Skip to main content

Main menu

  • Home
  • Content
    • Current issue
    • Past issues
    • Early releases
    • Collections
    • Sections
    • Blog
    • Infographics & illustrations
    • Podcasts
    • COVID-19 Articles
  • Authors
    • Overview for authors
    • Submission guidelines
    • Submit a manuscript
    • Forms
    • Editorial process
    • Editorial policies
    • Peer review process
    • Publication fees
    • Reprint requests
    • Open access
  • CMA Members
    • Overview for members
    • Earn CPD Credits
    • Print copies of CMAJ
  • Subscribers
    • General information
    • View prices
  • Alerts
    • Email alerts
    • RSS
  • JAMC
    • À propos
    • Numéro en cours
    • Archives
    • Sections
    • Abonnement
    • Alertes
    • Trousse média 2022
  • CMAJ JOURNALS
    • CMAJ Open
    • CJS
    • JAMC
    • JPN

User menu

Search

  • Advanced search
CMAJ
  • CMAJ JOURNALS
    • CMAJ Open
    • CJS
    • JAMC
    • JPN
CMAJ

Advanced Search

  • Home
  • Content
    • Current issue
    • Past issues
    • Early releases
    • Collections
    • Sections
    • Blog
    • Infographics & illustrations
    • Podcasts
    • COVID-19 Articles
  • Authors
    • Overview for authors
    • Submission guidelines
    • Submit a manuscript
    • Forms
    • Editorial process
    • Editorial policies
    • Peer review process
    • Publication fees
    • Reprint requests
    • Open access
  • CMA Members
    • Overview for members
    • Earn CPD Credits
    • Print copies of CMAJ
  • Subscribers
    • General information
    • View prices
  • Alerts
    • Email alerts
    • RSS
  • JAMC
    • À propos
    • Numéro en cours
    • Archives
    • Sections
    • Abonnement
    • Alertes
    • Trousse média 2022
  • Visit CMAJ on Facebook
  • Follow CMAJ on Twitter
  • Follow CMAJ on Pinterest
  • Follow CMAJ on Youtube
  • Follow CMAJ on Instagram
Query

Query

CMAJ June 08, 2004 170 (12) 1880; DOI: https://doi.org/10.1503/cmaj.1031756
  • Article
  • Figures & Tables
  • Responses
  • Metrics
  • PDF
Loading

As part of my pre-shift prep I search for my stethoscope and wonder: Will it happen today? I exchange my sneakers for scrub shoes and think: Will it happen today? I caress my palm pilot, confirming it's there, and have the same thought again. And again as I pull laminated flowsheets from my pocket, reassuring myself that they're there, too.

Figure
  • Download figure
  • Open in new tab
  • Download powerpoint

Figure. Photo by: Anson Liaw

I'm speaking here of the pediatric code.

I'm not a code virgin. I've led dozens on adults and been part of a handful on kids. I've intubated infants, toddlers, prepubertals and adolescents. I have more than an understanding of PALS and NRP protocols — in fact, I can recite exactly how and when I am supposed to save every age group with drug, shock and tube.

I write this not out of arrogance, for I've memorized this information out of fear. I review the contents of the flowsheets before every shift, thinking this ritual will give me some kind of control over the possibility that a child will die in the department today. By knowing exactly what to do, I hope that I'll be a good leader, that I'll inspire confidence in staff, that I won't fumble out of ignorance and in that fumbling increase the fear that I will inevitably feel.

I think Will it happen today? because I know that, sooner or later, it will. As it did, last week. Several hours into the shift, my fear was gone, replaced with worry about the waiting room backlog. I remember considering breaking for lunch when static broke on the ambulance line and an attendant said, Two-year-old, grey, no respirations or heart sounds, ETA two minutes.

Those words aroused my greatest fear as a doctor; to unfreeze, I touched my laminated placards, which was no help. I saw people looking at me, expecting me to do something. And it was their expectation that put me into action. I called for extra nurses, pulled down the age-appropriate intubation kit, and taped the Breslow chart to the stretcher.

