Switchfoot.
It’s taken a long time
to put these words onto paper. Many times I’ve started writing them and had to
stop. But the celebration of this little boy’s first birthday seemed like the
most fitting way to share his story.
Some of you already
know it; have heard it over cups of tea when it was still fresh and raw and
uncertain. The four hours I spent with him changed so much about the way I see
the world and people – but not for the worse… for the better. It is my hope
that when you read this story you see what I see – not the tragedy, but the
miracle.
5:25 am.
The call should have been winding down as the first wash of
sunlight began to run across the black night sky.
I was aware of the time because of the colour change I could
see through the tiny windows in the paeds room in casualty, and because I had
just turned off my alarm that would normally have woken me. Today it was almost
two hours behind the casualty officer who had called earlier about some
admissions.
I heard the sister call me to “just quickly see if this baby
is alright to go upstairs” and turned to see a young man, early twenties maybe,
cradling a mass of pink and yellow baby blanket. All I remember about him is
the panic in his eyes.
I could only see the baby’s face – big eyes, a soft little
cry, dusky pink lips.
“No, he’s fine to go upstairs”.
He was a BBA (born before arrival). This was straightforward
labour ward stuff. I had enough to deal with down here.
Still, something turned in my stomach when they had left the
room… a nagging feeling that maybe I should have opened the blanket.
“You’re being paranoid,” I distinctly remember thinking.
5:35am
My intern called - for some reason the time on my phone is a
clear flash of memory.
“Hey Scotty. What’s up?”
“Linda – I don’t know what is going on here but this kid has
a hole in his trachea…”
“A what?”
“A hole… in his trachea…I don’t know…”
“Ok Scotty, where are you?”
“4th floor.”
“I’m coming.”
In the back of labour ward I found him holding an oxygen
mask over the baby’s face, and the obstetrics registrar plugging holes in the
neck. The baby was still fighting, kicking his little legs and waving his
little arms. There may have been a bit of cry but I really only remember the
shrieking of an angry saturation monitor; partly because it was struggling to
pick up a nice trace but mostly because when it did the oxygen saturation was
40-something percent (less than 90 is bad).
The air was tense and uneasy. Scotty’s eyes were full of
intern distress. I could see the obstetric registrar was desperate to get away.
“Someone’s hurt this baby,” she said.
I took over from Scotty at the airway and counted maybe
seven or eight puncture marks on the front and right side of his neck and
chest. Some were bleeding, some were bubbling and some were jagged. One or two were
clean and elliptical. Flashbacks to forensic medicine in 5th year -
textbook blade marks.
The realization of what I was seeing hit me hard – a
physical blow to my stomach that stopped my next breath. For a split second I felt
myself pulled back tight, like an elastic band stretched, as if leaving would
undo what had been done; and then just as abruptly with the next breath, snapped
back to reality.
So I started with what I knew.
Airway. Breathing. Circulation.
Everything around me became irrelevant. All I registered for
the next hour was the little person in front of me, Scotty on my right and the
obstetrics registrar on my left.
We decompressed a tension pneumothorax but even so the oxygen
saturation only climbed into the fifty’s. I knew a tube was unavoidable, but as
I started to explain to the obstetric sister how to mix intubation drugs for a
three-kilogram newborn, I realised in one breath the futility of the exercise
and the fact that any kind of anaesthetic at this point was probably going to
kill him.
So I haphazardly ticked that ICU intubation checklist in my
head (I now understand the exercise completely) and proceeded with an awake-intubation.
It is a cruel thing to do I’m sure – but it probably saved
his life. Because he never stopped breathing there was time to find his cords
amid all the blood at the back of his throat, time to watch them flick open and
slip the tube in without his oxygen levels plummeting and his hear rate
dropping to a virtual stop.
By this time Scotty had a drip up and was pushing a bolus of
fluid and just like that we had oxygen saturation of 98% and a trace on the
monitor. I think we laughed at this point because a sigh of relief was not big
enough.
In the process though hands came off his neck. Fingers
stopped plugging holes and it was less than ten minutes and we were losing our
circulation again.
We tried pressure bandaging, which didn’t work. I didn’t have any other ideas.
A second fluid bolus settled things for a few minutes again
and the realisation that we had blood.
Good old un-typed, O-negative, emergency blood.
It was probably about 6:45am.
At this point I decided my consultant had slept enough…
“Hi…so I’m dealing with a bit of a unique situation… I’ve
got a BBA here that I’m resuscitating…who’s been stabbed in the neck and the
chest.”
Silence…
Maybe a soft “ok”.
“I’ve tubed him and dripped him, I’m about to start
emergency blood… but I need you to come…”
“Ok.”
