I didn’t see it coming. The child was just a few years old, just learning to swim, and went under. He didn’t come up for 5 minutes when his mother jumped in and pulled him out. She had gone in to answer the phone and left him unattended. That is how it happens. Drownings. What I didn’t see coming was the consequence of my decision to heroically resuscitate him when he arrived at the hospital.
Heart rate slowing, medication given, heart rate climbing. Over and over again. I was not going to let this beat me. That heart rate was going to come back, period. No ifs, ands, or buts. I was in control. Me. My show, my decision. And it did. After close to an hour of CPR in the hospital and forty minutes at the pool, his heart was beating again. I won. But, I didn’t see it coming.
He survived, but with significant brain damage. He was alive, but had no chance of a meaningful life. He breathed on his own, but was unaware of his surroundings. He got a tracheostomy to help with his secretions and a permanent tube in his stomach to feed him. He went to a long-term care facility since the parents were unable to take care of him. I didn’t see it coming. I was too focused on the medicine part, getting a heart rate back, rather than on thinking of the consequences of heroic care. Sure, there a few times when heroic care yields a “save” and the “miracle” occurs. One never knows, so we push and push for a heart to beat again and pat ourselves on the back for doing so.
In covenant medicine, it is so important to think about not only the “what”, the illness or the catastrophic event, but the “who”, the person, the patient and how important it is to do our best to ensure that when the patient leaves the hospital that they will have a meaningful life. I didn’t come close to that with this little boy. I was too focused on winning the fight, to tell the parents that I saved their little boy, and to see their happiness. But, I didn’t see it coming.
On the day that the little boy got discharged from the hospital to go to the long term care facility the mother asked if she could talk to me. I was expecting thanks and gratitude for saving her little boy. I didn’t see it coming. She looked at me with angry eyes and said, “Why did you do it”? I didn’t reply. She said, “Why did you get his heart beating again? Look at him. That’s not him. You’re the doctor. You should have known that he would survive like this. You could have talked to us and told us what the possible consequences were. We trusted you to help us, to guide us. You never asked us what we would want for our little boy.”
I said nothing, because there was nothing to be said. She was right. I had acting on a “contract” to get a heart breathing again. That’s what is expected of me as a critical care physician. I should have had a “covenant” with my family and patient and been accountable and be present when present with them, making the best decisions to sure that that little boy would have a meaningful life, or make the hard decision that there was no chance of that and to let things be.
I didn’t see that mother’s anguish coming. I learned a hard lesson, and sometimes the hard taskmaster is someone else whom I’ve affected and who calls me out. She did. I write this not to say that I am never heroic anymore when a child comes in needing CPR. What I do however is to remember that every decision I make has a consequence and I own it always and forever. Resuscitating a child is no easy task. But if the question asked is “how long is long enough” in doing CPR, then maybe, just maybe, we will find ourselves being honest with the answer.