Diagnosis: LOB: A Tragedy Laid Bare........

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A Tragedy Laid Bare........
By Diagnosis: LOB

“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 west London 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.