clings to this information, making me promise. I do so, and tears roll down her face. What had been imagined was far, far worse than reality.
She leaves my office, and I sit there, staring at my photographs, my own tears starting to flow.
EDIT: Now, this is really spooky. I have just come back from a job, and, while in the back of the ambulance, the para told me that the last time we had worked together was about 3 years ago, when a kid died after getting a lift from his sister's boyfriend! Three years ago!! I still have goosebumps, thinking about the strange coincidence, that I should write about this case this morning, and meet up with the same crew this afternoon...
11 months ago