But, she was fine this morning!

  1. 50

    Pediatric code, upset parents, nurse facing her own fears and breaking rules to help parents find closure.

    But, she was fine this morning!

    1.20 PM

    The red phone rang in the ER. This was the EMS line when they called with an incoming emergency.

    “South side ER. This is Nurse Annie. May I help you?”

    “Nurse Annie, Brian from EMS unit 134. We have a two year old female, found unresponsive at home; CPR in progress, ETA (estimated time of arrival) 4 minutes.”

    “Thank you Brian. See you in 4.Over.”

    I hung up and quietly announced,”Peds code, 2 year old female, CPR in progress, ETA 4minutes.”

    The team quickly swung into action. The code cart was pulled right to the stretcher. The suction, defibrillator and cardiac monitor turned on and ready, 2 nurses with IO/IV kits, NG, Foleys and emergency med box ready, and the registration clerk with her portable computer.

    The team gathered by the bedside as the doors swung open and the EMS team came through and was directed to Stretcher A1. The next hour passed as a blur and the team worked hard to save the young child’s life. The dad was allowed to sit at the side and sat quietly in a chair, tears coursing down his face as he clasped his hands convulsively and prayed. The monitor never picked up a rhythm throughout and after an hour the code was called off.

    The father was in a daze and kept repeating, “But she was fine this morning. How did this happen?” The rest of the family was in the waiting room waiting for the mother who was at school and had been notified.

    I triaged the child Sara as a tier 1(unresponsive, pulseless,) code and noticed that she had been in our ER the night before for cough, vomiting and fever. She had been given IV fluids, labs had been sent, CXR negative, urine negative, tolerated po and had been sent home at 5 am with a prescription for antibiotics as the white blood count was 14. The discharge note from the nurse read” Sara noted to be smiling, skipping up and down the hallways, tolerated apple juice and sent home with grandmother with discharge instructions on a BRAT (Banana, Rice, Apple sauce, Toast) diet with prescription for antibiotics. Grandmother verbalized understanding of discharge instructions”. EMS reported that the child was taken home after the ER visit and was fine and fell asleep on the sofa nursing on a bottle of milk around 12 noon. Mother had gone to school and grandma checked her around 1 pm and found her unresponsive. There was no one else at home. Dad was at work and came straight to the ER when grandma notified him. The mother was enroute to the hospital now. So what happened? This was definitely an ME (Medical Examiner) case.

    Sara’s body was moved to our isolation room where the family could grieve in private. It was almost 3 hours since she had been pronounced. The family came in quietly 2 by 2 as it was a very small room that fit a stretcher and 2 chairs only. All of a sudden the double doors swung open and I heard a scream.

    It was the mother and she was out of control. Screaming, cursing, crying hysterically and sweeping everything in her path. She grabbed a vase of flowers that a grateful patient had brought the staff and smashed it on the floor, then picked up a computer monitor that was on the nurses’ station and pulled it down. At no point did she go to the room where her daughter’s body was. By then, security came in and she was escorted out of the ER along with the rest of the family. No one was allowed back into the ED from that family. Luckily no one got hurt even though the ED was crowded. Sara’s body was sent to the morgue.

    The staff were all down emotionally as we were unable to save her and a child’s death always shook the most hardened ER RN’S armor. We pored through the chart looking for any signs that we missed from her previous visit but it looked like gastroenteritis and a slightly elevated white count without a known source. The only comfort we took was that we had tried our hardest to save Sara’s life even though she had been a DOA (dead on arrival).

    It was 10pm.

    One more hour, and my shift would end. I was sitting in my office going through the schedule when I got a call. The entire family was back; around 40 of them and they wanted to see Sara. As the evening ED manager, I had to handle this situation. Saying an internal prayer, I walked into the registration room and scoped the waiting room through the glass to gauge the mood. The family was subdued and I saw the parents. I called the security supervisor and asked him to have a few security guards inside the ED for easy access to the waiting room in case anything erupted.

