In memory of the ones we couldn't save

Note: I wrote this a few years ago but it never made it to my blog. It's a long time (12 years) since I worked in the ER but some patients have stayed with me. Maybe all of the sad things are melded into this one memory, this one little boy. This child didn't get a chance to make his mark in the world. This child, and many others who suffer by those who should protect them. Unfortunately child abuse is still all too common.

I looked up from my stationary bike at the gym and noticed a woman in a squatting position, her back leaning against the wall - an exercise meant to strengthen one’s core, hamstrings and quads.  I remember hating this exercise in gym class in high school.  

Watching her, I had a flashback to an incident that happened somewhere in the early 80’s during a shift I was working as a pediatric ER nurse.  This memory came to me so clearly that I almost felt panicky as I began to pedal faster on the bike.  I felt cold and hot and like I couldn’t breath as I remembered this little boy and his short life.  I tried to look away from the woman and I wanted to yell at her to please stop.  

A young boy  - maybe four years old, was brought in by paramedics in full arrest - no heartbeat, or breathing.  The story was vague - that he fell and injured himself - I am not clear on the exact history we received from the caregiver.  I remember though, that the story was one where we all looked at each other and we all knew - another case of child abuse.  The child's condition was not supported by the story of a fall. We put that thought aside though and quickly went into action to try to save this poor little boy's life.

The little boy’s face was blue and he had no heart rate.  He was cold.  He had bruising on his abdomen.  We went through the usual resuscitative efforts trying to save him but he didn't respond.  The doctor wanted to rewarm him, thinking that maybe his coldness was contributing to his lack of response to the resuscitation and if we warmed him it would help.  The saying “no one is dead until they are warm and dead” was popular at that time and the effects of hypothermia and benefits of rewarming were just beginning to be understood. 

We gave the little boy warm IV fluids and used heat lamps to try to warm him. We used the very unscientific method of heating IV bags in our microwave as we didn’t have a fluid warmer - that came years later along with using bypass procedures to bring up the body temperature.    

 Now looking back on it, I respect how hard we worked to save this young life and many others we cared for.  That little body was becoming stiff despite our efforts.  Chest compressions were even more difficult and we realized we could not fight against the fact that he was gone.  No amount of rewarming would bring him back.  We reluctantly “called it”   meaning he was declared dead before he ever had a chance to really live.

It was this resuscitation process that I thought of as I saw the young girl squatting on the wall trying to strengthen her quads. Her squatting reminded me of what we later found out had happened to this little boy. That was the horrible part of the memory - not the resuscitation itself but what had been done to him to end his life.

The little boy had pooped in his pants which enraged his caretaker.  I am not sure if it was a dad, babysitter, or uncle or even if it was a man.  I hate to think a mother would do something like this but I have seen mothers do some pretty awful things too.  The caretaker forced the little boy  to sit against the wall in a squat position.  I am not sure how long it went on, but every time he fell over he was kicked in the stomach. It was long enough to cause his eventual death.  It was then and is now awful to think about how he must have suffered before he became unconscious. The autopsy showed that he had a ruptured bowel and internal bleeding from being kicked.  That is what killed him in the end and his caretaker waited too long to call 911 with some feeble story of a fall.

There was no debriefing after this incident. We didn't do that in those days - just went on to the next patient. In the ER there was always another patient waiting. It was hard to go from something like a resuscitation to another patient with a minor complaint and a parent complaining about the wait time. But we did it. I don’t know how any of us coped.  We all had our own way of dealing with what we saw. My way was to go home and hug my kids, my husband and my dog really tight.  And to go for a run. Thank God for running.

I saw many unimaginable things in my career.  Some of them have molded themselves into one horrible thing - one child who didn’t deserve what they got - one experience that I just had to put out of my mind.  You never know when they will come back to you and you never know what will trigger a memory.  I didn't expect a memory to be triggered at Planet Fitness by a girl doing squats.

As heartbreaking as this experience was and the memory of it is, I had to tell this story for a few reasons.  This little boy deserved more and who knows what he might have accomplished?  Maybe though he would have continued to suffer.  Child abuse is all too prevalent and we need to pay more attention to what is happening around us and to the children who are born and not wanted.  Too often we don’t want to be involved.  There’s a lot of efforts made to protect the unborn but we often fail children after they are born.

I tell this story because I want to remember that this little boy once lived and his life meant something.  I hope someone loved him and in his short life he had some kindness. I hope someone who maybe could have protected him is sorry and misses him.  

Second, I have renewed respect for my career as a nurse so many years ago when yet to be discovered technology didn’t allow us to save everyone.  I respect the doctors who worked along with us and had to make the horrible decision to “call it”.  I think of all the nurses I worked with over the years and what they carry with them - memories of children who didn’t need to die  We took care of  our little patients with the best technology at the time and contributed to the knowledge that exists today and saves many children who earlier could not be saved.  .  We also helped each other the best that we knew before there was a thing such as debriefing teams.   

No matter the technology, we can never save everyone.  We can honor their memory and know we did the best we knew how.  And we can continue to advocate for children and work to protect them from the adults who harm them. We also need to take care of ourselves so we can continue.

I wish I remembered his name.