Ashen

"[Hospital] Base, this is medic 23. We are enroute to your facility code 2 with an ETA of about 4 minutes. On board today we've got a 9 month old male who is alert in no distress. Mom found him in his crib this morning, ashen and unresponsive. Upon our arrival patient was awake but not acting appropriately for himself, patient is extremely lethargic and still slightly pale. We have an o2 sat of 95% on 6 liters blow-by, pulse of 122. This patient has a trach, and is often seen in your facility. Unless you have further instructions, we'll see you in about 3. Medic 23 out."

"[Hospital] base copies medic 23, nothing further, please take your patient to room one on arrival."

While my internship took a small break, I had signed up for several shifts with the ER in the area to gain some more experience. I listened intently to the radio reports of other medics, hoping that I could figure out how to sound as calm and collected as they did. Often, the nurse taking down the report would point out to me the good and bad and give me pointers for when I was in the field.

"I think I know this patient. He's here all the time for respiratory problems." Was all the nurse said to me as she turned away from the radio and walked towards room 1. I followed her in, and soon enough the familiar stomp of tactical boots was coming down the hallway. What we didn't hear was a baby crying, which concerned me.

When they rounded the corner into the room, I looked first upon the face of the silent child. He was an odd shade of gray, and absolutely still and quiet. Sitting propped up in his car seat, his huge head lolled around but his eyes never met anything, never focused or tracked movement. It was the thousand yard stare, which I never wanted to see from such a small person. I almost didn't notice the mask that covered his trach, it was precariously placed around his neck and looked odd on such a small child. I've seen tracheostomy patients, even kids, but never 9 month old babies. There were lumps on his abdomen under his onsie, he obviously had a feeding tube as well. This was a chronically ill little boy.

The usual joking banter of the medics was replaced by a quiet concern as they gave report again to the nurse and doctor in the room. Their brows furrowed and faces worried, they explained that his mother had found him in his crib after a nap, completely gray and not responsive, but awake. Despite his illness, he was a happy baby. He made facial expressions, cried, cooed like other babies. But not today. Parents said he had not been ill lately, they suctioned his trach religiously and he had no secretions that were indicative of an infection or problem in his lungs. As they carefully placed him onto the hospital bed, he still made no attempt to move, squirm or cry. He sat like a doll in an awkward position on the bed.

The nurses began throwing equipment on the bed. The pediatric crash cart was placed close by, and the doctor spoke his orders out loud before leaving the room. As they tied tourniquets around his arms and legs to search for IV sites, one of the nurses told me I was welcome to try for an IV, but only if I knew I would get it immediately. I shook my head and declined. I knew it would have been good practice, but there was no way I could have gotten it immediately. I wasn't even sure I could get one at all. They stuck him at least 10 times. Each time, I expected him to scream, to cry, to move away or pull the offending extremity out of reach from the nurses. Each time, he sat as still as he had been, silent as ever. He never even looked up. The doctor finally decided to do an IO [intra-osseous, an IV in your bone just below your knee.] As he manually drilled the needle into the baby's leg, the baby flinched slightly, but relaxed immediately. We all looked at each other, knowing that this was not a good sign.

After discovering he had a temperature of 103, and all the necessary chest X-rays and such were completed, he was transferred to another hospital with a pediatric and neonatal ICU. The doctor later told me that he suspected the child had a brain infection because of the size of his head when he came in.
"Babies have large heads, disproportionate to their bodies. We all know this, right? But his head was a monster, way to big for a boy his age. There's something going on in there I think. We see this baby all the time, he's in here a lot but this isn't normal for him. Something is definitely wrong." He said to me while looking over the boy's chart.

I watched as the CCT crew carefully gathered him up in his carseat on the gurney again. I gently brushed his hair off of his face and gave his arm a little squeeze before they left with him. His parents touched my shoulder and thanked me for helping him. I gave them a sympathetic smile as they walked out behind the gurney.

A couple of weeks later my mom, who works as a respiratory therapist at the hospital, called me.

"Hey, do you remember telling me about the little baby with the trach? What was his name?" She asked.

"Oh, uh... I can't remember. Why?" I said distractedly as my fiance and I drove to a party.

"Was it Marcus? Was that his name? 9 months old, trach patient. You said you saw him a couple times at your internship."

"Oh, yeah. Marcus, yeah I know him pretty well. Why? Was he a patient of yours?"

"Yeah, sweetie. He was. He died yesterday."

I stopped fiddling with my cigarette pack and lighter and looked at my phone.

"Hello? You still there?" She said.

"Yeah. I'm here. What happened?" I replied quietly. My fiance placed his hand on my knee and quickly looked at me, frowning.

"I guess his family was at the mall with him in his stroller and his mom noticed that he wasn't breathing. They called 9-1-1 and the medics came and they tried, but he was gone. They brought him into the ER and we worked him for a few minutes but his mom said to stop. She was pretty upset, she said he had already suffered enough in his life and it was a miracle he had even lived this long, so she asked us to stop and to let him go. It was just so sad."

"Yeah, that's just terrible. His family was so good with him too."

Later that evening, I looked in the paper. Under obituaries, there were 2 sentences about him.

'Marcus Soto, 9 months, resident of [city] passed away on Thursday. Funeral arrangements are under the direction of Smith Funeral Home.'


And that was it.