Traumatic day

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The kid was left for dead..what could they do?

Early into my clincal career I wound up working in a local Emergency Department. I’d like to say this was planned but actually it wasn’t. I needed the work and had not been appointed to any of the choice training schemes.

I was very grateful to a kindly human resources officer who knew I was looking for work and rang a day or so before I was supposed to start. A hastily arranged interview that night established that I was half way competent, probably reliable and could fill vacant graveyard shifts on the roster to prevent the only senior medic in the department being left perilously exposed. The job came with the benefit of much needed free accommodation.

Later I would be able to repay the HR angel when we unexpectedly came to be sitting uncomfortably opposite each other in a sexual health clinic awaiting our turn.

“Don’t people pop up in the oddest of places?” As a wedding ring was hastily being screwed back into place.

“Yes you do..err” not sure what to say and flushing deep fuschia.

“So this is your test of ability to keep a professional confidence then..”

“Totally assured..” as I hurried away clutching my bag of antibiotics thankful I only had myself to worry about.

It took me a while to find my feet in the ED but I quickly found out who to ask and who to avoid. One person I was warned about was a particularly intimidating individual who literally loomed large over the entire department. Monty (made me think of Python) was a nursing force to be reckoned with but clearly knew more than the rest of the junior medics put together.

This was in the ‘80s so predated the 90s era TV medi-docu-soaps on which so many hospitals subsequently seemed to model their styling. Think about it. When exactly did surgical scrubs become so de rigieur? Now its practically required to keep licenced in most organisations who aspire to be viewed as ‘world class’, and colour coded according to rank in the hierarchy, bit like the martial arts. Very cool, but does it serve any other purpose I wonder?

Monty chose to go his own way with a dentist-like sartorial air and the beligerance of a hungry polar bear.

His colleagues warned me not to cross him and also that he liked to spend an unhealthy amount of time in the children’s department, leading to innuendo and veiled accusations, none of which I ever saw any evidence in support of. To me he was just a very odd but committed character.

I had tried to avoid working with Monty but one Monday morning my luck catastrophically ran out.

Lounging around in the resuscitation room overseeing the stabilisation of an old lady who had come in with heart failure, my peace was suddenly broken by pounding footsteps and shouting from the back corridor. This was odd because patients normally only entered this area on trolleys from the opposite side pushed in by ambulance drivers keen to make their escape.

Monty burst in carrying what looked like a pile of dirty washing in both arms. As his arms parted to rest his bundle gently down on the trolley in front of me, I saw hands, arms and then a head flop backwards, lifeless.

“Don’t just stand there you idiot- crash trolley!”

I realised Monty’s bulging eyes were aimed at me as two more nurses rushed in behind him and got to work cutting away at a dirty grey tracksuit to reveal a child, not breathing or moving. Blue, cold, mottled limbs, pants wet with urine where he had lost control of his bladder as he went into cardiac arrest. I was momentarily flummoxed.

“NOW!!”

Kit rushed towards waiting hands as Monty cleared the kid’s mouth of vomit with one hand while getting ECG leads on with the other and shoving me to the top of the trolley with an order to suction out the airway and get a tube down. This was not my first cardiac arrest but it was my first trying to resuscitate a child. Same principles, smaller kit, and I was amazed to see vocal cords at first try and get the endotracheal tube in place to begin ventilating a painfully thin chest.

The ECG was flatlining, a cannula was inserted and the drugs went in: nothing. We carried on grimly, all the time Monty cursing the situation and begging the child to start himself up again:

“Come on! Come ON!..No, no ,no..Not another one.. COME ON!”

After a while an intensive care doctor arrived to help and someone said: “They were sniffing glue-his mates dragged him to the front door then legged it. Could have been down for quite a while..?”

We carried on for an hour, warming the kid up, IV fluids, more drugs, everything checked in case we had missed anything, a few DC shocks in case there was any shockable cardiac activity- everyone willing the cardiac monitor back to life. Nothing. I had checked the kid’s pupils in the first few minutes: his eyes were sunken, conjunctivae dry, pupils dilated and non-responsive, dead even before we got started on him.

Someone wondered out loud if it was time to stop. The kid was obviously dead. Monty shook his head and instructed us to carry on, but by 90 minutes everyone had had enough. We agreed to stop. Death time was declared, a blanket placed over the kid for dignity and we backed away from his lifeless body.

Monty stood there, shoulders down, one hand rubbing his eyes, the other resting on the kid’s forehead. “What a fucking waste of life..idiots..”

After a while someone started to clear up and make arrangements for the body to be moved out of resus and down to the mortuary. I wrote up the notes of events as best I could recall they had happened and asked whether any family had been located. They hadn’t. He had nothing on him and his ‘friends’ were long gone. Police had been notified and were checking schools for absentees-but were not optimistic: kids ‘like this’ tend to ‘skip school or get kicked out for causing trouble’, social servces did what they could but were often stretched out and up against ‘difficult families’.

I do not come from a priveleged background but was thankful for having stable parents who loved and believed in me, a warm house to grow up in, regular meals, decent clothes and a half decent school that saw potential in me. The dead kid on the trolley had none of these things and had paid the ultimate price for society not getting to grips with the inequalities that continue to plague us now. We all shared responsibility but everyone felt powerless.

A few days later Monty pulled me to one side:

“ You OK?”

“Yes why?”

“That arrest the other day..the kid.?”

“Yeah-horrible..” shaking my head but in all honesty I had already put it out of mind- distracted by long shifts and endless anxiety that I still knew way too little to competently deal with the endless stream of patients flooding in through always open Emergency Department doors.

“ He was 11”

“Right”

“It took us a day to find his so-called mother.” Shaking his head and spitting the words in contempt.

“Really? Was she not worried sick?”

“No: she said he was a ‘little shit’ and often went missing for days- thought he had ‘done one’ again and had other, bigger things to worry about.” I stood there trying, and failing, to process what he had just said.

“Was she not upset? Regretful,emotional, something?”

“No. One less mouth to feed I guess.” He patted me on the shoulder “here if you want to chat-might take you time to deal with this in your head. We all bear the scars of this crap. Well done for getting that tube in..” He sauntered off head down.

Monty was right. That was thirty years ago. I’m still processing. Kids are still dying on the streets and many of us do not even notice. Much of it is linked to social and economic deprivation, a careless and disempowered society spawning careless people some of whom have uncared for kids. Emergency Departments, the police and justice system, welfare officers and teachers left to pick up the pieces. We are not as sophisticated or evolved as we would all like to think.