Thread by @tjwebbmd

Content Warning; death of a child.

I wanted to share about the single most salient experience I had deciding who I was as a physician from directly observing an attending. Tragically, it involved the death of a pediatric patient; a child about 18 months old.

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2/ I was an intern on the FM medicine service; our hospital didn't have any other residency programs, so we typically went to every Code because we were frequently more readily available than other doctors in the hospital, and often the first to arrive to help.

3/ One morning our team ran to a Code Blue in the ER; an EM doctor was leading the team when we arrived. My co-intern and I both had 18 month old children at home, the same size and age of the child we were trying to resuscitate. We were both assigned to chest compressions.

4/ The team worked well and diligently, but the child had been beyond our help before he arrived with EMS. Once this was clear, and the resuscitation had been going for a while and was into a stable rhythm, the EM attending asked another doc to take over. Then he left.

5/ He went to talk with the family, and he was gone for quite a while. After he returned, he summarized the clinical situation and the reality of the patient's condition. He briefly told us about his talk with the family and the decision to cease resuscitation efforts.

6/ He then asked if anyone on the team had any other ideas that might help this patient. He looked around the room, slowly, ensuring every single person had the opportunity to share if they had thought of something we should do or try but hadn't yet.

7/ Then he moved to just across from my co-intern and said he would take over compressions on the next cycle. After he took over, while doing chest compressions, he once more summarized the reality of the situation and the reasons to cease efforts. Then, he stopped.

8/ He had spoken to the family personally. He ensured that no one on the team had doubts about the situation or regrets about not speaking up. He made sure he was the last one to do chest compressions; the person whose cessation of effort meant accepting the death of the child.

9/ I still don't know if he knew that two of his team members were young doctors with 18 month old children, and that being the one to stop compressions would be incredibly traumatic for us. It was just his habit; the way he always did things in these terribly tragic situations.

10/ A few years ago I was working an ER shift and had the unenviable role of treating a patient and family in a very similar situation, with the same tragic outcome. This time I was the one to speak with the family, to call for ideas, to provide the final compressions.

11/ I was unspeakably grateful for that ER doctor then, because it meant I got to do for the family what he had done; make sure they heard the worst news of their lives directly from the person bearing the mantle of responsibility.

12/ And it meant I got to protect my staff as much as possible from doubt and regret, and protect one of them at least from the trauma of being the one to 'let go' of that small life with their own hands; so difficult even once we knew for a fact they could not be saved.

13/ Last week I taught our residents how to approach resuscitation; the communication tools, efficiency tips, and advanced techniques they should be building on their ACLS and PALS skills. But a big part of the talk focused on this; what does it mean to lead during a tragedy.

14/ Thank you to all of the leaders in medicine who model empathy and compassion; to patients, most importantly, but also to the staff, coworkers, and trainees on your team. You probably won't ever know all the ways your care and kindness reverberate in the lives of others.