See One, Do One – 10th November 2007

See One, Do One

BMA News, 10th November 2007

Aidan M. O’Donnell.

Eight years ago I was the anaesthetic SHO on call one sunny Saturday in a DGH near you. A stand-by call came from A+E. A 7-year old boy had fallen out of a tree. CPR was in progress.

Hurriedly I prepared everything I thought I might need: endotracheal tubes, laryngoscopes, a selection of emergency drugs in paediatric dilutions. Meanwhile the rest of the resus team made their preparations in silence.

We exchanged worried glances while we waited for the ambulance to arrive. It seemed to take an eternity. The child had had a lengthy down time at the scene, and a lengthy trip in the ambulance: both extremely poor prognostic factors.

This was my first paediatric resuscitation as the lead anaesthetist, and my greatest worry was that I wouldn’t be able to secure the airway. Although he arrived in a hard collar and strapped to a spinal injury board, I intubated him easily. He was in asystolic cardiac arrest. We continued with the CPR.

After a short interval, his parents arrived. The senior A+E doctor allowed them into the resuscitation room to observe. It was clear that the boy was dead, and it was also clear that the parents could recognise this for themselves. They were hysterical with grief and shock.

As we continued with the resuscitation, poignant fragments of the boy’s life emerged from the parents. His name was Christopher, but they called him “Crisps”. He was the boldest of his friends; indeed he had climbed higher in the tree than the other boys had dared to go. He was crazy for the football team whose strip he was wearing. He stopped being a casualty and became a brave and beautiful little boy.

At one point, the Dad suddenly fished in his pocket for a few coins: perhaps a pound’s worth, and stepping forward, pressed the money into the boy’s hand.

“Here’s that money, son,” he said, quietly. Then, to me, he said “Make sure he keeps his money, will you, doctor?”

I nodded mutely, unable to reply. I never learned the significance of this gesture. Was it pocket money? Money he owed the boy? Perhaps some sort of bribe to make him come back?

We stopped the resuscitation when the lateral cervical spine X-ray showed a clear inch of daylight between his foramen magnum and his atlas vertebra. He had died the moment he hit the ground.

Despite all our training and experience, we are sometimes forced to be helpless witnesses to tragedies which unfold before us.

Aidan O’Donnell is a consultant anaesthetist from Livingston.

Copyright © Aidan O’Donnell 2007.
This article first appeared in BMA News on 10th November 2007.
Unauthorised reproduction prohibited.