I will never forget when I watched chest compressions being done on a 4 year old boy that I had recently taken care of just the night before on a short assignment on the West Coast. Over that weekend I worked I watched him become progressively ill eventually getting transferred from the general pediatric floor to the Pediatric Intensive Care Unit (PICU). He had deteriorated from an unclear cause and was intubated within 48 hours of being admitted. That night I returned for my last night shift of the stretch and walked in to hear overhead, “Pediatric Code Blue. Pediatric Intensive Care Unit.”
His heart was in shock, his blood pressure was gone, CPR had been started.
As I am trained to do, I ran up the stairs with my charge nurse and walked into chaos. The crash cart was being moved to the side of the door, the xray machine had arrived, the respiratory therapists, phlebotomists, chaplain and multiple other nurses and staff were surrounding the room. Inside the glass doors I watched a dainty yet powerful Intensive Care Attending command CPR and call for the oscillator (the last mode of ventilation prior to moving to ECMO, or heart-lung bypass). She called for the ECMO machine to be ready, in the case that he was in fulminant heart failure and would need surgical intervention to insert giant tubes into his vessels to save his life. Surrounded by 20 others with many onlooking from outside the door, I put on a smock and stood there.
I was the only other doctor on the floor, and I was Helpless.
After a few minutes he had regained a pulse and the blood pressure monitors were picking up some trace of activity – they cancelled the Code Blue, but he was far from stable. Unable to contribute more, I walked away to see a new admission and shortly after, the siren sounded again throughout the cold hallways, “Pediatric Code Blue. Pediatric Intensive Care Unit.”
I turned to my new admission, “I’m sorry. I have to go, I’ll be back.” I turned around and ran.
ECMO was being pulled closer to the door, the circuit was being primed, the cardiologist and the surgeon were on standby… As the Intensivist swiftly glided around the room preparing to insert emergent IV lines and continued to harness control over a whirlwind of simultaneous interventions and personnel, I quietly slid in along the side of the wall to the back corner where the boy’s mother and grandmother were sitting, delirious, screaming, shrieking, pale… I knelt down next to her, she recognized me from the night before, and I put my hand on her shoulder. She looked up, at me, calming down for a moment and we froze in silence.
“Well, this is definitely not how I left you yesterday.” She stopped sobbing, a brief smile meekly working into the side of her face, “Yea.”
I focused on his mother’s eyes and slowly described each moment as it dragged on. The Oscillator. They are changing his ventilator to something that will help give him oxygen easier and keep his lungs inflated. The Central Lines. She’s placing a new IV to help get medicine directly to his heart. The ECMO circuit. They are talking to the cardiologist about heart-lung bypass.
You have the best team here. We are trained to do this. This. Is. All. We. Do.
Again he stabilized, the cardiologist had weighed in on an emergent real-time bedside heart ultrasound via face time, and ECMO would wait. Over the next 30 minutes or so I checked in with the rest of the family that was in the waiting room. His mother and grandmother eventually walked out to get some fresh air and during that time the Intensivist reported that his blood gases were improving, he was getting better, they put the ECMO machine away and his blood pressure was stable.
“You didn’t bullshit me. I asked you if this was bad and you said, ‘Yes it was bad.’ You were the only one that did.” – Grandpa. “No. I told you I would tell you the truth. I’m not going to sugar coat it. but right now, things are OK.” He smiled a deep breathe of relief.
There are some roles in medicine that I find incredibly heroic – some are realized immediately through surgery, intensive care actions and procedures; but, some are more slow championships that require patience and aren’t thought of as grandiosely in their latent appreciation. As a General Pediatrician, I often feel a delayed and only optimistic theoretical impact. That night scared me, and it wasn’t the first time I’ve been surrounded by the looming shroud of Death. So many feelings run through my heart every time I am in these moments of intensity and they often drive why I am a doctor and the purpose I feel in my life; but, that night, I felt helpless.
Afterwards when I spoke to a friend of mine he pointed out something I don’t take much time to reflect on, “… you explained what was going on to lessen fear and worry. You’re fluent in medicine, a language that most of us don’t speak.“
After a decade in medical training, I forget how deeply I have been immersed in medical vernacular. I am constantly conscientious while talking to families about translating every word. By training in an environment with very low education (Louisiana) and being always attentive to every word that leaves my lips, I listen carefully to my word choice and phrasing, constantly integrating new techniques, descriptions, or tones. I am a human before I am a doctor, but I forget sometimes that I do have the ability to be an interpreter for the unknown, when vulnerability needs it more than ever. I did nothing to save his life that night, but I did everything to be a vessel for communication for his family.
They thanked me as I left the floor that night to return to my patients downstairs… One week later he was extubated, alive.
Image Credit: https://indianexpress.com/article/india/state-of-the-power-crunch-7890717/