Tuesday 14 February 2012

A Tragedy Laid Bare........

"7 year old female, drowned, CPR in progress"

I've been meaning to write about this job for a long while. I touched on it briefly last month in 'Success or Failure?' but wanted to share the story in full and wanted to share the effect this job had on me personally and professionally. 

We were driving through the far reaches of the city on a miserable Wednesday evening during mid-winter. It was cold, it was wet and it was rush hour. As much as ambulance staff want the 'good job' to come, no one wants this job. A sense of fear and urgency engulfed the cab. Normally the paediatric cardiac arrest jobs are not as given but this was confirmed. Control had rung to warn us that CPR was in progress and the call taker was talking the caller through life support. As I heard this, a shiver ran down the length of my spine. My crew mate was driving like a bat out of hell, we were only a mile or so away so whilst I was being slung from side to side I just stared blankly out the window thinking 'shit'. That was all I could do. For the first time I was scared. Scared about what I was going into. Scared about what to do. Scared about the atmosphere. Scared for the little girl.

We pulled up on scene and flew out of the cab. We grabbed everything and ran to the open door. This remains the only job I've run into, but I felt it warranted it. As we entered the house we could hear the gut wrenching crying coming from upstairs. I bounded up the stairs and as my head breached the top step I saw at the end of the small corridor ahead of me a sight I will never forget. A sight that will haunt me. A crying mother doing CPR on her child. I rushed in and took over whilst my crew mate got to work.

"Please save her, please save her, please" she screamed.

She went on to tell us that whilst her daughter was having a bath the four year old twins were playing up in their bedroom. The mum left her for two minutes and when she came back she was submerged. Was it a seizure? Did she stand up and slip? I don't know. Her naked, lifeless body lay there, full of innocence,  asleep almost, in this tiny bathroom while we went through what was the slowest five minutes I've ever experienced. The pads were attached and with every compression that went by I was just begging that it was a shockable rhythm. It wasn't. Asystole. I began the second cycle while my crew mate intubated and got IV access. Paramedics often worry and stress about missing a cannula but I'm yet to see a patient not get one when they desperately need one and this was no different. Just before the we got to the end of the cycle the second crew arrived. They shoe horned themselves into the bathroom and took over CPR. Asystole again.

"Right guys, any objections to running?"

We had all thought it but my crew mate said it. We don't have the experience, the drugs and the confidence to stay on scene. We'd done what we could, the rest could be done on route. We put a collar  on her to protect the tube, scooped her up and ran to the truck. In the back was me and the paramedic from the second crew, my crew mate drove as he knew the area and the other member from the second crew drove the mum. Obviously distraught she was desperate to come with her daughter but we asked her to give us room to work. A neighbour was inside the house with the other kids trying to get hold of the father. We left, putting in the blue call on route. We were two minutes away from hospital so the blue call was brief.

"7 year old female, cardiac arrest post drowning, IV access and intubated, drugs as protocol, ETA 2 minutes"

The paramedic was giving drugs, I was doing CPR and ventilating her. The sirens of both ambulances were screaming and although technically the ambulance following wasn't supposed to be on blues and twos under the circumstances I don't think anyone would have dared to argue. I remember looking down at her face, so peaceful, and feeling completely helpless. I was desperate for something to improve, desperate to shock her, desperate to see a pulse or some respiratory effort but there wasn't. There was nothing. We pulled up to the A & E. The back do swung open and a resus team was outside waiting for us. We rushed her inside and the hospital took over. There was a hive of activity, about 15 people of all different skills levels and specialities doing everything they could. We just stood and watched for 5 minutes, still in shock about what had happened. I went out to see the mum. Due to the emotional charge and the work that was going on in resus it wasn't appropriate for her to be inside. It was a pressure the staff didn't need. I sat with her for a few minutes in the relatives room and she just cried. I didn't know what to say so I just put my arms around her. I remember just staring at a non-descript painting of a plant over her shoulder. I don't remember what I was thinking, I just remember staring. Her husband, the girl's father arrived. He knew the story. I left them together just hoping the hospital could do what we couldn't. They looked broken.

The five of us stood outside, all smoking, shell shocked. Just utter disbelief at what had happened and was happening. I was choked. I had the lump in the back of my throat and was holding back the tears. As were everyone else. Shivers were running up and down my spine and I had a horrible knotted sensation in my stomach. We all sat in the back of the ambulance and started on the paperwork. As bureaucratic and seemingly unimportant as it was it had to be done. It would form a permanent record of want happened and as it was almost certainly going to be going to the coroner it needed to be detailed and accurate. It took a while. A DSO arrived and offered us all support and down time. It was a sombre affair. No one had dared to go back inside and see how things were going. I suppose we were just hoping no news is good news. We all piled out for another fag. Four of us stood in a line with the DSO in front of us. It was at that moment we fell to pieces. The doors in front of us slid open. The mother came running out, screaming tears of despair followed by her husband. Their daughter had died. I've never seen pain like it. Their world was shattered, their daughter had lost her life. I felt the cold tears trickle down my face. I looked across and there wasn't a dry eye amongst us. Gutted. I walked away. I sat on my own for a few minutes questioning whether I could put myself through this again. No amount of training can prepare you for it. Nothing can prepare you for it. Sometimes in this job your best is not enough, and when not enough means a kid dies, I didn't know if that was something I could live with or deal with again.

