What you learn when your son dies

It was a typical, frantic night at the hospital for this young intern. Then she walked through the doors of the ED.

May 19, 2006
By: Delbe Meelhuysen, MD
Medical Economics (Original Source)

It was 12:30 a.m. and I was exhausted, as only an intern can be. My first day on call on the cardiology and C-ICU service had been difficult, and I was eager to get this last patient tucked in, so I could place myself in a horizontal position for a few brief moments.

As I sat reviewing the chart, the sirens blaring outside the windows caught my attention. Whoa, it's busy tonight, I thought. Glad I'm not in the ED.

A nurse interrupted my thoughts. "They want you in the emergency department," she said urgently. I glanced around; my supervising resident was nowhere to be seen. No surprise there, I thought. He'd been MIA all day, leaving me to do all the charting and patient care.

Frustrated and angry, I retorted, "The supervising resident does the cardiology consults in the ED. I'm the intern. Page him."

"No," she repeated, "They said to have you come."

"Who are they?" I asked.

"I don't know." She shrugged her shoulders and walked off.

I stomped down the hall to the elevators, seething. I can't take any more, I said to myself. God, I'm so tired. Why can't they just leave me alone? Why do I have to do the resident's work?

The ED was the zoo I expected. Securing the attention of the overworked ward secretaries, I said, "I'm Dr. Meelhuysen, from the cardiology service. What patient did you want me to see?"

Three blank faces stared at me. They all verified that no one had paged anyone from the cardiology service. Overwhelmed by frustration and anger, I turned to leave.

On the way out, I paused in the doorway to the cardiac room. My gaze landed on the still figure on the far gurney. Well, it looks like that guy didn't make it, I thought. My glance then turned to the frenzied activity at the closer gurney. Why are they coding that baby? I wondered. He's dead.

Suddenly, I noticed somethinga familiar blue sleeper. No, I thought, it couldn't be. There must have been hundreds of those blue sleepers sold at Mervyns a few months ago when I'd bought one. But it sure did look like the sleeper I'd packed for my brother to dress my son Michael in when he went to bed.

Earlier in the week, my husband had had to leave unexpectedly on a business trip, so I'd asked my brother and his wife if they would watch our 2-month-old. They had agreed, to my great relief. It was the first time Michael had been cared for by someone other than me or my husband, and I was glad it was close family.

Thoughts raced through my head. Nothing made sense. In a daze, I tried to work my way around the code team, attempting unsuccessfully to sneak peeks at the center of attention. As I wormed my way around the team, I pelted them with questions, trying to figure out how a baby would get to the cardiac resuscitation room. "Where are the other people?" "Was there a bad car accident?" "How did the baby get here?"

No one answered me. Maybe there wasn't a car accident, I reasoned, and was comforted by the thought. Earlier in the evening, my brother and sister-in-law had brought Michael to the hospital for me to see. He had looked perfectly normal, healthy, and happy. The only way this could be my baby, I concluded, was if they had been in a car accident.

If only I could work my way around and see the face, then I would have that final confirmation that it wasn't my son. After what seemed an eternity, I finally made it to the head of the code table. But the face was unrecognizable with all of the tubes and tape and hands flying.

"What's the baby's name?" I finally asked.

"I don't know," replied one of the doctors crossly. "Would you shut up or leave the room? You're disrupting the code team."

"I, I, I think it's my baby," I stammered.

The code came to a screeching halt as 10 pairs of eyes stared at me in absolute horror. They all knew me. Then as abruptly as the code stopped, it started again. One of the nurses told me, "We don't know anything about the baby. All we know is that the sheriff and a paramedic responded to a local blue baby call and scooped and raced with the baby here. When they came running through the doors, we all left the other guy and started working on the baby." I watched, frozen in place.

Finally, a nurse came in and announced that the people whose house the baby was picked up at were here. I followed her out of the room. I had to know.

In moments, the double doors to the hallway swung open and I stared at the tear-stained faces of my brother and his wife. I staggered as the meaning of their presence hit me. It took my full concentration and sheer will just to stay upright.

Voices faded in and out in an ethereal hum. I heard my brother say, "If it's my fault, I'll kill myself." My focus shifted to concern for him and his wife. I assured him that it wasn't his fault and that these things happened. I asked for a quiet place for them, and we were shown to the empty nurses' lounge. Soon a sheriff joined us. In a daze, I answered his questions. "No, I didn't suspect any foul play." "No, he'd been perfectly healthy." "There were no known birth defects." "He'd been born a little early, but was still considered term."

