You weren’t even alive long enough for me to see your face, little one.
But I remember every detail.
The overhead page for a pediatric rapid response team to the main lobby.
Running into the pediatric social worker as I stepped out of the stairwell, casually adopting her stride as we were pointed outside to the SUV idling in the hospital’s driveway.
Arriving to your mother’s screams as she tried to bear you down into this world.
Your father in a striped navy blue and white polo shirt, hands cradling his temples to prevent his brain from exploding.
Seeing your little foot dangling out onto the passenger seat, the same colour khaki as the upholstery.
The moment I dropped my heart into a bottomless pit to avoid being distracted by the possibility of your inevitable outcome.
The social worker pulling your older sister out of the back seat to make room for the flood of people in blue scrubs to attend to your mother.
The OB pulling off her white coat and throwing it onto the bushes, springing into action.
My voice demanding to know if NICU had been called.
“We need a bag with a neonatal mask! Gloves are here! Who has blankets? Where is transport?”
The flurry of activity behind me shouting answers from people unseen.
“NICU’s bringing the panda warmer!”
“I need a scalpel!”
“Just push the gurney into the bushes!”
Screams
Blood curdling screams.
The things living nightmares are made of.
But not loud enough to drown out,
“There are no heart tones. I need that scalpel NOW.”
Bushes tearing up my legs as I stumbled to get to the NICU team surrounding the panda warmer, yelling to be heard above the milieu.
“There should be a scalpel in the umbilical art line kit.”
Watching the plastic packaging float in the breeze as the nurses tore through the kit to find the one thing that could possibly save everything – a glorified scalpel in the form of a sterile utility knife.
Grabbing the “scalpel” and passing it off to a gloved hand, then waiting.
Seconds.
Minutes.
Long enough to know prepping the neonatal resuscitation equipment wouldn’t even matter.
Yet still we waited.
“Call the OR – we need to section her now!”
“We need to lift her out of the seat.”
“Who has the baby??”
“I have the baby.”
“On three… one, two, three!”
Five people in unison carrying your mother onto the gurney, trampling bushes to get to you.
One person holding your little legs and back, only leaving enough room for me to glimpse your vernix covered shoulders through their encircled hands.
The rest of you was still attached to your mother – her body would not let you go.
And just like that, the storm followed your mother’s screams as they ran her through the sliding doors into the hospital, leaving a handful of us standing in calm devastation.
Was the clicking of the SUV’s parking hazards that loud the entire time?
Who was responsible for picking up all the trash littered about?
As I started to collect some of the garbage at my feet, the nurse who first responded to the scene took an empty box from my hands. Her auburn ringlets were jarring as I realized we had worked together in the newborn nursery just a month ago. I observed as she and the security officer with over-sized clear acrylic glasses walked around in a daze, as if they didn’t know what to do.
Did I look the same?
Turning to my fellow hospitalist as I felt her walk past, she gave me a small grimace.
“That’s so sad. Well, I have one more patient to see…”
“Can I help you with anything?”
“No.. you’ve already signed out your patients to me, so you should probably get out of here.”
Nodding my head, I headed to the nearest trash receptacle and shoved the discarded packaging down.
Of course that’s what you do when your work day ends.
Go home.
Except I didn’t.
Who wants to sit in traffic alone with your thoughts for an hour and a half?
Pulling my purse off the leather passenger seat to exit my SUV, I struggled to let go of the details.
Leather would be so much easier to clean off all the blood and amniotic fluid – sucks that they have khaki cloth upholstery. How could they possibly get into that SUV ever again? I’d probably want to burn it.
As I strolled up to the hostess at one of downtown’s hottest restaurants, I pushed away the intrusive thoughts as she brightly greeted me.
“Hi! How are you today?”
Why do we bother with this formality? No one actually cares to know how your day is going.
“Great! Dinner for one, please.”
“Bar or dining room?”
“I’ll take the bar.”
I followed the bounce of her black dress as she led me past two women having the most inane conversation.
“Like, I just don’t know if this shade of red is too warm or bright for my skin tone, you know?”
“Oh, totally. Maybe you should go with the other lipstick. I bought this one off of Instagram…”
Settling into the bar seat, I noted the couple who were likely on a failing Tinder date to my right. Beyond them, a middle aged business man with his tie just slightly loosened, whiskey on the rocks cradled in his hand. The bartender’s sleeve of tattoos as he poured out a generous serving of merlot.
A baby’s piercing cry rising above the din of the room.
A cry I had been waiting for just 20 minutes ago, but never came.
How long will the NICU team attempt resuscitation? They’re probably doing it right now, as you sit here trying to re-integrate into normal life.
But go ahead, keep using your mindfulness techniques. Distract yourself by noticing all the details. Breathe the day away and re-center. Order yourself a burger and fries and pretend you tasted a single bite. Make small talk about how it’s starting to feel like fall with the bartender.
Because this all comes with the job.
A job you have to go back to tomorrow.
Why aren’t you more resilient?
Is it any wonder some of us choose to stay in a numb, detached state of existence?
How else are we supposed to deal with the shit society likes to pretend doesn’t happen, then re-surface and act like none of that stays with us?
That none of it changes us?
Denying we have the capacity to feel overwhelmed and lost has been reinforced since day 1 of med school – sometimes it’s much easier to continue to pass as “normal”.