In the days, weeks and months that past I thought about it a lot and often they are very intrusive thoughts. I'm not ashamed to admit that I took up the offer of counselling to help deal with it. I still think about it. It hasn't gone away. It probably won't go away and part of me doesn't want it to. It may still choke me but it stands as a stark reminder though about how cruel life can be and how precious it is. Life can be pulled away in a moment without notice and nothing can be done about it. The mother will blame herself but you can't watch three children at once. Obviously you don't leave infants unattended in a bath but a seven year old? I don't blame her. It was just one of those tragic events which can't be explained or justified. The coroner agreed. Clearly I didn't quit. I carried on and I'm glad I did. I decided I'd feel worse if I wasn't that last hope for someone, be it a futile one. I'm content with that. I still look for the 'good job' whatever it may be. Ce la vie.







12 comments:

  1. That brought tears to my eyes :-( such a sad job

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  2. I have been the 'tec standing at the door, watching Paramedics and nurses and family cry, I'm desperately blinking back the tears because police officers don't cry - I need to be completely composed when I speak to the family, I need to get the info out and give them the info they need. Then, hours later, at home on my own in the bath, I can cry. I dread child deaths, there's nothing more painful.

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  3. Excellent blog on the most difficult of jobs. I'm a police officer and have unfortunatly been to a few including a woman handing over the 4 year old daughter she had killed some 8 hrs earlier and a 5 year old that died Xmas eve with the same condition by boy has amongst others.

    Unless you have even through it you couldn't imagine how hard it is and your blog sums up the feelings well. I find it harder as I don't share the incidents with my wife as that would only upset her and do have to deal with it.

    Keep up the good work! As hard as it is we all know that the job needs to e done to sometimes give these families extra vital minutes at least of the person can't pull through.

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  4. Thankfully so far I have only dealt with one of these so far in my job (a police officer), though that is one too many.

    The overriding memory I have is the mum coming running through the double doors from the relatives room, collapsing on the floor and just screaming having been told her 2 week old had died.

    I was the only girl on so was asked to be there with the mum. It was so hard to keep the tears back but I knew I had to.

    I went home 5 hours late to my boyfriend, crawled into bed, cuddled into him and just cried!

    I know it will happen again and I just hope I can hold it together long enough to support the parents/family

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  5. An excellent post and one in which we all know that we may have to deal with but pray that we never will. From reading your post, the replies from others and my own experiences the most important points to draw on are 1) you can only do your best and sadly we know it isn't always good enough despite all our best efforts 2) No matter how it's done either through formal debrief or chat with the guys on station/down the pub, it's better to talk through your thoughts/feelings than to bottle them up.

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  6. I have unfortunately dealt with many many deaths. Most are tragic whether accidental, self inflicted or criminal. The best coping strategy is not to be dispassionate but to focus your empathy into professionalism, in the end your only responsible for what you do, so do it we and do it responsibly

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    1. "in the end your only responsible for what you do, so do it and do it responsibly"

      Agreed.

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  7. I've done this job for almost 15 years. I have to say that the way you put this into words is spot on. Excellently written!

    I have had way too many Peds arrest calls and I never really knew how much it has worn on me over the years. Reading this post has brought those calls back to the forefront and I am finally in a position in my life to "deal" with it, rather than shove it away to deal with later.

    Thank you!

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  8. Only just read this blog and memories came rushing back of the only paed arrest I've done ( thank god). I can remember every detail as yesterday. Times,names, where I was when job came in everything. The outcome of that wasn't good but the only solace I take is that my colleagues & myself were there and did our best for the child hope to god I never have to do it again

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  9. As a young police officer with a wife who was 8 months pregnant with our first child I had to attend and deal with a cot death. At that time as 'coroners officer' (investigating the death for the coroner) we also had to attend and watch the Post Mortems. Not the best introduction to fatherhood. As others have said before, emergency service workers have to be strong for the families. One of the most satisfying things for me as a Police Officer was to deal with sudden deaths and to help to bring order out of chaos and help a family start to cope with their grief.

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  10. All our emergency services are extraordinary, I don't think you guys ever get the recognition you deserve. I've had lifesaving surgery for crohns 2 years ago and was taken by ambulance a few times around that time. The amazing way you kpet me calm and my grown up daughter who was terrified she was losing me. That takes a very special person to do that many times a day, day in day out. Thank you and God bless you all xx

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  11. I have left my 7 year old in the bath before while I've gone to answer the phone or see to my 3 year old, since reading this I will never do it again, I don't know how you cope with your job, but I'm glad people like you do it x

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