"Hello, Cathy speaking, it's me speaking, from respiratory."
An attempt at a joke is brushed past casually as she informs me quite seriously that the suburban EMS crew has phoned ahead to let us know they're bringing us a dead baby. We're supposed to make him alive again; the crew themselves are a little busy with that right now. My heart drops into my shoes.
I am moving towards Emerg in long strides, as long a stride as I can manage without outright running. Nobody's here yet, they're five minutes out; I have no reason to panic, and running makes others panic. I must be calm, the lightning rod of calm in the sea of chaos.
I'm pacing the space of Trauma 2, all curtains thrown open, a stretcher, white, pristine, but not inviting. I'm pulling down my bagger, wondering how old this baby is, if the mask I have currently attached is going to be the right size. The Broselow tape is laid out on the bed, the expensive piece of paper, our lifeline, sandwiched between two pieces of lucite. I scan it quickly, opening the colour-coded intubation bag, pulling out things I anticipate the need for, organizing them as to size. Nurses stand almost at attention, an informal kind of attention, noses in the air, trying to see over the ambulance bay door for red lights flying in, straining ears for sirens that will come before the baby does.
Jeff is my doc, my emerg doc. He's a lanky cowboy of a man, with an easy smile, a calm demeanor, and a willingness to explain everything in a smooth and relaxed voice. I try and emulate his calmness, try to slow my heart down by thinking hard enough. My job is easy -- keep him breathing, or make him breathe, or both, and help where I can.
Medics pull in, doors open, a stretcher pops out. A man I recognize in shiny-stripe pants is at the side, one hand on the kid's chest. Another is trying to bag with a mask while a firefighter pulls their stretcher towards the doors. My heart sinks -- the paramedics didn't get him intubated. We'll need an airway first. I try and guess sizes from the trauma bay while I click laryngoscope blades into position, shining the light onto my hand to check for brightness.
Medics tell us breathlessly while we slide the kid onto the stretcher that the babysitter put him down for a nap, came in hours later to find him not breathing with no pulse. The baby is white -- his skin, and his colour on the Broselow tape. Jeff puts the laryngoscope blade in his mouth, sweeping tongue aside, while I get a good look at baby's limp body and notice mottled purple marks along his back and bottom. Jeff's having trouble -- his neck is stiff. My heart pumps cold blood all of a sudden -- this baby has been down a long time.
I take over compressions for the medic while Jeff tries to get a tube in. I overhear the medic say that the kid's airway was so swollen it was impossible to get a tube in -- Jeff is having the same problem, likely from all the poking around that happened earlier. Jeff gives up, and I grab the bagger, trading off compressions again. I have good air movement with just a mask -- I have enough of an airway to work with, for now, and given the way the kid looks, we won't be at this for more than 30 minutes. I feel a tightening in my chest, and quickly squash it -- I will have time to think about pain after the death certificate is signed.
We don't even know his name -- the medics grabbed him and ran. One is talking to the unit clerk, laptop in hand, and I'm sure she knows his name -- I don't need to know. He doesn't need a name to breathe.
He has no veins left, all of the blood pooling in his back and other areas gravity leads it to. His face is white, his skin translucent, and he is cold to the touch, with white-blue lips. We need to do everything we can, to try, to say we did everything we can. The ECG shows a flat line in three leads, a line that waves slowly up and down with the rhythmic pumping of my friends' hand on baby's chest. We are so far beyond gone, and I know, and it makes me relax. My colleagues are relaxed. We know there's nothing to lose, because it's already lost.
Rog, the other doc, is here, and we need to put fluid in this baby, fluid and drugs to try and kick his heart back into a rhythm. We have no line, no veins to get a line, and Rog grabs the blue-handled plastic contraption I know to be an intra-osseous needle. I avert my eyes and try and shut my ears to the crunch-snap of a needle penetrating bone.
Fluid is fired into a port in the IO needle and it immediately begins backing up in baby's lungs. Pink froth is coming out of his nose and mouth, smearing on my mask, smearing on my gloves. His eyes are closed, and it makes it seem less unnatural somehow. Drugs are pushed and nothing happens. More drugs, more nothing. Jeff's compressions are half-hearted now, as we near the end of our allotted 30 minutes.
Jeff and Rog say stop, and we all stop. Stop squeezing bags of saline, stop cracking boxes of epinephrine, I take the mask off of baby's face, the only pink now coming from his own blood, leaking out of his lungs. I stop, put the bagger down, and step back.
I have five minutes until my shift is over. Time for thinking is later. I grab my colour-coded airway bag, grab the equipment that's still clean, make a mental note of what we used, and stalk back to the department to re-stock. I am numb. The receptionist asks how it went. "Not good," I say, and disappear into the stock room to grab fresh gear.
Returning the bag to its altar on the back counter, I survey the scene. I deliberately don't look at the bed, but rather at the floor, where yellow plastic caps and blue plastic crash-cart locks are strewn about with gauze and crumpled up balls of tape. I exit without looking at anyone or anything, as if I'm invisible if I don't see anything. I know intellectually I have been profoundly changed. I cannot describe how.
Ten minutes later I have given report, changed out of my scrubs, and I'm in the grocery store squeezing avocados. I look around me, and wonder to myself if I've ever seen someone else in the grocery store, another shiftwork superhero, whose hands last touched a dead person before their vegetables. It has never occurred to me before, but somehow, I will not be able to shop at this store again without wondering that exact thing.
I still can't describe how I'm changed, and these changes inspire a kind of reverence in me. It feels like life should stop, now. I'm sure it feels like it's stopped for that mum, who thank God, I didn't have to look at. I'm not upset or crying now, but if I had seen her, I'm sure I would be.
I'm going to have to tell someone, before I wake up screaming from nightmares.