by Timothy Rhinehart
Christmastime 2023
“What’s that you’re choking on?”
I looked up. My cousin was talking to her daughter, seated in a highchair to my left. Around us was the bustle of the annual extended-family Christmas party. The one-year-old had coughed as she was cheerfully shoving a piece of ham into her mouth with toddler gusto.
I smiled. “She’s fine.”
“That’s okay,” she said matter-of-factly, turning back to what she was doing. “I’m sure you know how to do CPR.”
The past roared through my mind’s eye like a cataract. Suppressed horror, focus, deflation, utter emotional exhaustion swirled.
“Last time—” I started.
I paused. A few seconds later I spoke again quietly.
“I’d rather not do CPR on a baby again.”
“Again?” she said with inflection, accent lengthening into drawl for a brief second. Whether from distraction or mercy she let it drop and moved on to other things.
But I didn’t. And I continued to let the memory live as I watched my happy baby cousin.
Earlier This Year
2:05 AM
The ambulance entrance to the hospital is little more than a worn asphalt pad and a couple of glass doors leading to trauma and treatment rooms. There’s also a vending machine that only sometimes works. If there was no sign marking it as an ambulance bay, you wouldn’t guess it was there.
It was on a bench by this entrance that I found myself meditating in the middle of a warm summer night, shortly after 2 AM. I’d had some personal sadness on my mind that night., and because the Emergency Room isn’t a great place spiritual contemplation (even if that sometimes occurs within its halls under dire circumstances,) and since it was slow, I told my charge nurse that I needed to take a break and stepped outside to sit and enjoy the cool night air.
The night was still and tranquil, almost holy.
But it was pregnant with disaster.
I was interrupted by a radio transmission from a waiting ambulance with an open door across the lot.
“County, show us transporting to [the hospital] Code Three with a firefighter aboard.”
I perked up at that, my own thoughts momentarily forgotten. “Code Three” means lights and sirens, which due to the density of cars and pedestrians are actually not used as often as you would think in cities; this indicates a critical patient. The part about having a firefighter onboard added to this; it means the paramedic in the back needed significant help to complete critical tasks that couldn’t wait till the completion of transport to the hospital, and so they requested a fire department medic to accompany them.
I slowly stood up, stretched, put my hands in my pockets, and casually walked over to the ambulance. The paramedic was in the passenger seat, and I asked him if he’d be able to tell me what sort of patient his colleagues were bringing to us. He fumbled for his work phone, scrolled, and then opened up a notification that said CPR IN PROGRESS.
He looked at me. Nothing needed to be said. I nodded at him and turned to walk inside. I went to the nurse’s station and told our unit secretary that we were most likely about to get phone call and a report of a “Code Blue” (adult cardiac arrest) coming in. The charge nurse directed me to set up Bed 2 for resuscitation.
I was suddenly in an unexplainably good mood as I walked over and, with the slightest flourish, flipped the lights on. It may not make sense to someone who isn’t used to this kind of work, but I liked working adult cardiac arrests. The job of myself and the other in-hospital EMTs—specifically, to set the room up and rotate doing chest compressions—is absolutely critical, so now something had happened to make me useful and focused.
I began to move the adult crash cart from its usual spot over to the designated room. As I was doing so, the phone rang, and the unit secretary answered it.
That’ll be them, I thought, and I was right. Then only a moment later the Unit Secretary incredulously said two terrifying words—
“Four months?”
I stopped and looked over. He had frozen; everyone within earshot looked as well. The Charge Nurse looked at me. I mouthed pediatric? and she nodded. I wrestled the adult crash cart back into position and instead moved the pediatric cart into Bed 2. I cracked it open, switched on the cardiac monitor, then raced to the supply room to grab pediatric electrodes as the Unit Secretary called “Code Blue, Code White, Five Minutes” on the hospital intercom.
I paused in that supply room. I was shaking and more nervous than I’d been in a long time. I had never been a part of a pediatric cardiac arrest, that most dreaded of calls. Adult resuscitations are one thing; usually people are old or very chronically ill and ready to go. But a child? Only God could prepare me in this moment and so I begged Him to do so.
By the time I returned additional people were beginning to stream into the ER. Critical alerts (“Code Blue,” “Code White,” and “Rapid Response” calls) bring staff from most hospital departments per facility policy; members from the radiology, laboratory, and security departments were there, as well as the House Supervisor, a senior nurse who functions as the person in charge of the hospital. Everyone shows up so that assistance is easily extended and all efforts to help the patient go as smoothly as possible. Everyone was gloved and waiting. I stood outside the room door and to the right, next to one of the Respiratory Therapists. Other nurses and EMTs were there, as was the Physician.
Then she was here, a baby in a diaper, crisscrossed with small wires and tubes and having small compressions done on her very fast. The medics wheeled her in swiftly while giving a calm (if breathless) report. I stood next to the Physician, on the left of the charge and another RN, as two Respiratory Therapists applied oxygen and did chest compressions.
After a couple minutes we did our first pulse check. She had a pulse on the monitor, which was obviously good, but it was much too slow and so we kept up compressions. It was also too faint; we could feel no heartbeat in her wrists or legs, her heart was failing to perfuse. After pulse check the two Respiratory Therapists worked on and completed a successful intubation while I took over compressions.
