What It’s Like to
Lose a Child Patient

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in ,

In Short: Memorable.

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I was an ALS medic in rural northern California, and there’s one call I think of often — even though it was 38 years ago. We were dispatched to a possible drowning in the Mad River, which reaches the Pacific just north of the town of Arcata, where we were based.

We arrived just as the bystander who went into the river for the boy found him, pulled him out, and ran him to us. My partner and I got him onto the gurney and got to work. With cardiac arrest, the best chance of survival is to work on them then and there, not take the trip to the hospital and then work on them.

My ambulance then was nowhere near this modern! (Photo: Chiradech on YayImages)

It was one of those times that you do everything at once. Start chest compressions. Get the cardiac monitor going. Breathe for him. Start an I.V., and get your drugs lined up.

Chest compressions are most important. While CPR stands for Cardio-Pulmonary Resuscitation (also supporting breathing), chest compressions also compress lungs, pushing out stale air and sucking in fresh. That’s enough for awhile.

My EMT partner quickly wiped the boy down with a towel and started compressions; I was responsible for the rest. I got the I.V. going and pushed epinephrine (“adrenalin”) to stimulate his heart. To defibrillate (shock) the heart back into action you have to have some sort of heart action. The epi helped: I could see light activity on the cardiac monitor.

In those days we still used paddles (now it’s sticky pads: odds are you’ll need to shock more than once). As the defibrillator charged I looked out the open back doors for the first time, where a small crowd had gathered to watch. They were totally silent: I didn’t even know they were there! “Make sure you’re not touching the ambulance,” I told them, even though it’s almost impossible for them to be shocked.

All but one guy stepped back, and I registered his presence for the first time. It “had to be” the guy who fished the kid out of the water, because he was stark naked. It was surreal, but Paddles charged! Back to work!

My partner moved back and I shocked the kid, but there wasn’t much response: you want strong muscle spasms, which indicates oxygenated tissues. After more rounds of drugs and shocks with no results, his chances were dismal, but I told my driver to get going: it was only 3 miles to the hospital, but winding town streets the whole way. The E.R. doctor went over the same protocols …and pronounced him dead.

From the front page of the Eureka Times-Standard on July 22, 1983, which I was grateful to find online in 2019.

Robert Greer was 12 years old. If he had lived he’d be 50 now — hard to imagine!

The man who pulled him out of the water was Garland Popp, and I never saw him again. I didn’t keep any notes from that day and had forgotten their names until I found this newspaper clipping. It took Popp about 20 minutes to find Greer and pull him out, so his odds were about nil from the start.

While I still sometimes think about that day, I’ve always known I couldn’t have done more to increase his odds. I hope Popp was able to have peace with it too.

Randy Cassingham is WiLt’s head writer and publisher. His flagship publication This is True, established in 1994, is the oldest entertainment feature on the Internet.

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8 thoughts on “Lose a Child Patient”

  1. As a former medic, been there, done that…one year old bathtub drowning. It’s been over 20 years since that call. But I still think about it too at times. And like you said, there was nothing you could have done differently to change the outcome.

    I had an instructor that paraphrased a scene from a M*A*S*H episode. Rule #1: Sometimes people die. Rule #2: Medics can’t change Rule #1. It’s just something we deal with.

    I remember that episode and those “rules”. One of my instructors put it this way: “ALL of your patients will die …eventually.” (A corollary: “All bleeding stops …eventually.”) I’ve had to counsel young medics on this more than once myself. Thanks for the reminder. -rc

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  2. A tough memory to write, Randy ~ but acceptance meant the scar has no adhesions into the present. Thank you for sharing, it encourages me to continue the effort to halt the grim reaper before another sheaf gets mowed down.

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  3. I had just flown back to Australia from a business trip to India. It was my daughter’s sixth birthday party at a local indoor cricket centre. During the party a member of staff wandered over to ask if anyone knew first aid. I said I did and followed him across the warehouse and past six indoor cricket pitches filled with shouts and laughter, thinking maybe a broken arm or a busted knee. I looked across to the other end of the building and there was a mother cradling her son, all alone.

