A really bad day at the office

The girl stood in front of our patient in the hall way and stared, hypnotised as we did our job.  She must have been about sixteen.  Clutching at her legs were two other children aged possibly between four and six.  They too were staring – mouths agape, as only young ones do.  I caught the girl’s eye and tried to smile.

“You might want to take those kids away into another room my dear . . . they shouldn’t be seeing this eh”

Our patient lay sprawled out on their back, in a tight council flat hall way.  He was in cardiac arrest after suffering an asthma attack.  He was only nine years old.

Information on what had happened, and when, was limited to say the least.  No one seemed to know anything concrete.  A neighbour had eventually called us and when we finally arrived there was the inevitable chaos and confusion coupled with wails of disbelief and sorrow.

At this point your sphincter tightens to diamond crushing proportions.  You instantly curse yourselves for being first on scene and wish, almost sickeningly, that you’d been a bit slower to allow someone else to be lead.  But then, the training kicks in . . . in our case, bags flew open and kit went everywhere.  CPR commenced, pads were placed, back up requested and bagging started.

The boy’s asthma had caused his upper airways to contract so much we couldn’t get any air into the patient with the bag valve mask.  And we needed to secure the airway – fast.  Thankfully, help had arrived in the form of solo Paramedic in a car and an A&E support crew in an ambulance.

The time from now up until when we left scene was almost a blur.  My crew mate, Marvin, and the Support crew circulated the chest compressions between them whilst the solo medic and I completed the advanced skills of intubation, chest decompression, IV access and finally advanced drugs.

It was then time to go!  All the time we’d been on scene there hadn’t been an output for our patient.  They had remained in asystole (flat line) and this only highlighted our need to get going.  Under “normal” circumstances with an old patient we might stay on scene and eventually ‘call it’ if they remained asystolic.  But not with a child . . . never with a child.  Once the airway is sorted and drugs in place – you go!

At hospital the resuss department were ready as we burst through the doors.  And after we’d handed over we stayed and helped whilst their best team of Doctors and nurses continued to work on him for another 45 minutes.

But sadly, it wasn’t meant to be.  Not this time.  The main consultant in charge, after getting the agreement from everyone about calling it, looked up at the clock.

“Ok, time of death . . . 22.50”.  At that moment, some tears ran down her cheek.  I’d never seen that happen before.

There was a deafening silence.  More so than I’d ever seen with a death of this sort.  Catching my breath, I looked around at everyone and noticed that others were equally upset.  A nurse noticed my confusion and gently took my arm to show me the next bay.  Pulling aside the curtain slightly she revealed another child of a similar age, lying dead on the bed.  The nurse whispered in my ear . . .

“We’d literally just finished working on this poor boy when you came in with yours”

That lump that grows in your throat at these moments?  Well, a large one started growing in mine right there and then.  I staggered back out of the way and let everyone clean up so that relatives could come in and that the staff could prepare for the next case.

After walking back outside I caught up with the others to do paper work.  I told them what I’d seen.  There were a few moments of silence before the solo medic summed up the hospital staffs’ plight poignantly.

“That’s what you call a really bad day at the office.”




2 thoughts on “A really bad day at the office

  1. Heck, tough one. I feel for you all there!

    It’s amazing how many people we meet who still down-play asthma but it just goes to show…

    Question: Why IV access via the tibia?

    • He was a large lad so normal cannulation was nigh on impossible. So we (sometimes) have access to intra-osseous “drills” which we then gain access by drilling straight into a bone. In this case, the proximal tibia

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