Too Young to Die

Pedi-codes are the worst. I have run three in my seven years (well, 3 under one year old, one ten-year-old too.), and I don’t know anyone personally with more. It is not a personal record that I enjoy, and would rather not have that experience. While not technically challenging, there is nothing more unsettling than performing CPR on someone who weighs significantly less than the monitor attached to them that keeps telling me the bad news.

My first came early in my career, at 730 am on a shift that ended at 8. I was an EMT, and a new lead in the department. I can’t remember why, but there were two medics in the firehouse that morning that jumped on the unit for the call. I suppose we were lucky there, the call went out as a Stoppage of Breathing, and got everyone’s attention. The apartment complex was not far from the station and I was still shaking the sleep off when we arrived out front, our engine right behind. I rode in the back on that call, and I think I’d thought ahead enough to connect the infant BVM to the oxygen bottle. (BVM is Bag-Valve-Mask, the bag we use to breath for our patients.) I opened the door to see the firemen running up the stairs to the apartment, and I went up after them, oxygen bag over my shoulder. Following the apparent law of nature, the patient was on the top floor. I remember just entering the apartment when I hear “COMING OUT, MAKE A HOLE” and see Buddy, a firefighter starting down the hall towards the door, and me. He was coming at me like a running back, one arm holding a couple-month-old baby, doing CPR as he came. I barely got out of the way before he blew past me on the way to the unit. Just as fast as the train of people was heading into the apartment, we were all turning around and headed back. I only remember snippets after that. The baby was so small, and the medics had a hard time with the ET tube. The baby had been down a long time, a fact that never came into play for us. I remember that the got the tube, and we were to the hospital in no time at all. I also remember being met in the bay at the hospital by an over-eager staff who opened the doors to the back of the unit and started pulling out the cot before we were set, and dislodged the tube as they did. I didn’t fully grasp the impact of that at the time, but to this day, that hospital is not allowed to meet us outside anymore. I’d later learn that Dad had fallen asleep on the sofa, with the baby on his chest, and rolled over in his sleep… That call stuck for quite a while, and I spent most of that day in a hot tub dealing with it. I still know that baby’s name, and I know another EMT that was with me that day can recite the date, but that’s one fact I have lost. The next day we met back at the firehouse to talk it though. It was sad, of course, but to this day the sight of Buddy coming out of there, CPR in progress, babe in arms ranks as the most heroic thing I’ve ever seen.

I can honestly say that it wasn’t until after we were at the hospital on my second pedi-code that I realized that that particular task had been passed. It was the afternoon, and the call that went out was for an unconscious. We didn’t know we were headed for a baby until we were on the way, and it was later in the response that we heard the call, “CPR in progress”. This time, the medic was further away, I was the lead EMT on the ambulance, and the engine was coming from somewhere else. I knew we’d beat the medic in by a little bit, and I called on the radio to have everyone meet at our unit, or at the medic unit if it got there before we got back. This time it was me sprinting up the stairs first, past the screaming mom and into the back room of the apartment where a panicked dad all but threw his baby at me. I gotta tell you, lightning strikes you at strange times. Here I was, scared, pumped, and winded, busting into a home I’d never visited, with people I’ve never seen, at the worst time of their life, my mind screaming for control in my head, “STAY CALM, THINK, SMOOTH IS FAST” over and over. And at that moment, Dad, Daddy, is handing over a baby, blue and pulseless to me. He’s never seen me and yet he freely passes to me the source of every hope he has ever had. Woah, how do you deal with That one? Time stops. But, I can’t. Pivoting, I start CPR, and head for the door. I see the “Oh Shit” look on my partner’s face as I go blasting through the door, down the stairs, past the neighbors drawn by mom’s screams and the sound of sirens, and mercifully to the waiting medics. The baby had aspirated formula as it slept. I knew it because I had done mouth-to-mouth on the way out, not thinking about it, and got it full in the face. I later joked that I know why baby’s spit up….you taste the stuff and you will too. (As a note, we Don’t DO mouth-to-mouth anymore, or then for that matter, but they taught it in class, and you really do revert to training in times like that.) I know I helped the medics in the back of the unit, but I can’t remember any details of the run. I know the baby didn’t make it, and I remember being at the hospital, writing report and thinking of Buddy.

The third was in the evening, and was the first of two back-to-back codes of that day. This time, I was on the medic, but still an EMT. I stayed in the back, and mom came out to the unit as we approached. Mom was scary calm, and got hustled up front pretty quick by the fire guys. There were two medics there that night, and as a technical exercise, it went very well. I hate to say it but that is what that call was to me….mostly. The baby came in, and I started compressions. The tube was in fast, and they even got an IO started. An IO is a large needle that is bored into the shin bone of the baby for access to the venous system. Next to a chest tube, it is the thing in emergency medicine that most reminds me of the fact that we are only a few generations from blood letting and civil war surgery…but it works. We got a police escort that day. Two cars leapfrogged ahead of us closing intersections as we headed to the hospital. I don’t know what the people on the road thought, but I know what I thought, “there is nothing we won’t do for a baby”. If I have to confess that this one was mechanical, then I have to confess that it wasn’t totally so. For a brief time, we got a heartbeat back on this one. Just long enough to remind me that this was not a training manikin I was working, and give me hope. I thought for a flash that three was a charm, and this was a life we’d save. But, it wasn’t to be, and by the time we got to the hospital the pulse was gone, and I arrived angry. Not that we lost, again, but that I’d been allowed to think I was winning. These thoughts were all in my head this week for a call, but it is late, and I’ll have to tell that story another time…