Wow, you look well…….
An opening gambit, a friendly utterance which if you’re lucky, promotes an instant feeling of wellbeing in your patient.
This time, it was said with complete, genuine enthusiasm, for next through the door was Amy, a ten year old I’d known from birth, an absolute fighter who had overcome the odds and survived numerous surgeries for hypoplastic left heart syndrome. She looked beautiful, bright, bubbly and full of vigour and Mum looked on with a beatific smile on her face, whilst the child she hadn’t thought would survive, described her symptoms of a ‘routine’ illness. Reassuring normality.
How different to the last child I’d tried to help with hypoplastic left heart syndrome…….
I was a few weeks into my Obs and Gynae SHO rotation.
Mrs Knight had gone into spontaneous labour. Although she had polyhydramnios (excessive amniotic fluid), all of her pregnancy scans had been normal, so we weren’t anticipating problems. The labour went perfectly, husband in attendance, another awe-inspiring but routine delivery anticipated. Final stage, final push and out popped Charlie, a petite, perfectly formed baby boy.
Perfect, except that he wouldn’t cry or respond. Nothing too unusual or untoward. We transferred him up onto the resuscitation unit, trying to elicit a cry, rubbing his skin, then oxygen until finally he pinked up a little. Had we heard a little mewling cry? Then nothing again……..emergency bleeps, an every growing number of healthcare professionals gathered around the little bed, paediatricians called, senior obstetricians descended, attempted ventilations by first junior, then more senior colleagues. Cardiac compression, mask ventilation, another attempt at tracheal ventilation. Endless cycles. Increasing desperation on the faces and in the actions of the doctors and nurses, whilst all the time, Charlie’s parents looked on, helpless and distraught.
We couldn’t resuscitate him. For a few seconds at a time he looked as if his colour was improving when he was given oxygen, but it was never sustained and after an hour, we had to admit defeat.
We moved The Knights to another room. They couldn’t bear to be in the same room as the body of their baby son. He was so beautiful, so perfect in every way, to all intents and purposes, just sleeping peacefully. We wrapped him in the shawl that they had brought with them and laid him in a moses basket.
I went and sat with The Knights and held her hand, husband angry, pacing the room, wife shattered, speechless, motionless, numbed with grief. “Would you like to see Charlie?”. They reacted in horror. To see him would be to accept that he had died, he couldn’t be dead, they wouldn’t let him. We sat. I tried again. “He’s so beautiful, would you like me to at least bring him in so you can see him, you don’t have to hold him.”
I carried the moses basket in and put it at the foot of the bed. Gently I lifted their lovely little boy out, swaddled tightly in his shawl. He looked so peaceful, they wanted him so badly to just be asleep. I sat next to them and cradled Charlie in my arms. Stolen glances towards the bundle in my arms, then Mrs Knight could bear it no longer. “Can I hold him now?”
I left them, Charlie in his Mother’s arms and with Dad’s arms wrapped tightly round the two of them…..
Charlie, postmortem was diagnosed with Hypoplastic Left Heart Syndrome & Tracheo-oesophageal Fistula, hence the difficulties in ventilation and his momentary resuscitation improvement.
Learning and practising medicine is full of highs and lows. Some memories stay with you forever…..