The child was delivered to the bay by the paramedic, cradled in his arms and set down on the stretcher so quickly and so gently that the paramedic seemed like a lithe quarterback taking in his own touchdown. The child's father followed with a heavy step. After telling us in a low voice that no one knew how long the child hadn't been breathing, the paramedic slowly stood back. The father stood sobbing, watching us work. The paramedic then took him to an alcove away from the fray.

There is a certain omniscience in such situations. Inserting the laryngoscope, I couldn't help but sweep the scene — the team intent on their tasks, the paramedic's hand on the father's back. And I saw past that moment to another part of my fear, the fear of telling a parent of my failure, as I probed this cool child and rocked the jaw open — all my strength and the kid was too stiff; I couldn't see where to put the endotracheal tube ...

That night, I looked in textbooks for the reason why I couldn't get the jaw to open properly, discovering: the masseter muscle is one of the first to clench in death.

I walked toward where the father and paramedic had gone, a comfortable room where families can relax. I looked at the father and told him that his child was dead. I paused after that, stood back, and waited.

As I stepped back, I understood where most of my fear was coming from. I have a daughter who's two, and I'm sure that every minute I spend memorizing protocols and flow diagrams is a voodoo minute warding off exactly the kind of situation this young father was in.

I'm not just afraid that it will happen; I'm afraid that it will happen to me.

— Dr. Ursus

PreviousNext
Back to top

In this issue

Canadian Medical Association Journal: 170 (12)
CMAJ
Vol. 170, Issue 12
8 Jun 2004
  • Table of Contents
  • Index by author

Article tools

Respond to this article
Print
Download PDF
Article Alerts
To sign up for email alerts or to access your current email alerts, enter your email address below:
Email Article

Thank you for your interest in spreading the word on CMAJ.

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
Query
(Your Name) has sent you a message from CMAJ
(Your Name) thought you would like to see the CMAJ web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Citation Tools
Query
CMAJ Jun 2004, 170 (12) 1880; DOI: 10.1503/cmaj.1031756

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
‍ Request Permissions
Share
Query
CMAJ Jun 2004, 170 (12) 1880; DOI: 10.1503/cmaj.1031756
Digg logo Reddit logo Twitter logo Facebook logo Google logo Mendeley logo
  • Tweet Widget
  • Facebook Like

Jump to section

  • Article
  • Figures & Tables
  • Responses
  • Metrics
  • PDF

Related Articles

  • No related articles found.
  • Google Scholar

Cited By...

  • No citing articles found.
  • Google Scholar

More in this TOC Section

  • Query
  • Query
  • Query
Show more Query

Similar Articles

Collections

  • Topics
    • Medical careers

 

View Latest Classified Ads

Content

  • Current issue
  • Past issues
  • Collections
  • Sections
  • Blog
  • Podcasts
  • Alerts
  • RSS
  • Early releases

Information for

  • Advertisers
  • Authors
  • Reviewers
  • CMA Members
  • Media
  • Reprint requests
  • Subscribers

About

  • General Information
  • Journal staff
  • Editorial Board
  • Advisory Panels
  • Governance Council
  • Journal Oversight
  • Careers
  • Contact
  • Copyright and Permissions
  • Accessibiity
  • CMA Civility Standards
CMAJ Group

Copyright 2022, CMA Impact Inc. or its licensors. All rights reserved. ISSN 1488-2329 (e) 0820-3946 (p)

All editorial matter in CMAJ represents the opinions of the authors and not necessarily those of the Canadian Medical Association or its subsidiaries.

To receive any of these resources in an accessible format, please contact us at CMAJ Group, 500-1410 Blair Towers Place, Ottawa ON, K1J 9B9; p: 1-888-855-2555; e: cmajgroup@cmaj.ca

Powered by HighWire