Nothing makes you more aware of your limitations as a healer than pronouncing a child dead. There is a moment in every code when we know that it is futile; the outcome is decided before our hands and lips stop moving, stop giving directions. In that moment, I would give anything to bring that child back.
Students and residents sometimes ask me, a veteran pediatric emergency physician, if “it” gets easier — “it” being dealing with the death of a child. I have always answered, “It doesn’t get easier; you just get better at dealing with it.” But the unsettling and honest truth is that “it” is getting harder for me.
Aaron Fortier. You died this month. Twelve hours after I treated you. You were so sick. And so loved. As I treated you in our resuscitation room, the love your parents had for you was overwhelming, humbling, somehow humiliating and embarrassing. My feeble medical manoeuvres could not compete with their love. And yet, they turned to me in their time of need; their wordless eyes begged me to do something heroic. But I had nothing that matched their faith. I had fluids, and antibiotics, and vasopressors, and monitors. My medicine needed to rise to the same power as their devotion to you. But it could not. And less than a day later, you died in the intensive care unit from gram-negative sepsis, leaving broken hearts and souls strewn at your bedside.
I called your parents 10 days later. Foolishly, I thought this might be far enough along that they might be ready to talk to me. How naive and selfish. Your mother couldn’t bring herself to come to the phone. Your father was so gracious when he answered. I was immediately mortified that I had forced him to acknowledge your death. Again. They had just come back from your funeral services. And yet, he thanked me for calling.
I’m not entirely sure why I was compelled to call. Ostensibly, I called to relay my condolences for the loss of their three-year- old baby boy. And I did. I told your father that his family’s love for you was palpable at the bedside. I told him that your family’s love moved me, even in the short time that I witnessed it. I told him I would pray for your family, for their inner peace. But truthfully, I called for me. For closure. For some kind of reassurance that your family did not hold me responsible for your death. As if that mattered to anyone but me.
In my mind, I see the face of every mother of every child who has died under my care in my emergency department. Their features may have blurred, but their wild eyes still pierce my heart, and their screams haunt me. No matter what their culture, religion, background or race, every mother’s anguished cry sounds the same when you tell her that her child has died. For all the ways humanity seems to enjoy parsing itself, the death of a child seems to be the tragic equalizer. We are united in the expression of our primal grief.
I thought it clichéd that being a parent myself might make this job harder. Now I know that, at least for me, it is true. Looking at my children’s sweet faces leaves me vulnerable and raw. Knowing that fate and sheer luck left them in their beds instead of a resuscitation room tonight renders me weak. But feeding them, loving them and empowering them to make wise choices returns some sense of control to the chaos that my chosen career brings to my perception of the world. What I didn’t expect is that being an “emerg doc–parent” would also provide me with a place to refill my soul. Each heartbreaking story of loss may bring me to my knees, but it also forces me to stop moving and acknowledge all that I do have. And the tiny, healthy arms that hug my knees goodbye on being discharged home ease my soul and reassure me that I am doing something right.
I struggle with the death of every child who passes through my hands — hands that were meant to heal. Hands that resist checking a pulse for the last time, because I just don’t want to believe it is really over. So, I had a choice to make: stop working in emergency medicine or figure out how to move past the inner paralysis. A wise oncologist once said, “Do not try to make sense of a child’s death. You will never be able to, and you will lose yourself trying.” So, instead, I focus on forgiveness and grace. I forgive myself for not saving every life. I take space to heal and reflect, and allow myself to let go of some of the pain and self-judgment, so I can return the next day. I remind myself that it is a privilege to be present at this family’s most vulnerable and terrible moment. That I am blessed to have the knowledge to sometimes save a life with these hands. That I am humbled to be reminded that other forces are at play — forces that I neither fully understand nor control. Forces that deny me the privilege of saving every single baby who passes through these tired hands. And that I choose to do this each day because I can’t imagine doing anything else.
Acknowledgements
The author would like to thank Aaron Fortier and his family for their permission to share Aaron’s story and his impact on her. The author would especially like to thank Rachell Fortier, Aaron’s loving mother, who is strong and gracious and kind.
Footnotes
CMAJ Podcasts: audio reading at https://soundcloud.com/cmajpodcasts/171182-enc
This article has been peer reviewed.
This is a true story. Aaron’s parents have given their consent for this story to be told.
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