Cessation of Efforts -- written 4/9/2010

“Time of death: 1745.”

I can’t believe I said those words today. I cancelled the MEDEVAC, I stopped resuscitation, and I ceased all efforts to save a one year-old girl who girl who drowned in a nearby canal.

She had been brought in merely 15 minutes prior to my statement. From the moment I saw the Executive Officer doing CPR on her at the front gate, I knew this was going to be a futile effort. We ran into the Aid Station, and I instinctively placed a stethoscope to her chest to listen for a heartbeat. There was none. We began CPR. Despite the gravity of it all, it was calm. There was little conversation and no confusion – just work. Then acceptance. Although the delivered CPR was effective as noted by the strong brachial pulse and the readings on the pulse oximeter, her pupils were fixed and dilated and she showed no signs of resuscitation. Ceasing our efforts was one of the hardest things I had ever done.

It didn’t hit me until the end. One of the Corpsmen had pulled out a wool blanket and had set it beside her. The village elder and the girl’s uncle were in the Aid Station, and when I told them we had done everything we could and that I was sorry, they readily understood. They informed us through the interpreter that they “figured she had died”. I quickly recognized this ready acceptance from my previous deployments. The Arabic term for this fatalistic acknowledgment is “Inshalla” – God willing. I expressed my apologies again, and then held her up as a Corpsman placed the blanket on the stretcher. I didn’t want to lift her. I didn’t want to hold her. A part of me wanted to tell another Corpsman to do it. But I couldn’t. This was my responsibility. I placed her down onto it, but was not satisfied with her being near the edge of the blanket. I wanted her in the middle. I had to pick her up again. As I lifted her lifeless body, she released an agonal breath. The final air was escaping her lungs. I placed her in the blanket, wrapped her up, and allowed the village elder to take her. We then walked back to the front gate.

Seeing the elder walk with this little girl wrapped up in a blanket, it started to hit me. It seemed so surreal. This was my nightmare. This was my fear. There was a group of locals at the front gate, and after the elder explained to the father what we had done, the Executive Officer pointed me out and said, “Our Doctor did everything he could”. I looked at the little girl’s father. And, as the tears started to well up in my eyes, I told him I was sorry. It had hit me. I think he could see my pain, and a part of me hoped that he could. I had tried. I had failed. Although we did our best, it was not to be. After a few short seconds, I had to leave.

There was a small box of a shelter fifty feet away from the front gate. I knew I couldn’t go back to the Aid Station right now. I stepped inside and within seconds, I began to cry. The wave had finally crashed. Three minutes later, the Executive Officer saw me in the shelter. He shook my hand, gave me a hug, and told me I did everything I could. He walked away, and I released again with a renewed surge of tears and emotions.

It was not to be. As I sit here and go through the incident in my mind, I can’t help but think of the eight year-old girl we revived just a month ago. She had been near death and in respiratory arrest when she arrived, and by the time the MEDEVAC helicopter arrived, she was crying. That was a good day. We saved her. She didn’t die. However this one-year old girl today was not to be. There was nothing we could do. Inshalla.

Despite this acceptance, I will still cry. Despite my understanding of her fatal injury, I will still see her face in my dreams. Despite reassurances from others and myself, I will still think of her for years to come.