A pediatric intensivist offers reflections on a moving piece from the NEJM.
As I read this beautifully written, poignant article in the NEJM, in which Torree McGowan so perfectly describes the controlled chaos in the ED during the resuscitation of a critically ill, abused infant—her own anxiety, the parents’ distraught cries, the stark description of the critically ill child, I felt a pressure in the pit of my stomach, my own anxiety crept over me, my heart rate rose, my hands almost trembling.
I know this feeling. I have experienced it many times before during the resuscitation of critically ill children in the emergency room and pediatric intensive care unit where I am an attending intensivist. Although I am experienced, this feeling has not gone away over the years. I still have to calm my inwardly trembling hands and slow my breathing to intubate a dying child.
The author describes how the infant slowly responded to the resuscitation, “ your heart beat…ticked along…The pupils in your beautiful blue eyes shrank back, evenly sized once again.” How gratifying and miraculous for the team to see their efforts so rewarded. It is this resilience of children, their ability to look death in the face and then turn around, their back to it, that made me become a pediatric subspecialist many years ago.
The last two paragraphs of the article brought me to tears. This cri de coeur, this soulful prayer, “will you forgive me for saving you,” rips a veil covering me and exposes an ever present worry and fear after resuscitating a critically ill child.
Did I save you only to condemn you and your family to a life of burden and suffering? In the urgency of a resuscitation the intensivist response is to do what one can to save a life. Prognostication is not often clear in the midst of an emergency, frenetic resuscitation, and we do everything possible to save a life.
It is only later that I question as I lie awake at night. Have we saved you for a good life?