Monday, 12 July 2010

When Words Just Won't Come

I have tried, so many times, to write this post. Words can't express the emotions that this job evoked in me; I don't know how to write it and still keep patient anonymity. And yet, it needs to be written. It has been a number of months, but it is still as fresh today as if it was yesterday:

The call comes through: can I attend a 4 year old girl who has fallen into a pond at the local park, and is now in cardiac arrest. My heart sinks - every call this month has been to a child, and all very serious. This one sounds bad. I tell Control to let the crew know I am about 10 minutes away, and that they shouldn't wait for me, if they are ready to go before I arrive.

As I am driving to the scene, I am hoping that they leave before I get there. I don't want to be involved in this case. I know I can't refuse, but this is my nemesis, this is what I fear more than anything (it used to be the "one-under" - someone hit by a train, but desperately sick kids took over from that some time ago.)

I arrive to a scene of horror: a child, lifeless, blue, distended abdomen, vomit around her face; two paramedics working on her, another getting a monitor attached; the monitor showing a straight line, no electrical activity at all; the family, screaming and wailing. My heart, already in my boots, sinks even lower.

I rush over, my paediatric bag banging against my hip, my monitor slung over my shoulder. As I kneel by her head, I look into her eyes: the glassy stare of an arrested child. The deep blue skin and vomit over the face tell me all too clearly what I don't want to know: this child has been without oxygen for a long time, perhaps too long. I need to get a tube into her windpipe and breathe for her. It's all very well using mouth-to-mouth or a bag and mask, but most of the air goes into the stomach - the distended abdomen is the result.

Age over 4 plus 4. Age over 4 plus 4. My mind shouts the formula for calculating the size of an endotracheal tube in a child, yet I cannot work it out. I reach, blindly, for a size 5, and take a breath in before inserting the laryngoscope blade that has been handed to me by the paramedic. This isn't like an adult intubation. It's not just the size: in an adult we use a curved blade, the tip of which fits into the space between the tongue and the epiglottis, whereas in a child, because the epiglottis is usually much floppier, we use a straight blade that is designed to pick up the epiglottis as well as the tongue. In with the blade and lift. There are the cords, there goes the tube.

A few puffs with the bag attached, and the chest rises and falls. But that's not good enough; I need to be able to hear breath sounds on both sides, but, with the noise of the crowd, I cannot be certain. I need, instead, to get my monitor attached, and see if there is any carbon dioxide coming out of the tube. But, there are only us three, and we have lots to do. So, in between bagging the child, continuing chest compressions, finding intravenous access and giving adrenaline, we manage to get the monitor attached, and I see the reassuring rise and fall on the carbon dioxide tracing.

We move her on to the ambulance gurney, and wheel her into the ambulance, still giving chest compressions and ventilating her. I tell the crew that I don't want the family in the back with me; I need to keep my wits about me for the short journey; but, in reality, I cannot bear the thought of the questions, the hope, the need to know that she is going to survive this awful turn of fate.

Back home; I am quiet, sullen even. I talk, but I am not able to express just how I feel. The fear of not doing it right, of not doing all I should be doing. The anger at a death so unnecessary, so preventable. And the fear, that one day it will be someone I know. Later, after tears, Mrs RRD holds me, as I fall into a troubled sleep


  1. Words cannot describe this.
    Peace...if it is possible.
    I still see them in my minds eye.
    And they don't dim with time..

  2. A horrible situation to be in. Heartwrenching when you can't bring them back. But you showed the parents that people that have never met their child care enough to try their very best to help, even if it isn't ultimately successful, and I'm sure that somewhere along the line, it registers as a form of comfort to them.

  3. I can only imagine what you go through on these types of calls. Thank you for sharing your feelings as best you can.

    Speaking as a parent, thank you for doing your best, and for bringing your "A game" to every call... it's all we can ask of you.

    Here's a related article that my friend sent me: "Drowning Doesn't Look Like Drowning" by Mario Vittone ( It's a good read for everyone. I can only hope that you will have less calls like this in the future.

  4. Thoughts are with you doc... did my first young 'un only recently backing up a solo crew, her face a picture of relief when I arrived. Sadly, not to be a happy ending.

  5. RRD: It is most regrettable that such a case confronts you, but you were there doing whatever you were able to, as opposed to the family not having someone who could tend to their beloved daughter.

    Although she has now passed away, your conscience will always tell you that you did as much as you could, you were totally professional and that counts for a lot.

    You know we can chat if you wish to, especially if Mrs RRD is not available. She has broad shoulders (said in the nicest possible way Mrs RRD!), but I appreciate that she's not always available.

    We're your friends and without a doubt, we're here for you, even if you just want to be somewhere else for a short while?

    Stay cool....

  6. I'm sorry, BankMan, do I know you???

  7. Thanks for that, RRD. We see a lot in the field. When I bring the dead and dying in to the ER everything seems so controlled and cold by contrast-people included. I often wonder if being at the scene of a tragedy helps bring the enormity home, or if it is simply the event itself.

    Anyway, it is good knowing you are out there. I wish we had RRD doctors here, if for nothing more that shared grief. It seems we are separate entities here in the US- doctors unapproachable and the EMT's and paramedics on the outside.

  8. Hi,

    thanks for being there for the rest of us.

    All the best wishes


  9. Just terrible, my heart goes out to you.

  10. Doc, what a moving story.

    You did what you could; no-one can ask more than that, and you did more than 99.9% of the population could have done.

    Daft as it sounds, I'm just a little glad that it broke you up - and that you had the courage to say so. Too many laymen think that medical/ambulance people don't care other than professionally. OK, I'm an Amateur, but the same applies. I know it isn't true - we do what we do because we CARE.

  11. I have just come back from an awesome holiday in Canada! I've come back to rain, which isn't all that surprising. What I have also come back to are 8 comments to this post about the death of a child, all of which lead to a pornography site. Am I being naive, or should some things be safe from these perverts??