The Horror

The Sadness of a Father


The call came out as “chocking” some 14 miles away. “Damn, this is going to be bad or complete bullshit”…usually bullshit, either someone didn’t swallow right, or the drink went down the trachea causing the coughing and tracheal spasms we are all familiar with.

No other information came in as we are responding…

We arrive on scene and immediately, the ambulance sinks in the muddy driveway, we are stuck. I leave my partner to tend to the ambulance and call for an additional one for transport if needed, I gather the necessary equipment and walk calmly to the apartment…oh yea, we were never advised of an apartment number by dispatch. I was met by a middle aged man, not upset or unusually stressed, not rushing us, just calmly walking beside me trying to engage in small talk. Again, bringing my sense of urgency down to a normal level.

I walk into a Hell that no parent wants to find himself or herself in. A father, someone I know, is bent over his 2 month daughter and with tears rolling down his face, is doing mouth to mouth and chest compressions…

“Michael, she is not breathing. If anyone can save her, its you!...”

I immediately get in resuscitation mode. Quickly checking for a brachial pulse and other signs of life, my hands wrap around the chest of this perfectly formed infant and compress her heart between the sternum and the vertebrae of the thoracic spine. She is perfectly formed, looking so sweet, and except for the cyanosis around the face and the limp body, you would swear she was sleeping. No signs of trauma, no petieciea (sp) noted, just a perfectly formed dead infant…

My mind remembers holding Hannah Rae and Josie at this age…

Back to the task at hand, my mouth covering the infants mouth and nose as I breathe the 17% oxygen that is in my exhaled breath into the little lungs. Her chest rises, the air is getting in…my hands pressing against her chest and back, trying to get the perfusion pressure of her little heart up so blood will start to flow, all the while obtaining a history of the incident and a medical history, listening to key words…laid her down for a nap about an hour ago, came in not breathing, started CPR immediately…

I call for an additional ambulance for transport, get the infant oral airway sized and inserted, start ventilating with the infant bag valve mask and continue compression. My partner arrives and takes over CPR, I apply the cardiac monitor and see asystole, the absent of any electrical activity. No IV site immediately presenting itself and the infant’s neck is to fat for an external jugular cannulation…I immediately insert a pediatric intraosseous into the small leg of the infant, the IV fluids flowing…need a weight…estimate at 3.5-4 kgs…initiate Epinephrine every 3-4 minutes weight based…

“Michael, I did everything correctly. Why didn’t it work?”

Attempt to intubate the infant, her small glottic opening was so anterior, approximately at the level of C1 vertebrae that visualization of it wasn’t possible. The transport truck arrives and the medic walks in, seeing what I got and clears a path to the ambulance. I move to the ambulance, partner two steps behind me with equipment that is still attached to the infant, other equipment and trash left to be picked up in a bit…I continue the chest compression and the mouth to mouth to the ambulance…placed on the ambulance and the other medic attempts to intubate, the results the same as mine…we take turns with the chest compressions and ventilations, pushing the correct vasopressor medications, I place an NG tube…something new to paramedics in our area, except I place it in her mouth and withdraw approximately 60mLs of air from the small stomach of the child…her skin color immediately improved…I call our dispatch to notify receiving medical facility…”2 month old, 3-4 kgs, cardiac arrest, not intubated, IO, epi q 3-4 minutes, 6 rounds of meds so far, asystolic on monitor, placing NG tube now, ETA still 10-15 minutes…”

I hear the dad in the front seat of the ambulance crying quietly to himself…I can hear those quiet tears fall over the sound of the siren that is ringing through the rural air…the quiet converstation between a new and the season medics on the unit.

We arrive to the hospital with the ambulance door open and staff waiting. We calmly continue the resuscitation as we walk the infant into the primary resuscitation room, hand off the infant and I give my report to the ED doc…my hands are shaking from the norepinephrine neruotransmitters that have been released by my brain, sending my body into a severe fight or flight reaction, but my voice was calm and quiet…

40 minutes later, I walk with the ED doctor to tell this dad the bad news. As soon as he saw me and the ED doctor walking together he knew…and the strength that he had for the entire time of the resuscitation left him…and he became only a father.

I hold my friend for several minutes…a tear never left my duct…

Until now, 2 months later, writing about it…

We restock both units, complete the necessary patient care report, and go available for the next assignment…which came quick enough…grandma is bedconfined and needed transport back home…