Dr Mohammad S Razai trained at University of Cambridge and is an Academic Clinical Fellow in Primary Care at St George’s University of London.
In the blink of an eye, the tide had become too high and the wind too strong. The child, who was playing moments earlier in the sandy devon beach, had disappeared from sight. He was sucked to the sea by a forceful magnetic current. By the time the lifeguards recovered him from the riptide, his body had become cold and lifeless. He had no blood pressure or pulse or any signs of breathing. That was what the paramedics told us, as they brought him into the resuscitation room, still doing chest compressions. Stretcher flying, doctors, nurses all crashing into the small chalky white room. The anaesthetist frantically setting up the equipment to put a tube down his airway to push air into his deflated lungs.
With an adrenaline tsunami raging through me, I found myself on top of a small body covered in fine sands and seaweed that glowed under the glare of the spotlights. It was my turn to do the cardiopulmonary resuscitation, continuously – for now. Six years of the most rigorous medical training and countless practice sessions on dummies could not have prepared me for the moment I found myself in. The life of a young child hanging on getting right the depth and rhythm of chest compressions – every single one of them. There was no time to lose, only time to make sure compressions were done well to maintain adequate supply of blood to the organs of his body. Trickles of cold sweat ran over my back and down my arms and legs, as I continued the CPR, too fixated to notice what was going on around me. I heard occasional noises and sensed a flurry of activity – then on count of two I received a command by a tap on the shoulder to stop and step aside. I was too exhausted to continue.
Moments before this I was having an ordinary day on the paediatric ward. Rushing around prescribing medications, looking at the observation charts, discussing a possible discharge, comforting a worried mother. Then something happened. A white noise from the bleeper was followed by a macabre voice: “Paediatric cardiac arrest, A&E resus.” I started racing, along with everyone else, towards A&E. A pregnant colleague who was determined to outpace us all, ran along the long corridor and nearly tripped over. She then looked at us breathless, distraught and said with a parched-throated voice: “my daughter was with the child minder.” With a quick glance across the small bay she immediately found out that it was not her daughter lying on that narrow bed. The child’s mother on the other hand was mute, with a blanket around her she was too shocked to say or do anything. She observed me carefully with a desolate, forlorn gaze as I wrote down everything – the time he was brought in, intubated, electrodes put on his chest, injections flushed through his veins. And the instant CPR was stopped. “Note the time of ROSC” said the team lead, which is the return of spontaneous circulation. I could feel weak carotid and femoral pulses on his neck and both sides of his groin.
That evening I walked home several miles in the dark without realising. When I finally went to bed, I could not slow down or switch off. As soon as I closed my eyes I saw images, not of the child fighting for his life on A&E stretcher, but my younger brother’s smiling face, the same age and body frame as him.
Many days passed, terrified, embarrassed I could not even take my own fright seriously. I was unwilling to come to terms with my feelings and the weakness I perceived in myself. How could I be affected by something like this? This is not what I thought I would do after a normal day at work: sobbing quietly into my pillow. The image of a self-possessed doctor going about his work with an imperturbable tranquility shattered in my eyes. Since that frenzied summer afternoon I have cared for patients whose fitful pulses slipped away forever and were never felt again. But that experience alone transformed me from someone bursting with youthful hubris to a doctor more aware of my feelings, weaknesses and limitations. Faced with the eviscerating, brutal and at times humbling reality of work on the frontline of NHS, I am trying hard to make a small difference. That is all I am capable of doing.