"His hair is the wrong color..."

13:26 12/19/2019 will forever be engrained in my head. 

"His hair is the wrong color," I remember thinking to myself as EMS rolled him out of the ambulance, my first glimpse of the boy. I saw his pale skin under the hands of the EMTs working hard to compress his tiny chest in an attempt to keep his blood circulating. As he rolled past me, I quickly realized that "wrong color" was hair that had been saturated in blood.

The call came in just a few seconds prior, "Code 3, male, head caught in a gate, CPR in progress."

My co workers called for me to prepare a trauma room for a Code 3. I did my typical routine, got the crash cart out, began hooking pads up, prepared the Lucas so it was ready to go. Another coworker came rushing over with the pediatric crash cart. I looked at him puzzled. He said assuringly, "It's a 9 year old." Our hospital sees a ton of people in the older population, so a code 3, CPR in progress on a 90 year old was nothing new for us. I figured he just misheard the report. I repeated back loudly, "Nine-TY?" He confirmed my disbelief, "NO, NINE, ZERO NINE."  I just kept thinking, "We don't get traumas, it cant be that bad. CPR? He'll bounce back, he's young. A child is resilient to these things. He's going to be okay."

I understand now why the pediatric crash cart is color coded. No amount of education, classes, practice scenerios, or mannequins can prepare you for the completely blank slate you experience when coding a child after a traumatic accident. I was attempting to listen to the EMS report, all the things they had done for the patient so far, to gather all the details but it was all a blur. I was just staring at this little boy, trying to make my brain think about what to do next. All I heard them say was "25 kg, open the orange drawer!" I opened the orange drawer and began handing over supplies for intubation.

My job, being the recorder, was to write down everything that was happening and to keep everyone on track. Every person I knew in that hospital was in that room, and more that I had never even seen before. Multiple ER MDs, every ER tech, anesthesia, pediatricians, several respiratory therapists, pharmacists, nurse leaders from God knows where, managers, social workers, every RN in the department that had a free hand. Everyone was putting in everything they had in attempts to keep his little boy alive.

The code dragged on for what felt like hours, me calling out, "Pulse check" and "Time for another epi" every 2 minutes. Our ED techs were incredible keeping strong chest compressions going seamlessly. The RNs at my side administering medications never missed a beat. The MDs wracking their brains to try to find the cause of the heart failure and the source of the bleeding, kept communication clear and their demeanors calm. There was also, what felt like, a million other people outside the room making things happen. The pharmacists kept the necessary drugs coming. The charge nurse delivered Red Tag blood. The ANM called for not one, but two helicopter back ups for transfer of the patient when he was stabilized. After about 30 minutes of coding and drugs, it was obvious that this outcome would not be good, even if he did survive. The hope began to fizzle and you could see it on everyone's faces. Tears were fighting their way out of my and everyone else's eyes. We all were coming to the realization at the same time that in this situation, we were powerless. When Mom showed up to the room, it tugged at our heart strings. She looked the doctor straight in the eye and said, "I know you are going to do everything you can to save him." We kept going for another 25 minutes, despite the ultrasound revealing no cardiac activity and PEA on the monitor.

The boys father came in next. He couldn't even be in the room, he was screaming in pain, in disbelief at the sight of his son, his baby, who was supposed to be at school, safe he thought. He touched his son, whose skin had been cool to the touch since he arrived. He lost it. Collapsed to the ground, sobbing. Mom understood by this point that there was nothing that could be done.

I've worked at a trauma center before, dealt with pediatric traumas, and I've always forced myself to keep it together. Don't cry in front of patients, family members, doctors. Do not show emotions. You've got a job to do. Your feelings don't matter. This isn't your child. This won't affect you. Keep it together. Looking back, every single one of those pediatric cases has affected me, through nightmares, feelings of guilt, images of the patients. These images will never go away. Now when I have these memories, I try to welcome them and pay tribute to those we have lost, remember their souls in a positive light.

This time was different. My feelings were overwhelming. I could not suppress the stream of tears, the feelings of inadequacy, the guilt from simply having the opportunity to live another day. I saw my co workers, many of them my good friends, who just put everything they had into this code, devastated. We all needed each other in this moment. We needed to mourn together. A moment of silence was taken for the boy, while we all cried and held each other.

13:26 12/19/2019 will forever be engrained in my head. The day a mother lost her baby, a father lost his son, 3 siblings lost their little brother, an entire school lost their classmate, and an entire hospital lost their ability to keep it together.


Later that week, my mom told me a story that resonated with how I was feeling. She told me of her long, stressful work day, running around all over town and driving in inclement weather, ready to be home, warm in her bed. At one of her church groups, she noticed some children that we're piecing a puzzle together but were missing just one piece. She pointed to the missing piece and remembers saying, "That stinks! A whole puzzle almost complete but missing one piece! What a bummer."

Later that night, she was sitting silent with her thoughts, warm in her bed. She suddenly realized she hadn't even looked at the whole picture that made up that puzzle because she was so focused on the one missing piece. That hit me hard, understanding that what could come out of this horrific, devastating situation could be much bigger than the one piece that is now missing. The camaraderie in the hospital and between hospitals, the path that the child's siblings may end up taking, or his parents path could change. We don't know the trajectory of what will happen after his passing, but it could be something bigger and more than we can ever imagine.