Lucy
This story is drawn from real experiences. Protecting my patients’ confidentiality is of utmost importance to me; names, details, and timelines have been changed to honor their privacy, and any similarities to actual persons or events are purely coincidental. The emotional truth remains intact.
I surveyed her small body clinging to life, and realized in that horrible moment that I had run out of ideas to beat back death. The team looked at me as if to ask, “What’s next, doc?” I had nothing. I was young, well-trained, and probably at the peak of my pediatric knowledge, but I didn’t have an answer for them —or, more importantly, for her.
It was the loneliest moment of my young life.
—
Lucy’s heart held a dark secret. Within one of its chambers, deep within the muscle of the pump itself, a menace was growing—silently. Everything about her childhood was moving just as any loving parent would hope. She was full of joy, loved playing with her best friend, and was obsessed with figure skating. Even at her young age, she showed real promise, and her coaches had high hopes that she might one day become an Olympian. Then one day, in the middle of a practice skate—her breath in the cold air, the turns, the jumps, the laughter—stopped. Her dark secret made its presence known, and Lucy slumped lifelessly to the ice.
Staff at the rink, and her family, immediately began CPR and called 911. Paramedics were mercifully close by and arrived on scene quickly. The actions of people at the rink and the advanced care from the paramedics were successful; Lucy’s heart began beating again. She was transported to the nearest hospital, where the emergency department team began their life-saving work.
--
There are two kinds of days when you’re a physician on call for medical transports. There are the lazy days where almost nothing happens; you spend your hours reading, studying, watching TV, or chatting with the team. Then there are days so terrible, you have a hard time scrubbing them from your mind for years to come. It was one of those days when I met Lucy.
Since her arrival at the ER, Lucy had been in a tug-of-war with death. Since her arrival, Lucy’s team has been battling to maintain a stable heart rate. No matter what they tried, she kept slipping into a fatal heart rhythm. They did everything right. A tube had been placed in Lucy’s airway so that a ventilator could breathe for her. Lines had been placed in her blood vessels so that medications could be administered quickly and with greater effect. They had tried multiple rounds of medications and electrical stimulation shocks. Nothing stuck, so they called our pediatric critical care transport team to pick her up.
We arrived amidst this controlled chaos. I introduced myself to the ER attending, and he gave me a rundown of all they’d tried and what they’d found on an ultrasound of Lucy’s heart. Within the walls, a tumor had been growing and had reached the size of a golf ball. Unimaginably, this tumor had not caused her any symptoms up until that very day when something about it was too much for her heart’s electrical system, and everything stopped. I thanked him, and he moved on to manage his busy ER.
There was no operating on this tumor, no taking it out and sewing her back up. No cocktail of chemotherapy and radiation would save her. Lucy needed to be transported to a hospital that could keep her alive on a complete bypass machine called extracorporeal membrane oxygenation, or ECMO, and hopefully then, find her a new heart.
Our job was simple in concept, but ever so challenging in reality. Stabilize Lucy long enough that we could put her in a helicopter and transport her 10 minutes to a tertiary hospital equipped to care for her. One of the tenets of transport medicine is: never start the transport until the patient can survive it. It might seem like scoop and run is the best thing to do when someone is critically ill, but when all hell breaks loose in an ambulance, or worse, air transport, your chances of saving that patient plummet.
Nothing was working. Everything I tried had the same effect. Lucy’s heart rhythm would stabilize for a few minutes, then return to chaos. We had provided multiple rounds of medications and cardioversion, an electrical stimulation of the heart through the chest wall, to no avail.
Stable...chaos…stable…chaos…stable…chaos…
She was dying.
—
He walked in around 45 minutes after I started working on Lucy. He smiled and introduced himself as Dr. Tanaka, a pediatric cardiologist. His day in the office was done, but as he was leaving, he heard there was a girl with cardiac issues in the local community hospital where he had privileges. So instead of heading for home, he went back to work.
I’d never been more grateful to see someone in my life.
We talked about her history and what I’d been trying up until then. He pursed his lips a bit and shook his head. He knew what I knew. This was going to be a long evening, and very possibly a tragic one. But, he glanced at the telemetry, took his stethoscope from around his neck, and gently placed it on her chest—the cardiologists’ equivalent of rolling up sleeves. After about 30 seconds of quiet listening and contemplation, he suggested a new medication combination. And we were off. We made headway, but the battle still raged. Just when we thought we’d found a stable beat for a tantalizing stretch of time, she’d slip into another fatal rhythm. And so the cycle continued.
Throughout all of this, I would slip away from time to time to update Lucy’s parents. I can’t imagine how hearing the words coming out of my mouth must have made them feel. I shiver to think of it. What I needed them to understand was pretty simple, but exceedingly awful: Lucy will die if she stays at this hospital. Her only hope is to get her to a more advanced children’s hospital. But if I put her on a helicopter now, she’ll likely die in transit. I have to get her to a point where she’s stable enough to fly, but not wait too long and have her die here. I didn’t have to imagine how hearing those words would make them feel—it was written all over their faces, and they screamed it in their sobs.
Dr. Tanaka and I worked on Lucy for two more hours. He was a consummate professional. It’s easy to use words like hero, but I think I have an even more profound respect for the true professional. The pro wakes up one day very early in their journey and realizes something critical: people are going to depend on me, and their very lives might be in my hands. Once that realization hits, the pro does something many won’t: they dedicate their lives to doing the backbreaking work of becoming excellent. They’re not running into a burning building, as admirable as that is, but each morning they’re getting up and striving to be the best they can be at what they do. Day after day after day, they sacrifice much to put in hours of extra learning and practicing and failing and growing, because someday, somewhere, a little girl in an emergency room will desperately need them to be the very best they can be at this thing. It’s a sacred responsibility, and that, goddammit, means something. That was Dr. Tanaka. He could have been home, but instead, he drove the opposite direction to help some guy he’d never met try to save a little girl.
Finally, we got what we needed to move. Lucy’s rhythm stayed stable for ten minutes, and we knew it was now or never. At my call, my fantastic team had Lucy on a gurney and on the move within 90 seconds. I had only a moment to turn to Dr. Tanaka and, with a half smile,
“Thank you for everything.”
He nodded grimly, “Good luck up there.”
We shook hands, and I was off. The helicopter had been in hot standby, and we loaded hot, rotors turning. I put on my headset, looked at the pilot, and said, “Fast.” I probably didn’t need to say anything; he knew, he could see it in our faces.
—
Three days after successfully transferring Lucy to a local children’s hospital, I called the cardiothoracic team to check on her. Despite everything they tried, Lucy had died forty-eight hours after we dropped her off. I could hear in her voice how heavy her heart was.
She broke the short silence, “I don’t know how you guys were able to get her here—it must have been insane.”
“It was, but I had some pretty remarkable people working on her.”
—
As I think back to that day, I have many different emotions. As a parent, I feel deep sadness for Lucy’s parents, who woke up one morning having no idea their lives would be so horribly changed forever—such grief. I also feel angry about a world that can, in a heartbeat, so cruelly steal a Lucy from us.
Perhaps it’s what my brain needs to continue functioning, but I also take a small measure of comfort from that day. In a horrible, terrifying, unthinkable moment, a small transport team and two strangers came together to fight for her. In the end, Lucy was by no means alone. An emergency room team, a transport crew, two air ambulance pilots, and two doctors who’d never met before, went to war for her. Her little life, in that moment, mattered. And for this old doc, Lucy, and the echoes of that day, make up a part of who I am.