The Night I Lost My Faith
by R. David Lee, MD
I'd always been a man of faith—a born-again,
Sunday school-teaching Christian who believed that
his religious grounding made him a better doctor.
But a dead baby can change everything.
Returning home after a long day at the office, I
called the hospital switchboard to sign off from
call duty. Still, minutes later, the phone rang.
"We need you here now!" Rick, the charge
nurse quavered. "We have a dying baby."
I raced along winding country roads. I wasn't a pediatrician
and I wasn't officially on call, but neither mattered.
In the medically underserved community I practice
in, family docs are expected to wear many hats, especially
in emergencies. Still, minutes away from becoming
a pediatric intensivist, I realized I hadn't assisted
in a pediatric code since I was a resident.
I'd witnessed my fair share of pediatric tragedies,
although mostly from a distance. As a third-year
medical student, for instance, I'd stood on a step
stool to get a better view of the residents and attending
physicians as they struggled unsuccessfully to save
a toddler who'd been struck by a car. Three years
later, I was moonlighting in a rural ED when we had
a dual trauma code—two young children murdered
by their psychotic father.
How did my faith fare during tragedies like these?
Back then, I managed to redirect my anger to an inattentive
driver or a mentally ill father, or to some other
responsible human agent.
As long as I could find "meanings" for
deaths, I was able to put a cushion around my God's
role. I ignored whisperings in my mind that suggested
that God was either responsible or He was irresponsible.
The second I set foot in the code room I knew that
I was in way over my head.
On the stretcher lay a neonate, her eyes closed,
two IVs in place. The nurse anesthetist had intubated
her and someone had administered atropine. The monitor
showed sinus rhythm at a rate of 50. I confirmed
the bradycardia and ordered chest compressions.
"We've called the chopper," the ED doctor
said. "They're
putting a crew together, and will call us back."The
90-minute ambulance ride to the university would
be a 15 minute trip by helicopter.
"Do we have a history?" I asked, examining
the baby.
"Two-week old, discharged from another hospital
this afternoon," the doctor replied. "Spent
the last week there with fevers of unknown origin,
but septic workup and cultures were negative. Her
pediatrician discontinued antibiotics this morning,
and she became afebrile. She was discharged home,
with a presumptive diagnosis of viral syndrome and
drug fever."
As he spoke, I checked the baby over, looking first
for signs of abuse. No bruising, bony deformities,
bulging fontanel, or retinal hemorrhages. I turned
to other matters. Femoral pulses were good with chest
compressions, absent without. Abdomen and thorax
were grossly normal. There was no withdrawal reflex
when I pinched her tiny feet, but her pupils were
responsive. Her skin was cold and mottled, but with
no obvious rash.
"Mom and dad had only been home from the hospital
a couple of hours when mom noticed that the baby
felt cold," the ED doctor continued. "She
attempted to get a rectal temp, but the thermometer
didn't register. That's when she called the other
hospital's ED, and they told her to bring the baby
right in. En route, dad noticed the child wasn't
breathing, so he started CPR. Since we're closer
than the other hospital, mom came here. Total down
time was about 10 minutes before we got her tubed
and the atropine on board."
"Let's get a blood gas," I said, stepping
out of the room.
A race against time When I returned, I was surprised
to see Jill, the head of respiratory therapy, at
the baby's bedside. She was trying, unsuccessfully,
to do a blood gas on the child's right femoral artery.
"You're supposed to be on vacation, aren't you?"
She smiled crookedly, indicating that Rick, the charge
nurse, was taking his usual casual approach to the
work schedule.
"Mind if I try the other leg?" It would
be my first blood gas on a neonate.
She nodded, and I positioned the ABG syringe, but
obtained only a drop of what I hoped was venous blood.
"Blood sugar's nine," I heard someone say,
and then ordered a nurse to add more dextrose to
the
mix of naltrexone and dextrose I'd ordered moments
earlier. I'd figured they couldn't hurt even if hypoglycemia
or narcotics didn't enter into the equation.
Suddenly, Rick's voice broke through the code room
din. "There's a thunderstorm over the mountain,
and the chopper is grounded. The university has a
peds team ready to come by ground. They should be
here in 90 minutes."
"No," I shot back. "We can get there
in the same amount of time, and I can run the code
in
the back of the ambulance just as well as I can here.
Jill, will you ride with me?"
She smiled her assent, and Rick announced, "We'll
have a driver for you in five minutes."
"Great," I said. "Are the parents
here?" Rick
said they were, and I left the code room to talk
to them.
"I'm Dr. Lee," I began. "We need to
get your baby to the university. She's in extremely
critical
condition. The helicopter can't fly tonight because
of the weather, so we're taking her by ambulance.
I'm going to ride with her. Would you like to see
her before we go?"
They said they would, and I led them toward their
daughter. As we walked, I cautioned them: "We
have a lot of tubes hooked up to your little girl.
We're doing CPR. This is going to be scary.
"What's your baby's name?" I whispered
as I pulled back the curtain, exposing a drama no
parent should
ever see.
