Journal of the American Academy of Physician Assistants:
Mindful Practice

A baby died

REED, HARRISON MMSc, PA

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Harrison Reed recently graduated from the Yale University School of Medicine Physician Associate Program.

A baby died yesterday.

It was tragic and sudden. No one on my medical team or in the baby's family expected the bad news when we sent him from our pediatric floor to the intensive care unit. Sure, his condition was complicated. The list of suspected illnesses included SCID, MAS, and other jumbles of letters that even the most scholarly students had to punch into their smartphones for a definition. His progress had stalled and we were concerned, absolutely, but he only left us for closer nursing supervision and rehydration. And he never came back.

I was not there when he died, but even the chart's cold description of the resuscitation effort left me nauseous. The details are not medically important anymore‐the mystery diagnosis is in the pathologist's hands now‐but there was so much blood, no one could tell where it came from. All we know is it ended up in his lungs, and he drowned. Someone told me they cleaned his body before the family saw it.

The senior residents tried to notify the interns and students, but some of us still found out this morning. Today, no one missed the morning meeting. We changed the topic from asthma or antibiotics or free coffee to discuss the death.

We sat in a circle of hard plastic chairs and exchanged a crossfire of blank stares. This was a briefing, one doctor announced, to discuss our feelings about the death of Baby Z. We answered with a roar of silence. There is no mnemonic to remember the steps of pouring one's heart out.

“Maybe someone can explain what happened, for those of us who don't know?”

Sure, that part was easy. This most mysterious diagnosis, which even the pending autopsy might not reveal, was easier to articulate than something as dumbfounding as human emotion. One resident began to explain the situation, and another chimed in. The attending physician added his expertise. Soon, the tension in the room was lightened by an intellectual scrimmage, something to stimulate that other region of the brain‐the one that wasn't so taxed by death.

Minutes passed, though, and tendrils of sentiment crept into the discussion. Still objective at first. “I think the family felt this.” “I think the other team thought this.” “These are my observations.” But 25 minutes into the discussion, someone finally offered their feelings.

“We all feel like we could have done something differently,” one resident said, with nods from his colleagues, “but we have to keep in mind that we made the best decisions with the information we had at the time.”

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We all agreed, of course, but tell that to the little voice of doubt in the back of our skulls. The brightest minds in the hospital had weighed in on the baby's treatment, and now they all shared a small part of death's burden.

“It's OK to cry,” a respected physician said.

One resident did. And then another. For most of us in the room, the first death on our watch was an adorable infant. That isn't supposed to happen. Not in this hospital. Not in pediatrics.

“These decisions, the ones we look back on and question, are not easy to make,” another physician said. “This job is not easy. You all are very brave for doing it.”

At the end of the meeting, students and residents hugged and cried. I couldn't digest the experience until I went home and slumped in front of my computer. I cried after I wrote a few paragraphs, though I do not know if it was from guilt or pity or just emotional exhaustion.

My colleagues may not want to discuss that day or how it affected them. But our response to the tragic death didn't make us unprofessional or soft. It made us human.

And when my child is sick, I want a human. JAAPA

© 2013 Lippincott Williams & Wilkins, Inc.

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