It’s surreal, completely unforgettable doing CPR on a baby. I leaned over slightly and held her like I was going to pick her up facing me, her arms in the dips between my thumbs and index fingers, my thumbs gently but firmly and from opposite sides of her chest compressing around 120 times a minute. There was little resistance. At one point, to rest my thumbs, I switched to using one single index finger, pressing on her chest like I would a button.
As I was doing this, I was able to get my first good look at her. She had lovely brown eyes, and soft, pale-white skin; but otherwise, she was a tragically unhealthy child. She had a curious bruise that looked like it didn’t belong, and she had an unseemly lump on her head. Her hair was thin, too thin, as if she was cancer-stricken or geriatric. During another pulse check a nurse took her diaper off and let out an exclamation.
Someone had done something heinous to this baby. Someone had beat or or sexually assaulted or done something to her before she was brought here. Red bruises stood stark against the pale white of the rest of her skin. Nobody really addressed it; nobody needed to. It was obvious and equally unspeakable.
As chilling as that was, it didn’t matter much right now. What mattered most was trying to get her heart to work, so resuscitation continued. We had tried multiple drugs, but none would have lasting effect. Our hopes briefly rose when her heart responded positively to one specific medication and soared above a hundred beats per minute, but it wouldn’t hold; She was beating consistently only in the thirties without our assistance.
One of the Respiratory Therapists swore they could hear a heartbeat; he put his stethoscope on her chest and drummed his fingers for each beat he heard. Tap. Tap. Tap. But with no pulse in her legs or arms, her heart—even if it was beating—wasn’t getting oxygen to any other part of her body.
The Physician was clear-eyed in a manner that only comes from seeing this a hundred times over. He suggested we cease compressions but try a medication drip to see if her heart rate would raise and sustain itself with no more help; in effect, to shrug our shoulders and watch for a little bit. But the Charge Nurse—who also had seen this many times—suggested that further efforts were futile, and that we needed to stop completely, and avoid further damage to her body. Unspoken was the implication that the police would need to see her with as little additional desecration as possible. The Physician agreed.
We turned off the monitor, called a time of death, and filed out, leaving her and everything else to rest undisturbed till law enforcement arrived. It was shortly after 3 AM. From the first radio call to the end of life-saving efforts an eternal hour had passed.
More hours passed. The remainder of the night passed in a slow blur. Thankfully, there were no other critical patients to attend to.
Before the end of the shift, another EMT told me that the baby’s mother was in the lobby. My coworker told me I needed to see her face; “she’s got lipstick smeared all over it like she just F— in the back of her car.” By this time law enforcement had arrived and were beginning their investigation but had not informed her of her daughter’s death.
I found an excuse to walk out and through lobby, where I walked right by the only person who could have possibly been this baby’s mother. Her face was numb, her expression hollowed out. Our eyes met for the briefest moment and, while mine may have betrayed many things, hers told me nothing.
My shift ended, and I went home. I slept hard; there was nothing that could have kept me up after such a night. Around 5 PM I awoke to a text from a coworker—no words, just a screenshot of a news article: the woman whose eyes I had met had been arrested, and the authorities alleged that she had tortured her little baby to death. I also heard that it wasn’t her who called 911, but another of her children.
I sat there for a few minutes, unsure of what to say. Finally, I texted her back.
“It doesn’t make any sense.”
Christmastime 2023
I came back to the present. My baby cousin has moved on from ham to a Christmas cookie, which she was serenely crumbling over her face. It suddenly struck me that my little patient’s first birthday was—or would have been—yesterday.
I imagine her as she could have been. She is laughing, people are singing happy birthday to her as she turns one year old. Her birthday is around Christmas, so the house is decorated brightly and festively. An overexcited sibling blows out her candle for her. Her parents are there, smiling. She grins and shoves cake in her mouth.
There are no bruises, no lump on her head. Her mom is not now in prison for torture and child abuse leading to death. There are no confused and terrified siblings. The sirens do not scream through her neighborhood on her final night, there is no red and white lights painting the neighborhood, and there are no men in uniforms asking sad questions of her neighbors.
There is no tired EMT to pull a curtain, walk away and leave her heart to cease its final beating in a room alone.
I sighed. Yes, I would like to never do CPR on a baby again. More profoundly than that, I simply never want to fail again, to walk out of a room and concede the tug-of-war to death, to see my own limitations and those of modern medicine. Let me leave the trying to someone else. But if I stay in this career field, I know I will certainly do that again.
Can I do it? I know now that I can. I was focused and relaxed after she arrived and treatment began. I prepared the room correctly. I performed good compressions. I followed orders and stayed out of the way when others did their own tasks.
So yes, I can do it. But am I willing to try after failure? Am I willing to bear sadness and risk defeat because someone will regardless?
My baby cousin coughs again, looks at me and grins. She reaches out.
I smile, and it’s real.
Yes. I will try.
___________________________
Timothy Rhinehart is an EMT, college student, and aspiring Marine Corps Infantry Officer. His interests and hobbies include literature, theology, hiking, and running. He resides in Redding, California, and can often be spotted at one of the bookstores or coffee shops in the area. He writes book reviews, amateur short fiction, and personal essays on Substack at his newsletter, We Are The Times.
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