    I went out to the waiting room and 40 pair of eyes swung my way. I went straight to the parents. The father recognized me. I introduced myself calmly and asked them how I could help them.

    The mother looked at me with tears in her eyes and whispered, “I want to see Sara. Please!”

    I told them, “I am so sorry you lost your daughter! She was taken to the morgue. She is not in the ER anymore.”

    “Can we go to the morgue?”

    “No. No one is allowed as per hospital policy. I am so sorry”

    They were distraught and kept begging me. Right next to the parents were the two grandmothers and would not take no for an answer. Finally I told them to have a seat and that I would come back. I then discussed with the Evening Nursing Supervisor and the Security Supervisor who basically told me to make the call and that they would support me. I went with the security supervisor and another guard to the morgue, put on gloves and mask. I pulled the drawer with the child out and unwrapped the head. Sara looked like she was sleeping.

    We then went back to the ED and I went back into the waiting room. I called the parents and grandmothers and told them that I would take the four of them only to the morgue. The rest of the family could not come. I told them straight up that I was putting my job on the line as the policy strictly prohibited visitors. I told them that they had to contain themselves as the morgue was in the sub-basement which was pretty far away from the ED in case anyone fainted or fell. They promised that they would not create any issues and we went down to the morgue accompanied by 4 security officers.

    The next 20 minutes was very hard to watch as they knelt by her drawer and cried and kissed her. I held back my sobs though tears ran down my cheeks as I watched that mother’s heart rending pain as she hugged her child in the drawer. A couple of times I thought that the grandmothers might faint and prayed earnestly that nothing happened. After half hour we shepherded them out and they waited as we closed the morgue door and wrapped her body and slid the drawer closed before joining them.

    As we walked back to the ED waiting room, the mother apologized for trashing the ED. The father thanked me and asked me to thank the staff for working hard to save their child. The entire family left and I thanked the security officers and huddled with the staff and informed them. Sara’s body was transported to the ME’s office by his team.

    I left around 12.30am and reached home around 1 am and went straight to the shower. Later in bed, I hugged my two year old daughter’s warm body and watched her breath in and out and thanked God for her life. I knew that even though this was one of the hardest days in my life as a Nurse Manager, I had done the right thing. As I mother, how could I refuse a mother’s plea? As a nurse, I could see beyond the anger to the grief of a loving mother who completely lost it when she heard that her daughter was dead.

    I got in big trouble for breaking the rules with the Medical Director and got a discipline for not following rules. It honestly did not change me in anyway as I would have done it again if needed (I didn’t tell them that!). My gut and my heart has always steered me in the right direction and it taught me to take a stand even if it is unpopular.

    The Medical Examiner’s report was that Sara had aspirated on the milk she drank while sleeping.

    Going to the morgue, seeing dead bodies and handling them was one of my biggest fears and I had to pray and ask God to take those images off my head. Recently, when my then two year old, now 11 year old daughter hugged me, I thought of little Sara who would have been the same age . I hope her family has regained some measure of peace after 9 years. I hugged my daughter back extra tightly for Sara’s mom.
    Last edit by spotangel on Jul 21
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    About spotangel, BSN, MSN

    Nurse, mother, wife, writer who feels that everyday is a precious gift. Never take life for granted. Loves God above all!

    Joined Mar '12; Posts: 196; Likes: 807.

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    25 Comments

  3. by   brownbook
    I am shaking, peds codes/death's and that she had been in the ER less than 24 hours earlier, I can't imagine a worse case. Thank you for sharing, I hope sharing the story also helps you deal with it.

    Your Medical Director is an idiot. I did the same thing, except (thankfully) with an elderly man who came in via ambulance, ACLS in progress. The code was called soon after arrival. Several family were there, they saw his body and left, I took him to our morgue. About two hours later an adult granddaughter came in and wanted to see him.

    Luckily I was the House Administrative Nurse, on the the 11 - 7 shift, so I had no one to answer to. I explained to the granddaughter that the morgue was old, not very pleasant, he would be on a metal slab. She still wanted to see him. I went ahead, made him a presentable, and brought her back. She was fine.

