Black Thursday

It's never a good day when you arrive at work and everyone's scurrying about trying to deal with the aftermath of a dead baby - distraught parents, the missing Death Certificate pad (doesn't get used that often), where to put the body, seeking consent for a post-mortem, self-blame, and groggy, grumpy consultants (from being dragged out of bed at 5 in the morning).

But two deaths in one day - now that's almost turning into adult medicine. Baby A was admitted to the special care unit with hypoglycaemia. That resolved with nothing more than a bottle feed, but as he was sucking poorly, he had a nasogastric tube passed, and was fed hourly through that. All seemed well until 6 o'clock this evening, when he was found ashen and lifeless in his cot. The midwife immediately pushed the cot round to Intensive Care, and raised the alarm. I was in the next room, and was soon at the bedside leading the resuscitation. We bagged the baby and started chest compressions as his heart had stopped too. I intubated him fairly easily, and was able to get good chest movement. He had no IV lines in (he had been so well) so we gave him adrenaline through the tracheal tube. We even got a cardiac output back for a few seconds. But after half an hour (with one of the midwives trying to phone the consultant at home) it became clear that we weren't winning. So we stopped. That was actually the first time I've ever called the time of death in a resuscitation (belated, I know, having been working for 4 years) - being a mild sort of character, I usually get sidelined in these kinds of situations.

Then came the grim task of speaking to the parents. I'd never done that before (though have seen it done) either, not even with one of those crappy actors they hire for clinical exams. I decided to be direct. I started with the classic "I'm sorry, but I have extremely bad news" then said (after a calculated delay), simply, "your baby has died". I described briefly the (arguably heroic) measures of the resuscitation, and how they had unfortunately not succeeded in bringing the baby back. They cried. The midwife hugged mum and offered her some tissues. We just sat for a while, then I said I would leave them alone, but would come back at their request if they had questions, and encouraged them to come and see the baby.
It went OK, I suppose. I've been told (by a consultant paediatric oncologist) that if you're breaking bad news and you don't get a suitably negative reaction, then you aren't doing it right.