    I immediately ran to her, took the boy from her arms and did my checks. He had no pulse and wasn’t breathing. My then-wife, her sister and I performed CPR on him until the ambulance arrived, and I continued to perform CPR on him until they were set up.

    Sadly, neither our efforts nor the efforts of the paramedics were successful, and it hit me like a hammer blow, even though I knew that without immediate CPR and subsequent defibrillation his chances were about 5%. It took me a long time to come to terms with his death. My friend eventually got me past my guilt by telling me that I had given him every opportunity for life. The poor little bugger had been born with an undiagnosed heart condition and was dead before he hit the floor. Nothing any of us first responders could have done would have changed the outcome.

    I can still picture him in perfect detail. From his hair colour to the clothes and gold chain he wore.
    All you can do is try your best. I take my hat off to anyone willing to step up and try.

    Just as I take my hat off to you, Matt. -rc

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  4. I’m an Army trained, Licensed Nurse (depending on your state, either an LVN or LPN,) now many years retired.

    In the late 70’s I did a three year tour of duty with the United States Army Institute of Surgical Research (USAISR or ISR for short.) It was more “popularly” known as “The World Famous Burn Unit.” It was also the lead trauma unit for the city of San Antonio, and most major burn victims from the city came to us.

    One afternoon, just going on shift, we got a call to get to the loading doors for a City Rescue Squad bringing in a burned child, and I took the call. Our unit was on the fourth floor and the loading doors were in the basement. As the elevator doors opened, the Fire Department Rescue Squad rushed in and placed a small child, about 2 or 3 years old on my gurney, and I hit the quick close button. As the doors were closing, I heard a yell, “WAIT! There’s another one!” and a bundle flew through the opening to me. Another 2 to 3 year old child.

    This child was in cardiac and respiratory arrest, and burned over 85% of his body. I started doing CPR on him like he was an infant (holding him along one arm, doing chest compressions with the other hand, and rescue breathing. Five chest compressions to each breath), and continued doing this as I was running down the hall when the elevator stopped, and until he was on a bed and could be intubated.

    I continued to work on him with the team of Doctors and other Nurses for about two hours, until he died.

    One of my teammates looked at me and told me to go get cleaned up and change my uniform (we wore scrubs.) I was covered in burned tissue and blood, and never realized it. Later in the shift, and before the shift ended, our charge nurse told me I was “green around the gills” and sent me home, even though I protested that I felt fine.

    I did. I felt fine. That is until the next morning when, after dropping my wife off at work and our baby at the sitter, I came home to one of the buildings of our many-building apartment complex on fire. The smell was the same as the night before, and I sat in front of my building, crying my eyes out. A neighbor, who was also a military nurse, saw me and got me into my apartment, and called my wife and the unit. The shock and the “let down” (adrenalin loss) hit me hard.

    When I did return to work (the unit gave me a couple days to recover), the parents came up to me to thank me as they were leaving. They had just lost their other little boy.

    What’s it like to lose a child patient? It sucks! I still wonder if I did the right thing by starting CPR on this little fellow, because I (and all of us working in the unit) instinctively knew he was not going to live. Would it have been better, for the child, to not have restored his life for the short period of time he lived?

    That question haunts me today, 45 years later.

    My take on that: the child was dead (just not pronounced) when firefighters turned him over to you. You (and a lot of colleagues) tried to reverse that, and couldn’t. Was it the right thing to do? Yes. Is there anything else you could have done? No. Thus, should you beat yourself up over it? No. -rc

    Reply
    • You’re right, I shouldn’t beat myself up about it. But guess what? We’re “Medics,” people doing a job we love, and remembering what has been done keeps us from being automatons, and keeps us human. And it is why you and Kit still ride the bus, and why I still study the field.

      We all will hang tough, but remain human.

      Oh, the other side of the coin is sorrow for what happened. It’s tough to watch a doctor pronounce a child dead no matter what the circumstances. And may we never, ever, blow that off. -rc

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  5. This is why I always feared to get child patients.

    I took shifts in the children’s A&E to overcome this.

    Smart. -rc

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