    I wonder if I broke some policy? I would have done it irregardless. That is the good part about working nights. No administrators around to mess things up!
  4. by   macawake
    The mother looked at me with tears in her eyes and whispered, “I want to see Sara. Please!”

    I told them, “I am so sorry you lost your daughter! She was taken to the morgue. She is not in the ER anymore.”

    “Can we go to the morgue?”

    “No. No one is allowed as per hospital policy. I am so sorry”

    We then went back to the ED and I went back into the waiting room. I called the parents and grandmothers and told them that I would take the four of them only to the morgue. The rest of the family could not come. I told them straight up that I was putting my job on the line as the policy strictly prohibited visitors. I told them that they had to contain themselves as the morgue was in the sub-basement which was pretty far away from the ED in case anyone fainted or fell. They promised that they would not create any issues and we went down to the morgue accompanied by 4 security officers.
    Of course you did the right thing. It would be downright cruel and inhumane to refuse a parent to see their child in this situation. I don't see how she could ever had begun the painful process of accepting that her two-year-old child has passed away if you hadn't let her see her.

    What was it that had you worried to break the rules in this case? Since you mention falling and fainting I'm guessing it's fear of law suits in case someone got injured during the trip to the morgue? As a European this is such an alien and absurd concept. Sometimes, and this was certainly such a time, common sense and basic human decency has to be the guiding light. If you were worried about the security aspect, not bringing all 40 family members along but choosing a smaller group consisting of the parents and the two grandmothers was in my opinion, a sound decision.

    I got in big trouble for breaking the rules with the Medical Director and got a discipline for not following rules.
    I simply cannot fathom that this happened. The monumental stupidity of it beggars belief.



    You did the right thing! As a nurse. As a human being.
  5. by   CardiacDork
    I cannot even fathom this. We recently had pediatric death in my adult ICU. Mind you, we are ADULT ICU Nurses. Some of us do adults because we clearly do not have the fortitude to deal with children.

    You did the right thing. You did the humane thing. Some rules, under some conditions, they are meant to be broken.
  6. by   3ringnursing
    I agree - you did the right thing. How could a mom be denied seeing her little girl who had just died? I would have done the same thing too.

    Your stories always put a lump in my throat - your way of writing always makes me feel as though I had been there witnessing the events you so eloquently describe.

    An ICU I worked at in the past had a strict no visitors under 14 y.o. policy. We had a woman who had been with us for about a month who had an infant < 1 y.o. She so badly missed her baby! Our unit was on the ground floor and had large windows that slid open sideways ... I remember taking pity on this poor woman (my own child was 3 y.o., so I could relate) and found myself participating in sneaking the baby in for a few minutes visit one day. The memory of closing the door, sliding open the window and accepting a baby in a car seat still is very clear in my mind over 20 years later.

    ... Less than a few months later I also agreed to sneak in a toy breed dog the same way to it's dying master. I still recall it's little tail wagging so fast it was a blur.

    Sometimes your heartstrings override rules.
  7. by   morte
    at this point it was a medico-legal case, they should not have been allowed to touch, that is probably part of the reason for the rules.
  8. by   blondy2061h
    Quote from 3ringnursing
    I agree - you did the right thing. How could a mom be denied seeing her little girl who had just died? I would have done the same thing too.

    Your stories always put a lump in my throat - your way of writing always makes me feel as though I had been there witnessing the events you so eloquently describe.

    An ICU I worked at in the past had a strict no visitors under 14 y.o. policy. We had a woman who had been with us for about a month who had an infant < 1 y.o. She so badly missed her baby! Our unit was on the ground floor and had large windows that slid open sideways ... I remember taking pity on this poor woman (my own child was 3 y.o., so I could relate) and found myself participating in sneaking the baby in for a few minutes visit one day. The memory of closing the door, sliding open the window and accepting a baby in a car seat still is very clear in my mind over 20 years later.

    ... Less than a few months later I also agreed to sneak in a toy breed dog the same way to it's dying master. I still recall it's little tail wagging so fast it was a blur.

    Sometimes your heartstrings override rules.
    You have to think that someone knew what they were doing putting those big, opening windows on the ground floor ICU.

    We never let pets into the BMTU due to infection control but we have rolled a few dying patients' beds into the waiting room.
  9. by   RobbiRN
    Quote from morte
    at this point it was a medico-legal case, they should not have been allowed to touch, that is probably part of the reason for the rules.
    First, thank you Spotangel for another touching, well-written story.

    I agree that from a human standpoint denying a parent the chance to say goodbye to a dead child is inconceivable. The legal world -- which is not necessarily right, rational or even sensible -- is often inhumane, but it has been granted authority. Morte may have a point.

    I was recently stuck between the family and the police following an unexpected death of a healthy adult. Two adult daughters were present and wanted to say goodbye to their mother, but they wanted to wait for another family member so they could all go in together. The officers told me that if the daughters wanted to come in there would be a limited opportunity because after the the ME accepted the case, the body would become part of a crime scene and they would not be able to see her. I immediately relayed the officer's explanation and the daughters chose to come with me. As soon as we entered the room the police move between us and the body and told us they could no longer come in. I argued in their behalf, asking if they could be there with the officers present if they didn't touch the body, but the police said it was an ME case now and no one was allowed in the room.

    The daughters waited in our quiet room for other family. When they finally left the ER, they hugged me and thanked me for doing my best to give them the chance to say goodbye. Can any of the legal people on here confirm the limits and timing of access in these cases?
  10. by   JKL33
    I must agree about the situation of it being a Peds ME case.

    That said, spotangel - you did a courageous and compassionate thing, and covered your bases as best you were aware at the time. Thank you for sharing this story.
  11. by   spotangel
    All peds death in the ED except for kids with bad medical/chronic issues get referred to the ME automatically in the ED I worked in.
    A lot of people touched Sara from grandma, EMS,ED staff to family who saw her after she was pronounced . So the issue was not tampering with evidence . The two issues were compassion and safety and to manage it.The same Hosp has a different policy now for morgue viewing but then strictly prohibited it.
    I knew I did the right thing but I was between a Nurse Manager who was extremely narrow minded and always tried to pull me down(She had a field day with this incident ) and a medical director who was into lot of shady stuff and did not like the fact that I was straight up. So I was not part of the in crowd--ever ! Incidentally the Medical director was fired a year later for something big and couple of years ago , the Nurse Manager was stripped off her title and is not allowed to work a management job anymore.So I have learned that God works in mysterious ways and don't fret anymore!
    Thank you for all the comments ! I am very humbled !
  12. by   spotangel
    I love it.That is exactly what I would do 3ring nursing!
  13. by   KelRN215
    In my experience, with peds deaths everything is done to the family's requests. When I worked inpatient we once had a child, I think he was in the 4-6 year old range, dying of a diffuse intrinsic pontine glioma (100% fatal brain tumor). Dad was adamant that he stay with the body until it was embalmed. He did not want the child's body transferred to the morgue because he would not have been allowed to stay in the morgue. The child died on the nigh shift and the funeral home was not available to pick him up in the middle of the night, I believe, or they could have but they would not have allowed Dad to stay with the body. We allowed the family to stay with the body in his hospital room all night and the Dad accompanied the nurses when they brought the body to be picked up by the funeral home at 6am.
  14. by   imenid37
    I was really touched by your story. Working in OB, I have seen my share of fetal/neonatal deaths. I remember a boy who was resuscitated and lived in a very compromised state for several years. The fact that we got him back was harder for his family than death. They were criticized for making him a no code when he was a toddler. He would be college age now. I think of him periodically and cry like I felt I wanted to when they placed his lifeless body on the warmer. You can't go back. You have to do what you feel is right at the time. Though very sad, you should be at peace because you did the right thing, rules or not. I admire your courage and compassion.

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