I don’t remember the call.
I know there must have been one. There must have been a paediatric cardiac arrest call put out, otherwise I wouldn’t have attended the ED. I don’t remember it though. I was the ICU registrar on call, and I was in the ED waiting to receive you.
I don’t remember checking my equipment. I must have done, as I had it all to hand.
My first memory of you is your limp little body being hurriedly lifted onto the resuscitation trolley by your dad’s strong, determined, speedy arms.
You were covered in a rash. A viral exanthem, I thought.
You weren’t breathing. You had no pulse. We started CPR. I intubated you with one swift movement. We started ventilating you, and your chest rose, and CO2 was detected. Sigh of relief. Good.
Children have respiratory arrests most of the time right? Restoring ventilation should make you live again.
Your pulse didn’t come back. The ECG was a flat line.
Multiple thoughts now. Causes of asystole in a young child. Hs and Ts. Running through; no signs. Adrenaline boluses. No response. External pacing. No response.
Oh God. Please, God, no.
ECMO. Please can we put you on ECMO?
The nearest centre is an hour away. 30 miles as the crow flies.
No no no no no.
If you lived 30 miles south of here you might have–might have had–a chance at living.
The pain that shoots through my heart in that one moment is excruciating. Anger. Fear. A horrendous sense of a giant universal wrong.
I don’t talk to anyone about ECMO. I can’t. The team leader isn’t thinking it. No one else is. I just…. I can’t do it. It hurts too much.
I hope someone else would bring it up. I would go with you in the ambulance. A mad dash to try to make you live.
But no one does.
We carry on CPR for 40 minutes. I carry on ventilating you; a shell of a man, watching myself holding back tears of frustration at the inevitable situation that is to come.
You’ve been down for an hour. The team leader, a consultant paediatrician says “stop”.
Your father utters a painful, weak “No, no”…
Your parents crumple around your little, rash-covered body.
I excuse myself from Resus. I tell myself I’m giving the parents a chance to grieve. But it is I, it is I who needs to grieve.
I collapse. Shaking. The tears flow, stinging my cheeks as they fall. I weep for you, for your parents, for the sun you will no longer see, the warmth you will no longer feel.
You had a beautiful 18 months on this earth that were cut tragically short.
I am so sorry.
I learn ECMO now. You sit on my shoulders as I study. Your little hands widen as I understand what it can–and what it can’t do.
I will never forget you.