This was a hard day! One of children with medial problems. My last day in the Bahamas hurricane disaster relief.
I hear them calling for help in the ER as I’m in the step-down tent. They have a 8 year old school girl who has had a seizure and is in status epelecticus- a continuous seizure. She has been seizing for 30 minutes before getting to the hospital. The ER has given her a dose of medicine to stop it, and it continues. She is being bagged, and lays there in her cute school uniform. It consists of black round tipped shoes, black socks, a dark blue skirt, and a white button up shirt. Her hair is in woven brads. She is intubated by the anesthetist and bagged. She is put on a drip of sedation and meds to stop the seizure. Later she is flown to Nassau for a pediatric ICU.
The second one effects us all. Death is never easy! It’s a little easier for me, when expected- a very traumatized person that has life threatening injuries that can’t be repaired; the huge heart attack that kills suddenly; the person with very advanced cancer that withers away; or the person who has a massive pulmonary embolus. Those that I find harder, are the seemingly insignificant injuries that kill, or the asthma attack, or the mild symptoms that turn horrible and quickly the person decompensates. It is always hard for the loved ones of the person who dies. This death was hard for me today.
I’m in the ER evaluating an adult patient on the edge of the tent when I hear a nurse behind me scream out the name of the ER doctor. I had seen an x-ray on the monitor of a small person with a whited out left lung field. It is this child. I turn around and she is grabbing a 5 year old boy who is seizing. She flips him over on his stomach and some stomach contents come out his mouth. I race over and we grab a mask and bag to help him breath. The ER doc is helping him breath and we check for a pulse. There is none- so we start CPR. We suction and bag the boy. The ER doc tries to intubate and is unsuccessful. The family is standing by watching our CPR efforts. The anesthetist arrives and I help her get the suction ready again. The endotrachial tube ready, then she intubates. She holds the tube after taping it in place. The CPR is bouncing the boy all over the place and the tube seems like it’s dislodging. So she holds it and I bag. The lungs feel stiff and hard to expand. There are distended neck veins, so Dr. J places a needle on the left side, followed by a chest tube. No real air or fluid comes out. We are continuing to give the different drugs that may have an effect in a situation like this, but nothing seems to be changing. We are now about 30 minutes into the code. There were still distended neck veins so we place a chest tube on the left. Again no difference. We keep re-assessing the lung sounds on both sides. I keep bagging and chest compressions are continuing, with people switching off doing chest compressions, changing about every 2 minutes. Family is crying. Staff are crying. Staff are praying. CPR continues. Again, for the hundredth time, we check for heart beat, checking again with ultrasound for heart motion. Nothing. Eyes are fixed and dilated. We continue chest compressions and bagging difficult lungs. No one wants to give up. The ER doc running the code continues to order meds. At an hour in he surveys the physicians and nurses present- whether to continue or not. There seems to be a slow heart beat now, so we continue with chest compressions and breathing with the bag. He starts a pressor drip, and we decide if this doesn’t make a difference, then we will stop. We try for another 15 min or so after the pressor. No changes. So after 1.5 hours of bagging and chest compressions… we call an end. The mother has gone outside some time ago. The father sits there with his head in his hands. The end is called, and he goes out to join his family and friends outside. We were all exhausted, physically and mentally! The family wails outside and many staff are crying in different areas of the room, some are hugging each other.
I’m asked to see a patient in triage that they think has appendicitis. There is a 79 year old man that has the classical physical findings of appendicitis. He has pain in his right lower quadrant, exquisitely tender there. But instead of having an elevated WBC (white blood cell count), his is normal. I cant get a IV contrast abdominal CT at night so I decide Im convinced enough to take him directly to the OR. As I come out of triage back to the ER where the family and staff are gathered around the dead boy- I hear the family singing- It is well with my soul! Wow that hits me! That is an incredible hymn with and incredible story all of it’s own. It has huge meaning to me in that moment- especially with the family singing it.
That night I hear that someone found out that the child had a congenital condition that gave him only one ventricle in his heart. Something no one could change. I look forward to the day when Jesus comes again, and birth defects are corrected, and children don’t die any more!