Five minutes of CPR given, no change.
In the space of a few minutes a baby has gone from being sick but stable to having a full blown cardiac arrest.
The emergency buzzer blares through the unit and doctors and nurses come running in from every room on the unit. The consultant assesses the situation in a few seconds and starts to give out instructions; calmly taking charge although inside she, like the rest of us feels anything but calm.
Someone breaks the seal on the resuscitation trolley and starts taking out the equipment that will be needed.
We work on this little boy, the six of us barely breathing, only speaking to ask someone to do something or confirm that something has been done.
Six people for one tiny boy; one person in charge, one to give CPR, one to give manual breaths, one person to write everything down and two people to draw up medications and be ready to hand over pieces of equipment.
I am writing.
I am responsible for looking at the clock, making sure that I record the time of medications given, defibrillator shocks delivered and how long we have been attempting to bring this little boy back.
Ten minutes of CPR given; no change.
The monitor on the defibrillator shows that although his heart is still trying to beat it’s completely uncoordinated and all the different parts of the heart are trying to beat at different times and rates. As a result the heart flutters or ‘fibrillates’, hence defibrillator.
Although the heart is still technically working, if it doesn’t beat then blood and therefore oxygen will not be pumped around the body and within a few minutes the brain and other organs will start to fail. By giving CPR we are pumping some blood to the brain while we try to get the heart beating properly but it’s not nearly enough.
The electrical shock delivered by the defibrillator is intended to stop the heart momentarily so that when it restarts the different parts should start working together again.
Everyone stand clear…
No change, resume CPR.
It’s not working.
Twenty minutes of CPR given, no change.
We give all the medications we have at our disposal; some to try and correct the heart rhythm and others to try and prevent the damage done to the body by the lack of circulating oxygen.
It’s becoming clear that we aren’t going to be able to save this little boy.
We’ve tried everything that we can but his heart is still wriggling like a bag of worms.
The consultant asks for the parents to be brought back in. One of the senior nurses took them to the quiet room as soon as the emergency buzzer was pulled.
No parent needs to see their child like this.
Resuscitation, whether it’s done on an adult or a child is a brutal process. The force needed to pump the heart from the outside through layers of skin, fat and muscle as well as the rib cage is huge, even for a baby. Patients are left with bruises on their chest and broken ribs but the alternative to these is certain death.
Defibrillation is equally difficult to watch. It’s not as dramatic as portrayed on the television, the patient isn’t lifted of the bed by the force of the shock.
A baby being defibrillated is actually quite pathetic; their arms and legs twitch momentarily before becoming motionless again.
Thirty minutes of CPR given, no change.
We continue with the CPR while the consultant kneels down next to the parents and explains that there’s nothing left we can do to bring their little boy back.
The parents collapse into noisy, howling sobs.
It’s actually quite rare to have a baby die unexpectedly on the unit. By unexpectedly I mean that although they’re very sick we usually have some warning and time to prepare the parents as best we can. We’re able to continue supporting the baby until the parents are ready and then enable the little one to have a calm and peaceful death in their parents arms.
This is not one of those times.
The consultant stands up and asks us if we’re all in agreement that we should stop.
I look at the clock and check that we’re all agreed.
I announce time of death, just loudly enough for everyone to hear.
Mum starts to hyperventilate.
We quietly switch off all the equipment and remove the various lines and tubes from the baby.
The consultant wraps him snugly in a sheet and then a colourful knitted blanket.
I hand her a wad of soft gauze to wipe the trail of saliva from the little one’s cheek. It’s a side effect from one of the emergency medications that we gave.
She takes the little bundle and carefully gives him to his parents so that they can cuddle him while he’s still warm. He looks peaceful but he doesn’t look like his still sleeping, he’s far too pale for that.
Mum catches her breath so that she can talk to her little boy.
We step outside of the curtains that have been drawn around the incubator .
There’s nothing any of us can do to help the three of them now.