Because there are still patients to see. RVU’s to be clocked. Metrics to be met.
And it’s harder to do all that when you’re crying in a stairwell by yourself.
So detach until you’re fully incapable of tears. Not even when you finally tell your husband the next day,
“It just sucks when a baby dies, you know?”
***
This is not the way I wanted to doctor.
But it’s the only way I can keep going through this week.
***
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***
Photo taken of my gorgeous friend on the Hidden Lake Trail, North Cascade Wilderness, WA.
That is a very tragic memory and one that a lot of docs have gone through unfortunately. The death of a child is the hardest thing anyone has to deal with in the medical profession. I am in a specialty that fortunately does not have me encountering this at all. I can’t imagine those dealing with it on a more frequent basis.
I’m so glad I haven’t had to deal with it on a frequent basis myself – I’ve only had less than 10 pediatric deaths over the last 10 years when I started my clinical rotations as a med student. Still remember every single one though 💔
I left trauma about 10 years ago and I still reflect, remember and think about how I could have done better in my role, how I could have controlled the room, did I provide the right resources, etc. I think of the family especially the mothers, how do they cope? There are pictures, videos and memories that are brought into the room, everything changed in an instant. I also reflect on how our team coped, especially on night shift. We knew which bars in the morning were open, we would all show up with some ear basins and snacks from the vending machines to decompress. Trauma was some of the best and hardest times in my career.
The aftermath is always the hardest to contend with. When you start seeing these “cool” cases as real people, with real families who are going to mourn the loss of their loved ones, it can be hard to shield yourself from that devastation. Conversely, when you know you were involved in saving that person’s life, there’s no greater satisfaction.
Living in the extremes can be exciting, but it also can wear us down. Thank goodness you know you’ve had some great wins.
Brutal.
I recall my first pediatric death, from SIDS. Dad exited the ambulance clutching a framed image he’d drawn by hand of his son. Still visits me in dreams sometimes.
Medicine risks transforming us into damaged goods.
My first pediatric death was actually on my OB rotation as a med student. I can still remember mom laying on the bed crying as she told my resident that her baby had been discovered on the pregnancy test prior to her planned hysterectomy for endometriosis. It was the greatest day of her life, but a car accident took him away from her.
We may be damaged goods, but we can still serve a purpose. I’d much rather have this than live the trauma my patients have lived.
Obviously, this story generates a lot of feels for me. You are right though, when we understand our patients as human being, the jobs becomes harder. I think we do a better job, but the cost we bear becomes heavier.
As a defense mechanism, we are acculturated to create artificial emotional walls between “us” and “patients.” Having been on both sides of this, those walls have become far more permeable. Moreover, it reminds us there is no magic wand which protects us as physicians from these terrible events.
There but for the grace of God go us.
The only difference between us and our patients is time and luck.
You know, I actually thought of you as I was writing this. I almost thought to send you an email to not read this one, but that seemed rather presumptive that you would read it AND a little too patriarchal/matriarchal. I hope it didn’t cause you too much distress.
Of course I agree with you on the “us” vs “them” mentality, and I think this divide has only made our work that much more difficult. Patients want us bridge the gap and be more human, but sometimes that comes at too high of a personal cost for us.
It’s inevitable though – those feelings come out when you least expect it and at the most inopportune moment. For me, it was at a dinner party when I was post call and operating on 4 hours of sleep when my very pregnant friend asked me why I had such a bad week. As I choked out that I didn’t want to talk about it, I couldn’t stop the tears from flooding. One way or another, we have to deal with it.
One time I was in a section. The baby was lifeless. The pediatrician did his thing. I took a look, put in a #3 tube put my mouth on the connector and gently sucked in and pulled the tube back. A perfect tree of coagulated amniotic fluid about 3 generations deep in the bronchial tree came out attached to the tube. Thank God for fetal hemoglobin. I was working in a pediatric ICU. a kid was playing on a 10 lane highway a mile north of the hospital. He was playing frogger for real. He lost despite the bolt in his skull, a-lines etc. Another time I was attending a delivery of twins. Healthy 22yo mother. I was asleep and awakened by banging on my door. I got to the room and the second baby was being born. Mom was in EMD. I did the Curley shuffle but what she needed was immediate crash to bypass and extraction of her saddle embolism. How do you heparinize a raw bleeding wide open uterus being fed by pulsating named arteries directly off the aorta the size of your thumb? How do you crash to bypass when the nearest bypass machine is 25 miles away?
It’s virtually never how it should be. It always is what it is. There are no pat answers. All you have to play are the odds. It’s like playing blackjack. Strait up the houses advantage is 10%. Learn to count the cards the houses advantage is 2%. Learn how to count and when to bet your advantage goes to 1%. If you play enough, that advantage overwhelms. How strongly it overwhelms is a function of the skill you bring to playing the game, and how long the house will allow you to play. I started out good and as time went on I got better and better. People benefit from better and better. It doesn’t mean the loss isn’t hard, but people benefit from better and better. None of those cases and several dozen others were lost to me. I still carry them. That’s the cost of doing business. Despite the cost and the dissonance, if you show up, you bring better to your community. It’s not about being resilient. This is easy for no one. You can conclude what it is about.