Tragedy

"Hurry to the ER! James! Run!" The familiar words come not in the usual African French but in the familiar English of our friends, Gary and Wendy Roberts as they whiz by the house on their motorcycle.

I'd just gotten up a little before 5:00am to write email when I heard the roar of the moto and the cries of the anguished parents.

I quickly pull on some scrubs and rush out the door where I run into Sarah who's just come to get me. She is just finishing up a night shift in the ER. It's about 6:00am.

The hospital is bathed with an early morning tranquility that would've been soothing on any other morning but this one.

I arrive at the ER and see Gary bent over his son, Caleb, giving him mouth to mouth as his pale, limp body wants to sink into the top of the desk he's lying on.

"He was still breathing as we were coming but he just stopped. He has no heart beat!"

I start giving chest compressions as I bark out orders to Sarah, Wendy, Koumabas, Hortance and Augustin who luckily happens to be there.

"Get some IV glucose and some IV tubing!"

"Someone look for an IV!"

"Call the lab for a hemoglobin and glucose check!"

"Get the pulse ox from the OR!"

As they rush off to find the material I look closer at Caleb. His body is flaccid, his face is pale and haggard, eyes closed, mouth half open, a mild gurgling coming out of his throat with each chest compression. He has no heart beat and his lungs sound filled with fluid. His belly is soft with an enlarged liver.

Gary takes over chest compressions as Hortance hands me the D5W attached to some IV tubing which I quickly insert under the skin of his stomach for a subcutaneous perfusion of glucose in case his blood sugar is low.

"Give him half an ampoule of IV furosemide IM.

Augustin is patiently searching for an IV on Caleb's small, white hands and arms. Sarah arrives with the pulse oximeter. We continue chest compressions. The O2 sat is 15%. I have Gary start rescue breathing again. The pulse ox stops working.

"Sarah, get some Adrenaline and Atropine from the OR!"

Still no IV.

"Koumabas, get me a blue IV catheter and a 5cc seringe!"

I keep doing compressions while Gary does two rescue breaths every 10 cardiac compressions.

Wendy has come back with an epi-pen and accidentally sticks her thumb with it instead of Caleb's leg.

Sarah gives Adrenaline and Atropine intramuscularly.

I listen and detect a faint, slow heart beat.

We continue CPR.

"Wendy, find me one of those small red, urine catheters in the OR so we can empty his bladder!"

Koumabas gives me the IV catheter with which I miraculously find his right femoral vein on the first try despite feeling no pulse and am able to thread the catheter in. I attach the IV glucose bottle and let it run in.

Meanwhile Mathieu has arrived and now has the results: hemoglobin a little low and blood sugar extremely low.

Wendy returns with the foley and Augustin drains Caleb's bladder. Calebs lungs are clearer. He still has a faint heartbeat.

"Sarah, inject the Adrenaline as rapidly as you can....now!" I quickly pump Caleb's heart has fast as I can with my external compressions to get the medicine to his heart.

"Sarah, take over chest compressions, I'm going to find some Magnesium in my office!"

The magnesium goes in the IV fluids and slowly trickles in.
Gary still does rescue breathing. Wendy offers to take over but Gary wants to keep going.

"Mathieu, can we do a Potassium?"

"Oui!"

I draw a milliliter of dark blood from Caleb's femoral vein and Mathieu hurries off to the lab.

CPR continues. We've been going for 40 minutes.

I listen to Caleb's chest. No heartbeat.

We continue CPR.

"Sarah, more atropine."

Gary speaks up after his 2 rescue breaths. "Should we stop?"

"Let's go just a little more."

Atropine is in. We continue CPR 5 more minutes.

I listen to Caleb's heart...

Nothing.

We stop.

Gary and Wendy collapse weeping into each others arms as sobs explode from within my chest. I grab Gary from the side my arm draped across his neck. Sarah is on the other side hugging Wendy.

Gary solemnly wraps up the still, little body.

"Do you want to use the van? We can drive you back home."

Gary turns to Wendy, "No, let's just put him between us on the motorcycle and go home."

"Anything we can do?"

"No, we just want some alone time. Then in the afternoon we'll have a service." The trudge out to the motorcycle, the quiet bundle in Gary's arms.

Tears streaming down my face I walk slowly back home thinking back to September 3, 2001 when I also found myself stopping CPR on someone I loved and sadly giving them up temporarily into God's hands. Just like then when I told my twin brother, "I know where you'll be...I just better make sure I'm there as well," I think the same thing about little Caleb and can't wait to see him again, maybe even by my brother David's side, when things are finally finished down here.

But, meanwhile, I'm back home sobbing like a baby. Sarah walks in and kneels down in front of me. We embrace and cry together. Outside, the wind is blowing, whipping up a storm. It starts to rain. God is crying too.