I found his obituary today. Kids do not always have obituaries. I am not sure why. Perhaps it is because children are not supposed to die and no one quite knows what to say. Still, I always look for them.
His death was so unexpected. I have never seen a child become so sick so fast. I was the pediatrician covering the hospital ward that night. He was an eight-year-old boy admitted with an infection. By all accounts, the antibiotics were working, and he was improving. But by the time I walked into his room, part of me knew it was too late to save him. Still, all doctors have seen miracles.
I scroll through the photos on his memorial page. He looks so happy. So alive. I wonder what his little brother is doing right now as I sit alone in my kitchen looking at their photos.
I could see the jugular vein in his neck bounding from across the room. He was gasping for air. His heart was failing.
When one of my patients dies, I save their birthday on my phone. It has resulted in a calendar full of dead children. It helps me imagine their lives before we met. Blowing out candles on their last birthday cake, parents running around, stressed out but smiling. These imagined memories shield me from the intrusive memories of their deaths.
At his bedside, I silently repeated the mantra of any medical emergency, “airway, breathing, circulation.” Quickly – oxygen, IV fluids, antibiotics, labs, X-ray. This child needed more.
It was well past 2 a.m. when I finally looked into his mother’s eyes and introduced myself.
“I am the supervising pediatrician. It looks like your son has gotten much sicker. I am not exactly sure why, but we are calling the ICU doctors to help us.”
She nodded and mouthed OK, as tears began rolling down her face. A mother always knows when her child might be dying, before anyone explicitly says the words.
I still do not know exactly why he died. I have read every detail of his chart several times. I have searched the medical literature for his symptoms. I have not found an explanation that helps me sleep at night. This uncertainty is far more common than I ever anticipated when I embarked on a career in medicine.
Soon we will review his case at a morbidity and mortality conference. His autopsy results will be available by then. We will dissect every move by everyone on his team. We will decide if there is anything we could have done differently.
When the ICU team arrived, I stumbled through an explanation. I did not have a good one. He was stable just hours before. The team calmly observed the boy, processing the vital signs, watching his body struggle. Away from the mother, the ICU physician turned to me and whispered, ”He looks like shit.”
Within minutes, he was whisked to the ICU. Dozens of people joined in the desperate effort to save his life and support his family. For days a battle was waged. Slowly and quietly, one by one, each person eventually admitted defeat.
Yes. He most certainly did. I close my computer and pour my coffee before heading into the hospital for another night shift.
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