"Her name is Lisa," the mother said.
"Come here and give Lisa a kiss before we leave," Jill
said.
Mom leaned over her newborn child, weeping, ignoring
the CPR, ignoring the endotracheal tube, ignoring
monitor alarms, ignoring frantic medical professionals.
For one moment, it was just mother and daughter.
"Be strong little angel," she wept. "You
have to be strong . . . for mommy. Oh God! Be strong,
be strong, be strong."
She kissed Lisa one more time, and then looked at
her husband, who was sobbing. He remained where he
was, shaking his head vigorously.
"Give your little girl a kiss goodbye before
we take her," Jill urged him.
But the father remained immobile, without the strength
or courage to do what his wife had just done.
Jill left the baby's side, walked over and put her
arm around him, gently pulling him toward his daughter. "Kiss
your little girl before we take her. Please. You
have to do this."
Trembling, Dad leaned over his little girl, the daughter
for whom he would never have a cute nickname, the
daughter he would never give away at her wedding,
and kissed her quickly.
As he did, my eyes met Jill's. We knew
that he and his wife would probably never see their Lisa alive
again.
We made the trip to the university hospital in less
than an hour. En route, Lisa's condition deteriorated
rapidly: Hematomas spread across her tiny body like
a rash. Blood oozed out of every pore and orifice.
Holding the ET tube in place with my left hand, I squeezed
the Ambubag with my right, and then rested it on Lisa's
forehead. As I did, a hematoma developed beneath it.
Disseminated intravascular coagulation laid to rest
any question about my patient's prognosis.
On the elevator, I studied my gloved hands, which were
dripping with Lisa's blood. I watched Jill's fingers
compress Lisa's bruised and broken chest. I had kept
her alive long enough for some other doctor to call
the code.
As we entered the PICU, a swarm of neonatologists and
pediatric intensivists surrounded us, transferring
Lisa from stretcher to incubator. I recounted the history
of the case while one of the specialists took over
the code.
"Start an epi drip and give her some bicarb," she
ordered a nurse.
Suddenly, as if on cue, Lisa's heart monitor flat-lined.
"Oh," said the specialist, turning to me with tears
in her eyes. "You've come all this way, and you've
tried so hard."
She looked back at Lisa's dead body.
"Let's give three milligrams of epinephrine, one to
ten-thousand bolus." She paused and shook her
head slowly.
Everything gradually stopped. Ventilations halted,
chest compressions ceased. A nurse turned off the monitor.
Quiet fell around Lisa's body.
And then Jill pushed her way to Lisa's bedside. As
we all watched, she used a damp cloth to wipe the blood
from the infant's delicate skin. Next, she wrapped
her in a receiving blanket, snuggling the baby's tiny
body to her chest. A nurse brought her a rocking chair,
and Jill sat, gently rocking, while we all stood around.
I didn't move until someone told me the family had
arrived.
I'm not a stupid man—I know how believers and
disbelievers would interpret the events of that horrible
evening. An atheist would say that Lisa's death didn't
destroy my faith, but rather served as a final crack
in an already shaky foundation. Believers would tell
me that instead of trying to decipher the meaning of
Lisa's death in the cosmic scheme of things, I should
just accept that God sometimes permits bad things to
happen for reasons beyond our comprehension.
Though I lack the insight to answer either party, I
do know that the emotional investment I bring to many
patient encounters is as much a liability as an asset.
I search constantly for answers, but I can't fathom
why this one particular death has affected me to this
degree; why this one baby's death has destroyed part
of my identity. Regardless, life is much simpler now
that God is no longer in the equation.
I searched longingly for a divine presence as I led
Lisa's parents to the room where Jill was holding their
lifeless baby, but I sensed nothing but an infinite
void. Mom gently removed Lisa from Jill's arms, dropping
to her knees and beseeching a divine benefactor for
help. I knew, at that moment, no one would hear her.
A world without God? Perhaps all doctors, like me,
are one dead baby away from atheism. Medicine, after
all, is a profession that leaves all of us who practice
it so spiritually vulnerable.
But a world without God isn't necessarily a world without
hope. When Jill nestled that lifeless baby in her arms,
steadfastly refusing to allow any of us to dehumanize
the child, I saw real kindness in her tears. When the
attending pediatric specialist called me two weeks
later with the autopsy results (disseminated herpes
simplex), she displayed an enviable human and professional
decency. And when Jill and I returned at 5:00 that
morning to the hugs and well wishes of staff, I felt
surrounded by people of goodwill. And I got a message
to call Rick, the charge nurse, at home. He was still
awake, waiting for my call. There was no mistaking
the love in his voice as we spoke.
There is kindness in this world. There is compassion
and decency. In a universe of death and suffering,
there are things that make existence worth our while.
In the heart of each person there is a penchant to
make one's environment a better place. There does not
need to be a God if we choose to exercise our proclivity
for decency.
If God is nothing more than an intangible concept that
motivates our hearts—a synonym for "love" and "kindness"—He
is more powerful than I ever imagined as a believer.
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