January 15th, 2004

Toledo doorway

There's one sensation I never wanted to learn...

Today, I listened to my chief lie to a patient. And I knew he was lying, and I knew why. And I kept my mouth shut, because today, he was right.

We were eating lunch when all the residents' pagers went off at once. Peds trauma, we're not on that paging list. 6WM TRAUMATIC ARREST ETA 5MIN. Peds trauma. We ran.
Vital signs arrived with him, in simple terms. Flatline. Intubated at the scene. Shocked 3 times to no avail. We gave him chest tubes, IV fluids, two go-rounds of code drugs, did CPR, did everything. It was...well, as BW put it later, it was a code run the way it should be run. Exactly as it should be run. The only problem was that it was a code run the way it should be run, on a dead child.
He came in with his eyes fixed and dilated, with no heartbeat, with the chest compressions the only thing maybe keeping him oxygenated. It was so familiar, except that unlike the last dead child, when they stopped doing compressions, he didn't move. And BW looked at Dr.W, who is so kind and so gentle and so adored by her patients in Paediatric Surgery, who'd come over from the children's hospital to help with the trauma, and she nodded, and he put his hands down, and shook his head, and we all stared at the tiny pale body.
And someone said "Time of death: one thirteen." And someone else wrote it down.

They were in a minivan. Something happened; they slowed down. Something happened; they were clipped by a semi going 65. That's the gist of the story. I know, because I came from the shockroom where the nurses were washing the blood off of his body and I tended to his mother, who came in shortly thereafter. She was the driver. She had her seatbelt on. She shattered her T10 vertebrae and will never walk again, but she's alive.
She asked about her son. We lied to her, we told her that he was in another room and we were working on him. We lied because it wasn't time to tell her yet; we had to make sure she wasn't going to die as well. We lied because there was nothing to do but lie. She looked at me, unable to move from her pain, unable to feel anything below her waist, looked at me as I ran a damp piece of gauze across her lips - the only liquid she could have - and said "Tell the doctor he's autistic. My son is autistic, he's nonverbal." And I said I will, because there was nothing else to say. Because when she told me that, her son was lying dead not fifty feet away. And he would be nonverbal forever.

Her son was an unrestrained backseat passenger. Why was he unrestrained? My son is autistic, he doesn't like to be restrained. Well, now he's dead. I don't care if your son is autistic, O Best Beloved. He is not old enough to make his own decisions about whether or not he's willing to sacrifice his life to bravado. Until he is old enough to decide, knowing the consequences, then he'd better damn well not be out of a seatbelt, even if you have to harness him in. Even if you have to glue him in.

More things happened today, and maybe I'll tell you about them later. But right now, all I can think about is that tiny frail body, from a perfect vantage point - standing at the foot of the bed holding an IV bag high because there was no pole on that end of the code. I watched them shove chest tubes into his ribs, tubes as big around as my thumb in a vain effort to ease the burden on his overwhelmed lungs. And then I watched them leave, one by one, faces above the fluid shield masks displaying a variety of emotions from emptiness to agony to nothing at all. I took the bag with its half-litre of fluid still remaining and I set it down beside him, not knowing what else to do with it, stepped back. I watched after they all left, as the nurses washed the blood off of him, tried to close beautiful grey-green eyes, brush back dark brown hair tousled and spiked with blood. I looked down at six-year-old first grownup teeth, clamped around an endotracheal tube, lips now pale and faintly grey with death, face a pallid near-white. They don't have any reserves, kids. They only have so much blood.

I reached out, before I went to find my team and help attend to his mother, and I touched his hand, brushed my fingertips across his cheek. He was so cold, his skin soft, flexing beneath my fingertips. I could feel its texture through the thin material of my gloves, feel the heat gone from it, chilling my touch and robbing me of some tiny portion of life. That feeling, O Best Beloved, is something I cannot describe, something there are no words to evoke. There is a softness to a child's skin, a perfection that is retained in bruises and scrapes and scabs, an innocence in the curve of cheek and lip and neck, in the angle of the jaw, in the delicacy of tiny veins that carry the blood - so much blood, as it appears, spilled onto sheets and backboards and gloves; so little blood to sustain life - there is a feeling of something finely molded, freshly made, newly awakened into being. It is there, O Best Beloved, in every child I see, every child I touch, every newborn infant and earachy toddler and oppositional ten-year-old, and at some ineffable time in our lives it fades into the tough and ungentle substance of adulthood. It is there in life, and it is there in death - made somehow more powerful and potent by the stillness that surrounds it. And to touch it is to leave something of yourself there, to take away a tiny fraction of the cold alabaster perfection of death in your fingertips and exchange it for the warmth of your own blood.
And I have seen three children come into the emergency room in nine months, O Best Beloved. Three boys, ages 2, 6, and 7: M, E, and one other. Two of them dead before they even arrived, one of them lucky to have survived. None of them seatbelted.

And I know the face of death, O Best Beloved, and it wears a tolerant masque and rides a pale and nonchalant horse.