Posted by: medicblog999 | March 26, 2009

The death of a child

angel-0003TS at other peoples emergencies shares a post called Children Change Everything, where he describes his feelings regarding traumatic paediatric jobs and how his outlook on these incidents has changed following the birth of his own children. Im sure this is something that all health care providers with their own families can identify with, I know that I certainly can!

It got me to thinking about this. I freely admit that the child deaths that I have had to deal with so far have been the most upsetting jobs I have been involved with. They remain with me for some considerable time and they keep popping back into my conscience at the strangest of moments, but I guess this is only to be expected. 

I had a job the other day where I was called to a 46yr old female called Laura (not her real name). She was having her tea when she suddenly complained of severe chest pain and collapsed to the floor in an apparent fit. By the time I arrived on scene, some 6 minutes later, she was agonally breathing and had no palpable pulse. I commenced CPR and awaited backup from a crew so that we could carry on with our  full ALS guidelines. Whilst waiting I defibrillated her once from VF to asystole. Within 5 minutes a paramedic crew arrived and we began with our ALS. Further shocks were given when she returned to VF, cardiac drugs were given IV and we prepared to move her to the ambulance.

Laura was in asytole as the ambulance pulled away. I was left on scene to clear up all of the mess associated with a frantic resuscitation attempt whilst trying to comfort her husband who was waiting for Lauras parents to arrive (he rang them as we were doing CPR and told them what was happening and as they only lived 10 minutes away they decided to come to the house first other than the hospital)

They walked into the house, almost like timid mice. They peeked around the front door and then hesitated before they walked in. They hadn’t seen the ambulance leave and were unsure if their daughter was still in the house or not. I walked over to them and told them that she was now on her way to hospital.

“Does that mean that she is going to be okay?”

“The paramedics who are with her are doing everything they can to help her, but you need to know that Laura isnt breathing at the moment and her heart has stopped. We have been breathing for her and massaging her heart to try and get it started again, but you have to understand that it doesnt look good. It is unlikely that she is going to recover from this….Im really sorry”

She took one look at her husband, and let out a cry that will stay with me for a long long time. She fell into his arms and kept crying out

“No, no, no, no…I love her so much, please don’t let her die, shes my baby!”

You could tell that Lauras father was trying to maintain the decorum of true British grit which you only tend to see in the older generations these days, but he couldn’t hide the tears that were now flowing freely down his face. He didn’t say anything……he didn’t have to.

I offered to take them up to the hospital in the rapid response car. At first they declined but they were in no fit state to drive to the hospital, so I managed to persuade them to come with me.

Whilst driving to the Accident and Emergency department, I answered a constant stream of questions from Lauras mother.

“Will she be breathing again now?”

“Shes going to be alright, isnt she?”

“Why did this happen?”

“What happened?”

We arrived at hospital and I took them through to the relatives room. We had to walk past the resus room, and as I passed I had a quick look over and saw that there was no sign of a frantic resus behind the screens. The inevitable had happened and the team had terminated all efforts.

I went and informed the doctors that the family were in the relatives room waiting to speak them. I sat down to complete my paper work whilst the doctor and one of the nurses went down to the relatives room. It was only a matter of seconds before her mums blood curdling cry echoed down the corridor again. Everybody just stopped in their tracks and shared a moment, the briefest of moments, where we all took in the enormity of what has happened for one family.

Laura was an adult, this shouldn’t make me feel like this, yes she was young to die, but she was still an adult. Its not the same as a child death, is it?

The presence of Lauras mum and dad turned this into a child death for me. It doesn’t matter that she was 46, she was still her mums baby. Her mother and father  are  going through all of the horror  and grief of losing their child, just like a young parent would feel after  loosing a 4 yr old.

Not a nice job. Not a nice moment. Not a nice experience.

Advertisements

Responses

  1. A very difficult job indeed. What seems to be a pattern in jobs like this, for me at least, is the issue of being left behind after the patient and the team who have taken over the care of the patient have gone, either from scene or from the A&E Department. Suddenly, you have nothing more to do, apart from the banality of tidying up. You have no further input into the care of the patient. While you are concentrating on CPR or other forms of resuscitation, your mind is occupied, and the family can see you working with all effort to keep their loved one alive.

    Then they go, and you stop. You think. They see you there, and expect, or at least pray for, good news. You are the only one there, and your job, as they perceive it, is to reassure them that all is going to be ok. But you can’t…

    • RapidResponseDoc,

      It is something I question myself about every time that I have to break news.

      In most cases we do not move patients from the house, either due to 20minutes of asystole, no CPR carried out prior to our arrival (If patient is asystolic we do 5mins BLS, then stop), or obviously deceased (presence of post mortem lividity, rigor mortis, decomposition etc). Its fairly straightforward to inform relatives that their loved one has died when you have decided to stop or not even commence CPR. Its also fairly easy to let them know what is going on during an active ressus – we are doing everything we can etc.

      What is difficult is like in the situation above, where you are left on scene with a family, when the patient has left and is undergoing active ressus attempts. You know that the likelihood of recovery is so small and sometimes you know that you are just going through the guidelines with absolutely no chance of survival, but what do you tell the relatives?.
      Some staff give them a false hope and tell them that they are doing everything they can and that the doctors will try their best at the hospital. Some like me, tell the truth (in as gentle way as possible). Its not easy giving such life changing information, but it comes with the job. I don’t think there is a right or a wrong answer for what is best. Sometimes you have to judge the family and how they are likely to respond and do what’s best for them at that time.
      I’ve had to do this every night for the last 3 nights. It would be nice to get back to the drunks and the stubbed toes tonight!!

  2. We are all someones children no matter what our age. To be in the presence of someones mom and dad brings that home to us, infiltrating past our barrier. You have a moment were you see them through the eyes of a parent and that makes it very difficult. I am not sure of the best way to handle it, I suppose each medic is different. I always have the talk with my families after I have turned their loved ones over to the ED. The best I have to offer them is what we found and what we did. And an I am sorry is there anyone I can call for you or can I get you anything.

  3. that is sad,,


Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s

Categories

%d bloggers like this: