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.
