It was one of those nights in the ER - not too busy, quite a few things I was going to tell you about, O Best Beloved, interesting things I saw. They all went flying out of my mind the moment the call came in. "We've got the [helicopter] coming in, paediatrics trauma." Nobody knew any more than the paramedics had radioed in - that we had, incoming, a two-year-old boy who had been ejected 30 feet from a car, that his heart rate was 90 (too low) and his blood pressure 90/60 (also too low), and that they would be there in 13 minutes.
So we pulled together the peds trauma team, and we sent the onsite EMT's to meet the helicopter, and they brought him in, bagged and on oxygen, and we saw some neurological responses, coughing and a little bit of a gag reflex, and I stood as far out of the way as I could as they assessed him, transferred him off the EMS cart, and got permission from the peds neurosurgeon to take him straight to the CT scanner.
I stayed in the ER while they went to CT. When they came back, the chaplain came in with them. His ventilator bag was gone, and half the monitors were quiet. And I stood in the room, staring at the tiny pale face with the mussed dark brown hair, and I listened to the chaplain read him last rites, and I didn't know what had happened but I couldn't ask until later.
Later came, and Dr. S showed me the CT scan. Where there would normally be nice grey and white matter, sulci and gyri and all the landmarks I'm used to seeing, there was nothing but a flat and featureless grey haze, punctuated by tiny bright white pinpoints of blood and draped with the unmistakable light space of a subarachnoid haemorrhage. They call it diffuse axonal injury, and it's what happens when the brain dies from lack of oxygen. And it's permanent.
They pronounced him dead in the CT scanner. When he came back to the trauma room, he still had brainstem functioning - he was breathing on his own, he had pulses - but you could see his oxygen saturation dropping and his blood pressure falling. It was 72/40 when I left the room for the last time, and even though they'd started running oxygen again and using a bag to get it in, his oxygen saturation was well into the 60% range. And the plan was to continue supportive care - an IV drip of saline, a bag or a respirator - and nothing else. There's nothing else to do. They took him to the paediatric ICU to wait until his mother got there.
His mother was taken by ambulance to a closer, local hospital. Also two other children - 2 months and 5 years. All of them were restrained in the car. Buckled in. All of them were checked and released with only minor injuries. That's why I can name it murder by omission, O Best Beloved. If he had been in a carseat with the harness fastened when someone rearended their car, there's no reason to doubt that he would have had the same lucky fate as his family.
B. said to me, "was he restrained?" I told him no. B. said "They should hang parents for that." Dr. W turned away from his computer and said, very softly, "They've already had their punishment."
I don't know what that mother will think or do or say when she arrives at the hospital; my shift ended at 10:30 and I got to go home, walk out of the hallways where the curtain is still drawn around the double room that serves us as a trauma room, where there are still packets and wrappers at the edges, where they were just finally as I left removing the single crosswise bed with its tiny wooden backboard. I got to go home. I got to leave, and I can still hear his choking breaths, see the tiny chest with its tiny tubes and wires and stickers and all the things that couldn't preserve a life that had already fled. How much more agony must it be for the mother who has to ride an hour and a half with her still-living son to say farewell to a dead one? How much pain can one person bear?
Tonight, O Best Beloved, I was baptised by fire into the reality of death and the paradoxicality of it. I have never seen a person die; I saw a little boy, face marred only by the tubes in his mouth and nose, with skin somehow nearly undamaged despite a thirty-foot flight, despite being found face-up in a field, a boy whose body was nothing more than an empty, hollow, broken shell holding a heart and lungs and kidneys that would never grow again. I saw a tiny pair of tennis shoes in a bag, the only clothing the medics brought in. And I listened to the last rites and I cried inside, and something bright and innocent and vulnerable in me broke apart and bled like he did not. And then I bit back my tears and I swallowed the lump in my throat and I walked out of that brightly-lit room feeling older, somehow, and I wondered if it showed in my eyes or my face.
I went back to the doctors' station, then, and I went to the chart rack and I picked up a chart, and I looked at it, and I turned to Dr. S, and I said "All the labs are fine, and the CT looks good." And he said "She can go home, then. Why don't you go let her know?" And I walked into the room of a 50-year-old woman who'd just come off of a two-week drinking binge, and I smiled.