Pedi call

The call came in as “Man Down”. It was the first one of the day, we had barely finished logging in from the parking lot and it was only 6:08 in the morning. It was chilly and grey as a thick blanket of fog sat over Oakland and it’s immediate suburbs. “Man Down” is a very common call and can mean anything from a bum taking a nap to a drug overdose to a murder victim to anything else you can come up with that would make you lay down outside. Quite often we arrive and the “man” is not only no longer down, but no longer anywhere to be found.

The labor is divided up on a dual medic unit such as the one that I was on that day. If you are driving, you are responsible for of course safely driving, any radio traffic, verbal reports, and filling out the daily activities log (or DAL). On scene you assist the paramedic that is the “patient medic” with various duties such as gurney manipulations, gathering vital signs, negotiating egress from the house, etc… If you are in the “hot seat” you are the patient person in charge of all patient care. You make all the decisions on patient care, destinations, and priority of transport. Before you get there, you are primarily the navigator and a second set of eyes as where the patient is located is not always as easy as it would seem. Today I was in “the hot seat.”

“Copy man down, show us enroute to the call” my partner Jeff replied into the CB microphone. We were both a little irritated that we didn’t get our first cup of coffee right after login, but this would probably be a quick cancellation and then we could get our caffeine levels up and possibly a tasty muffin to boot. Little did we know but the coffee would have to wait.

As we turned the corner to the street of dispatch, I noted the types of things I try and notice. The street was a dead end and probably not paved or repaired in the last 20 yrs. The lawns (if there) were not well kept and more used for storage for broken down cars. The housing was run down, single family and multi-plex units in need of paint. Probably lower to no income families. More often then not representative of a lower education level and high occupancy. All part of the picture.

The fire department had arrived before us, as usual, but they were all huddled in the street behind the engine. The sun was just starting to come up so it was difficult to see what they were doing. Probably putting their gear back together, I thought. I think my partner joked they were “working” the street meaning that they were performing CPR on the pavement. Typical medic humor, taking a cheap shot at the firefighters.

The first thing I saw was the soft, pastel yellow color. Just a flash of it through and elbow or knee of the hunkered down guys. Not a color I am used to seeing, especially in the street. It caught my attention. The captain looked up as we approached and his stare said everything to me; something was very, very wrong.

I was squinting to see as we rolled up, I could feel the muscles in my forehead tensing, but I still could not figure out what I was looking at. Suddenly for whatever reason it all became clear.

“Dude, it’s a baby.” I said.

“Shut up”

“No I’m serious, it’s a friggin’ baby. Son of a bitch” I said. Instantly I felt a cold sweat. I didn’t care about the coffee anymore.

“Bro, I have never run a pedi code” my partner said tentatively referring to our common contraction for pediatric, meaning child or baby.

“Me neither” I relied. “Let’s get at it” My door was open before we even stopped.

I was struggling to not allow the tunnel to close in on my vision. I knew in this neighborhood it was important to keep your eyes open and mouth shut or things could go south very quickly.

Pediatric CPR is very weird to see. We practice it all the time so it shouldn’t look so odd, but it does. It seems almost barbaric, but at the same time absurdly silly. Grown, muscle-bound men using two fingers to compress the chest of an infant they outweigh by over two-hundred pounds. The captain looked at me with a very concerned look, clipboard in hand. He had been collecting information from the gathering family who were standing in the gutter by the curb. Their sobs were audible. Palpable.

“Downtime?” was all I could come up with to say. As sad as this was, I could only serve this child and his family by getting these answers. After all, I had to pass the info on to the ER doctor.

“Unknown. The baby was warm, but pulseless, apneic, and cyanotic when we arrived. Last seen normal at bedtime last night”

The captain asked me what I wanted to do. The firefighter quietly suggested “calling it” on the down low so none of the family would hear. “Calling it” would mean that it was a lost cause and we would stop life-saving efforts.

That was not going to happen.

I looked up and saw a couple large SUVs pulling up filled with family members. These people were streaming out of their clown cars without shutting them off or closing doors. The extra light from their headlights was welcome, their menacing approach was not. Dressed in the uniform of the hood, long oversized white T-shirts, pants falling down, and tattoos. They were also very large people, even the women, Maybe Samoans or Tongans. I had a baby in the street, traffic backed up, and a crowd that was growing more and more agitated. The women went straight to the other women on the curb. The men were bee-lining for us with authority. Their disbelief and anguish converting to anger, the only emotion they are comfortable displaying in public. It was time to go.

“Let’s get the hell out of here.”

I scooped the kid up and we were driving in seconds. I took the firefighter with me to serve as an extra pair of hands and emotional support.

Enroute we were quickly doing everything that needed to be done. It was like clockwork. We both knew it was a lost cause, SIDS kids generally don’t come back, but still, we had to try. I suddenly realized I knew very little about this child. Our retreat had been so hasty, I did not even know the sex of the child.

The rest of the call was a blur and the patient was out of my hands and swarmed with emergency room personnel before I knew it.

The family arrived and the wails were too much, I had to leave the hospital. I went over to the fire engine that had followed us in. I locked gaze with the firefighter. There was nothing to say really. So we joked about something else. Perhaps the absurdity of the scene or the guys coming at us. We wrapped it up pretty quickly. Everyone was sizing each other up, but too much man to ask if we were all OK. The jokes were more a barometer and emotional release than humor.

I am having my second child this spring as I write this. I try to never put myself in the shoes of the people I serve. It is far too dangerous and I fear I may not make it back to me. I just hope I never have to know a day like that day.

Copyright 2010 Jon Kuppinger