Lessons from an Infant by Steven P. Arthur

In loving memory of my father, my friend, Lyle A. Arthur Jr.
A simple man, completely loved, and eternally missed.
Oct. 9, 1944-Nov. 21, 2016

Looking at her silent, motionless form on the queen-sized bed made her appear impossibly smaller than she already was. Brightened by the blush of the mid-morning sun, her balled up fists at level with her closed eyes and careless face, mimicked a serenity that only an infant can possess. She could’ve easily been mistaken for being asleep, but I knew she wasn’t. Ambulances and paramedics don’t get called for sleeping babies.

I was early spring in Oklahoma. We just shook off an especially cold winter, and were thankful of the reprieve. The past year had been a busy and exciting time for my wife, Christy, and me. Shortly after exchanging our vows, I graduated paramedic school and began my new career. Which enabled two very excited young adults to purchase out first home. But all of those great happenings paled in comparison to the blessed arrival of our healthy baby girl.

It was my day off and the three of us were outside enjoying the weather at our modest starter home, when the call came in. I was still laughing and smiling at something my daughter had done when I answered the phone. It was the emergency dispatcher from work and immediately I knew it couldn’t be good. As I watched my wife and daughter play in the yard, the dispatcher explained the situation. My smile faded.

The dispatcher said there was a 911 call for a child not breathing. The closest ambulance was responding but it was more than ten minutes away. Eons in paramedic time. Compounding the terrible situation, the small volunteer fire department that would normally respond was out of town on a brush fire. Fortunately, the local police had a unit en route, but I knew they were ill equipped and minimally trained to handle this type of emergency.

The dispatcher, a coworker and family friend, was aware that the emergency was just around the block from our home and asked me to first-respond.

While I threw on my work uniform, I relayed all this to my wife. It took no convincing her that I had to go. She was a new mother; she shared my urgency to help the baby and rushed me out the door.

So quick was the trip, that I arrived at the residence in my personal vehicle before it even had time to warm up. I hadn’t much to bring with me. Only my stethoscope and penlight, none of the basic equipment a paramedic relies on. Those things were still miles away in an ambulance speeding to my location.

I rushed up the concrete steps and found the baby’s mother at the front door, still on the phone with the dispatcher, who was giving her first aide instructions. Without hesitation, and only a quick glance at my uniform, she let me in. She spoke rapidly as she led me through the house. I don’t remember her exact words, but she was terrified.

In the master bedroom, the frantic mother stopped at the bed and stepped aside. And there she lay in a shaft of sunlight, six-month-old baby Abby.

If a paramedic cannot control his emotions and suppress the natural physical response to stress, his effectiveness is greatly reduced. This ability becomes easier as one gains confidence from years of experience. But as any honest paramedic will tell you—no matter how many years of training—children are the most terrifying and heartbreaking of patients. And I was still very new.

Anxious and petrified are words that still fail at what I was feeling. Abby was only a few months younger than my own daughter. The situation hit close to home, and I was without my usual equipment. I had to do something. I had to think back to the basics.

She was lying on her back wearing only a diaper. I placed my ear on the soft skin of her chest. I caught the familiar scent of baby powder and shampoo. I listened for breathing and a heartbeat. I found neither. With no pulse or respirations, this little girl was clinically dead. In medicine, there are two definitions of death. One is characterized by the cessation of breathing and heartbeat, which, if determined within a few minutes, can be remedied. The other definition is biological death. This is characterized by an extended period of cessation of bodily functions, and signs of this include lividity (a black and blue discoloration of the skin) and rigor mortis. Abby showed none of these signs. Abby’s mother had reported that the baby was fine an hour before when she was laid down for her nap. I knew Abby still had a really good chance.

I began the only thing I could do: cardiopulmonary resuscitation (CPR). Unlike performing CPR on an adult, which is surprisingly difficult and physically demanding, performing CPR on an infant is easy. The difficulty is more emotional.

I covered little Abby’s mouth and nose with my own mouth. I had to carefully deliver just a puff of what my own lung capacity was. It would have been very easy to accidentally rupture her lungs with too much of a rescue breath. Abby’s mother was justifiably distraught and helpless, so I had to perform both rescue breaths and chest compressions. Adult compressions are performed with both hands stacked and placed over the patient’s sternum, using most of one’s weight to depress the chest wall approximately two inches. The infant patient requires use of only two fingers: the index and middle fingers placed over the sternum and compressions of half an inch.

Although I had only been performing CPR for a few minutes, it felt like an eternity. I was so focused on Abby that when a city police officer walked into the room, I didn’t realize it until he asked if he could help. By the look on his face, I could tell he hoped I had it under control. I have never before witnessed big, tough men become more distressed or heroic than I have when a child is in danger.

I picked up Abby, carried her outside to the front seat of the officer’s car, then asked the officer to contact dispatch for an estimated time of arrival for the ambulance. If it didn’t arrive in the net few minutes, it was my intention to have the officer drive us to the hospital.
Only a minute later, with the officer still on the radio and me performing CPR, I heard the approaching siren.

Now, after many years of working in emergency services, most of the personal thrill of the lights and sirens of emergency vehicles has faded. But, that day, when I saw that big, top-heavy truck come screeching around the corner, and despite the odd sight of having only one technician and who that was, I couldn’t have been more happy and excited.

I quickly loaded Abby; we were off to the hospital.

I later learned that the responding ambulance was farther out of town than initially reported, so the owner of the ambulance company, still a licensed emergency technician himself, staffed a fully equipped back-up unit and drove it to the scene.

I was so relieved to be in a controlled and familiar environment. I knew where everything was and finally had all of my equipment: cardiac monitor and drugs, endotracheal tube with bag valve delivering 100% oxygen. The ride to the hospital took four minutes. It couldn’t have gone smoother. Absolute textbook treatment of an infant in cardiac arrest.

Because of the quick-thinking and competence of the emergency dispatcher, police, and the company-owner-turned-temporary-ambulance-driver, Abby was soon in the care of the superb hospital staff.

Everything went right.

But we lost.

Less than an hour after I first saw her still and silent form, Abby was pronounced dead. She was the unfortunate victim of sudden infant death syndrome (SIDS).

It’s been almost twenty years and thousands of patients since that day, but I still think about her from time to time. Especially when I consider my own daughter: healthy, bright, and full of life. I wonder what Abby would have been like if given the time, or what she would be doing with her life. Had they grown up together, would my daughter and Abby have been in the same classes, or cheerleaders on the same squad? Would they have been friends, or rivals for the same boy’s affection? The birth of my daughter matured me in many ways. But the loss of Abby was the first and most influential death that I have known.

Every life has value, meaning and impact no matter the duration. Abby’s little life was only a brief flash of brilliance, but she instilled in me that life, our very existence, is tenuous.

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