When I couldn't handle any more questions, I went and watched the code. In and out I went, pacing back and forth. No one seemed to notice. No one tried to stop me. Finally, I sat in a chair behind the secretaries' desks where I could listen, but not watch.

I called my husband, frantically searching for words. Even though the code team was still going strong, I knew that things were dismal. Then I called a close friend and a pastor I knew for support. This was new for me. I was used to providing the comfort, not reaching out for it. Giving, not receiving. And it felt awkward.

My brain switched back and forth between the emotional and logical sides. What could have gone wrong? SIDS? A congenital defect? I grappled with a million random thoughts. The ED attending sat down across from me, discussing the case as if I were a colleague consulting on it. "The core body temperature was 91 degrees when the baby arrived." "We haven't gotten a spontaneous heartbeat yet." "We're artificially ventilating him." "We've coded him for 50 minutes." The information streamed in and out as my mind wrestled with the facts.

Left brain: Those numbers aren't compatible with life.

Right brain: Don't give up; try harder.

Left brain: If he survived, he'd be a vegetable; there has been too much hypoxic damage.

Right brain: Good grief, why are you telling me all of this?

Left brain. Right brain. Left brain. Right brain.

"What do you want us to do?" the attending finally asked. "Do you want us to continue? The team is willing to keep trying because it's your baby."

We discussed the code and the facts of the case as rationally as I was capable of. Finally, my left brain asked me, "Do you want to take care of a vegetable for the rest of your life, even if they do get the heart going again?" And the right brain shrieked, "NO! Don't give up!" But the words that came out were, "Call the code. Stop the code. If I can't have him the way he was, I don't want him at all."

Why did I say that? What a self-centered statement!

The ED attending sighed in relief, "I think that's the right thing to do," he stated and left to stop the code.

I asked for the phone and called my anxious husband. A half-hour had passed. "It's over," I said, verbalizing what I'd already known the first time I'd called.

I walked back into the too-quiet code room. It was empty except for two cold bodies and me. No one bothered me, except the assigned chaplain who walked in awkwardly and shifted nervously from foot to foot in the back of the room.

"Touch the baby," he instructed. "The grief books say it helps in the grief recovery later on."

No, I thought, I don't want to touch my baby. He's cold and hard, and babies are supposed to be warm and soft.

Dutifully, I touched my son. He was cold and hard and waxen. It was repulsive.

I asked to be left alone, and the chaplain, who seemed grateful to be excused, left. I sat there pondering, trying to figure out something that made sense. I prayed, because that was what I'd been raised to do. I asked God for a miracle. Silence. I asked God to raise my baby back to life. I heard a word being uttered. It was "No." Startled, I looked around the room. No other living person was present. Okay, I accept that, I thought. Just promise me that someday, you'll explain why.

Suddenly a sense of peace and calm came over me. How long I sat in the room, I don't know. Eventually the practical side of my brain woke me up out of my reverie. They're busy; they're going to need to clean things up, I said to myself. They probably need this room for other patients.

Then came the parade of law enforcement officials. There were going to be two investigations: a criminal and a coroner's. The words flew at me and bounced off, landing somewhere else in the room. "Where was my brother going to be? Where was I going to be?"

Good question, I thought. Where does one go after losing a son? What does one do after losing a son?

Finally, someone suggested that I go home for the rest of the night. What do I do with my pagers? I thought. I don't want the nurses to get mad if I don't answer my pager.

I called my supervising resident. It was now about 2 or 3 in the morning. He seemed irritated to be awakened by my call. Although I suspected that he'd already been told, I explained that my son had just died in the ED and that I needed to go home.

"Are you going to take the rest of the night off?" he asked incredulously, more concerned that he'd have to round on all the patients without me.

At first, my left-brain almost responded, "Of course I'm not taking the rest of the night off. I'll stay and help." Then my right brain kicked in and I got angry. Reluctantly, he agreed to take my code pager. I made my way up to the resident sleeping quarters and handed it over. He took it gruffly and shut the door.

Because my family wouldn't let me go home alone, I spent the rest of the night sitting, unable to sleep, on my sister-in-law's couch hugging pictures. Morning came ever so slowly. But it came.

I learned a lot about being a person and a physician that night. I experienced, in a dramatic and personal way, the intensity of life and death, of grief and suffering. Having a baby changed me a little. Having a baby die changed me a lot. As I've reflected over the years on the experience, I have come to be grateful for the personal growth, the lessons learned, and the insights gained.