“I need someone to make phone calls, and write letters and I
just need more hands…”
“I’ll be there in 20 minutes”
There were still enough veins to get a second drip up. The
first bolus of blood made him pinker. He was textbook fluid responsive.
We managed to move him up to NICU where there were brief
moments of control, but mostly the growing sensation of sand slipping through
my fingers.
Too be honest, I don’t think I even considered that we were
actually going to save this baby. I only knew at each point what the next right
thing was to do and in this resuscitation the next right thing involved a
vascular surgeon. I was out of options on this end. I could only keep running
through ABCD, looping back again and again, like a song stuck in your head,
until we reached the point where the blood that was saving him turned toxic. I
knew when we crossed that line we would not be able to pull him back across. I
also knew that that was the only way I was going to stop fighting.
My consultant arrived and got hold of the surgeon at Red
Cross*. The trauma team knew we were incoming. I told them to let ICU know. The
flying squad was booked.
The responses were always the same.
“I need to transfer a 1 day old baby”
“What’s the diagnosis?”
“Stab neck and chest”
“Excuse me?”
“Yes… ”
Around 8:30/9am
“So it’s true?” the paramedic said when he arrived for the
pick-up.
By this stage my baby was bleeding not just from his wounds but
also from his drip sites and his nose. If we hadn’t already crossed the line,
we were walking dangerously close to it. I had given him a whole adult bag of
blood (just under one and half times his normal blood volume) to try stay on
top of his circulation, but in the process I had flushed out most of his hope
of clotting. On the gas his pH was undetectably low, his lactate was undetectably
high, his potassium was approaching double digits. We were hovering perilously
close to a cardiac arrest. I was flabbergasted that we hadn’t seen one already.
My consultant went with in the ambulance so someone could
keep pressure on the neck for transfer.
I watched them go certain he would die… if not in the ambulance,
not long after he got to Red Cross.
I was sure he was never going to make it to theatre.
As the adrenaline rush tapered, like the tide being sucked
out slowly before the tsunami rushes, the magnitude of what had just happened
hit me when I walked into the on call room. The city was only just stirring on
New Years day. No one I could think to call would possibly be awake yet. Those
who were, were all working like me. In the silence I felt heavy and tired, sad
and angry and defeated.
I worried about Scotty, who was still so new in this
profession and not yet conditioned to the violence that we had just witnessed.
Even worse, there was actually so little to say. These are the moments you must
wrestle through in your own mind and decide to keep going despite them in this
job. Often you must do it without being able to really understand how something
like this happened. There are often no answers about motive and means. You
write a chapter in the story, but you never see it as a whole.
I have deliberately left out the who, the how and the why
because the bits and pieces I have heard are jagged and broken, and mostly
speculation and conjecture.
I left somewhere between 11am and middday. In the hours that
followed there was a bit of sleep, a few phone calls, and a fair amount of
tears. I knew no one would be surprised if I didn’t show up for work on the
Friday.
The details of what happened on the other side I know from
what others have told me.
Not long after he arrived, his heart stopped.
As far as I know, three paediatricians, at least two
surgeons, a trauma doctor and an anaesthetist resuscitated my baby.
After twenty minutes there was some debate as to whether
letting him go would be kinder, but for reasons only a Red Cross doctor can
explain, no one would make the call. After forty minutes, there wasn’t much of
a pulse, but there was a heartbeat, so they took him to theatre.
Altogether the surgeons stitched up twenty-two wounds.
Neither of his carotid arteries were touched but both of his
external jugulars had been hit. His trachea was fine; the bubbles must have
been coming from his lung. The wound on his abdomen hit nothing.
Almost 12 hours after he was probably born, he made it to
ICU. His blood pressure was too low. His blood wouldn’t clot. His kidneys and
liver stopped completely and he needed dialysis. His lungs looked horrible. He
started having seizures.
No one could quite understand how he was alive. No one expected
him to survive.
He proved us all wrong in the end and just kept going.
After two weeks his kidneys and his liver turned around.
After three weeks he came off the ventilator.
After a month he made it into the general ward.
After two he was discharged into a place of safety.
I saw him after about three months when a friend spotted him
at a follow-up clinic and called me. He
was still so little, but he smiled.
A year down the line one of the loveliest ICU sisters is
fostering him and in her home he has fattened up and flourished.
He is chatting and crawling and full of little boy mischief.
His story is surely one of the happiest I ever get to tell.
His smiles and cuddles are the most precious I get to see.
Almost everyone I tell this story to say I saved his life –
but so much more saved this little boy.
Scotty saved him.
My consultant saved him.
The trauma team saved him.
The anaesthetist. The surgeons.
The ICU team saved him.
And in the end, it’s the family that have taken him and
loved him desperately and deeply that save him every day.
* Red Cross War
Memorial Children’s Hospital
