Introduction by Croakey: Amid devastating global health news, Melbourne academic Dr Kathryn Daley writes below about a ‘sliding door’ moment in her family’s life and being overcome by both gratitude and guilt that her young daughter could access life-saving care in an emergency.
Daley is a Senior Lecturer in Youth Work and Youth Studies at RMIT University.
Kathryn Daley writes:
A few weeks ago my daughter went to hospital to have her tonsils removed – a completely unremarkable paediatric surgery. A week off school, ice cream, some new toys and a bit of TLC (tender loving care) was the extent of my post-operative care plan.
The kids’ ward was decorated like a jungle and the nurses all wore scrubs that had the same vibrant patterns her kindergarten teacher wore. Our surgeon came in and told Kate that the hospital ID bracelet was a pass for unlimited ice cream. She was both sceptical and hopeful that this was true.
Holding her while she was being anaesthetised was confronting, though quick. I left the operating room, held in my own tears, bought a coffee for me and balloon for her, then got stuck into my inbox.
A little while later the surgeon phoned, said everything went well, Kate was on her way to recovery and I would be called down soon. I continued with the emails while I waited. None the wiser that minutes after that call, four floors below me, my daughter would stop breathing.
So much for mother’s intuition.
Against the odds
It was an hour until I was escorted down to the post-anaesthesia care unit (PACU) and I wasn’t concerned it had been so long. Once there, I scanned the room but couldn’t see her. I could hear staff calling me to her bed, though she was not in it.
On the lap of one of the nurses was my daughter, agitated and in pain. Moaning that her mouth hurt, yet refusing the icy pole that was there to help. The anaesthetist was there too, and it hadn’t yet occurred to me that anything in this scenario was unusual.
I picked her up from the nurse’s lap and she moulded into me the way a child does with their mother. “That didn’t go as we’d like”, said the doctor, yet the gravity of what had unfolded was not dawning on me.
Maybe my head was still in an email.
While trying to console Kate, who was writhing about on my lap, the doctor explained to me that there is a reflex in your larynx that prevents water filling your lungs. “I tried propofol …” he tells me – though I have no idea what propofol is or does – “… but I had to put her back under and reintubate her”.
This was when the penny dropped that she had stopped breathing. As in, STOPPED BREATHING, and that something catastrophic occurred while I was doing emails.
The doctor elaborated that this reflex happens when liquid hits your vocal cords, but it’s so rare an occurrence that they don’t mention it as a risk to patients in advance: “You are more likely to have a car accident on the way to the hospital”.
The frequency that it requires intubation would be less than one patient per year, he tells me. He sees 30 patients a week. I do the math in my head – just under 1,500 a year. And my beautiful Kate is the one.
I learn that Molly, Kate’s post-anesthesia care unit (PACU) nurse, hit a button and doctors came running. Our anaesthetist had been in the “holding bay” with his next patient. Which sounded to me like a police cell but is apparently the room you wait in right before you go to the operating theatre.
“What if you had been in theatre?”, I asked.
“There are many other doctors here.”
I hadn’t met this man before today. I had googled his name earlier in the week but that just brought up information about a vegan GP in New Zealand. I knew nothing about him yet I was suddenly extremely anxious at the prospect that he might not have been able to attend my child. Because although I was being told a very bad story, I already knew the ending to it – he saves her.
“Still shaking”
Kate is still in pain and unable to settle, he realises I might be at capacity for taking in information about laryngeal reflexes and suggests we talk more later.
While waiting to be discharged to a ward, the PACU nurse from the next bed pulls back the curtain and introduces himself as Scott. He had been holding my daughter when I arrived. He seems affected.
“It sounds like that was a lot for you all”, I said to him.
“I am still shaking an hour later”, he replied.
Molly is less revealing. I ask her many questions about the specificities. How long was my child without air? When did they first realise she wasn’t breathing? What happened? She explains this is in the top five emergencies she sees in her role.
“Monthly”, she tells me. I do more math in my head, trying to reconcile how she sees it monthly, but the anaesthetist sees it yearly. I wonder why, if it is a top five emergency, is it not part of the informed consent information?
Of course, none of this matters, or would change anything, yet my brain seems obsessed with having a definitive account of events, as though each person in the room experienced it the exact same way.
If I can just ascertain this objective account – ideally viscerally – it might compensate for the fact that my daughter stopped breathing while I was doing emails.
Scott comes to visit us on the ward after his shift. With daughters of his own, this case hit close to home. “That was as bad as that gets”, he says, “… nothing was getting in.”
Of course, it was not as bad as it gets, but neither he nor I are prepared to contemplate, let alone say out aloud, what could have been worse.
I am left envisioning the anaesthetist’s experience: hearing the alarm, running from one patient to discover the alarm was for another of his own. Assessing, medicating, sedating and then forcefully reintubating a five-year-old child whose airway is closed, and time is critical – and doing all of this in front of an audience of many – including other patients.
It seems that some of these tasks must have been done concurrently to not run out of time? I think, but am too scared to ask, “how long can a child go without air?” I google this later and immediately wish that I hadn’t.
What on earth motivates doctors to put themselves in specialties where they end up playing God?
“How do you cope with this pressure?” I asked him later.
“It’s part of the job, it’s what we are trained for”.
“But if it’s once a year it’s not really a typical part of the job, is it?”
“Once a year, if that, to be honest”.
I do more math. I guess he’s been practising for about 15 years. That’s 15 times this has happened — if that. Truly extraordinary, I think. But he doesn’t – “we are in a hospital that had six ENT (ear, nose and throat) lists. There were a lot of airway doctors around”.
I can’t tell if this is really no-big-deal for him or if maybe it was a bit of a day. This is the irreconcilable gulf between doctors and their patients, isn’t it – this event will change my feelings about anaesthesia for the rest of my life and he’s anaesthetised eight other patients already.
Grave work
It is late and he looks exhausted. We must have really held them all up, yet he’s worked through the rest of the surgery list, presumably with the same care and calm I was witnessing in front of me.
He tells me that doctors who attended the call saw us in the cafeteria later in the day and messaged him to say Kate looked better. I try to understand how doctors can care enough about patients to text status updates, but not care so much that they fall apart at the responsibility they hold. Surely, if they truly reflected on the gravity of their work, they would be crippled by it.
I thank him, though not in a way that feels sufficient. What would be sufficient? Dr Wilson saved my daughter’s life. Just part of the job, apparently.
Kate is sitting on a chair next to us watching a show about koalas and enjoying the novelty of unlimited screen time and my unexpected “yes” to her request for a chocolate donut – the icing of which has left a circle around her mouth and sprinkles over my keyboard.
I’m reminded of her birth. Where things moved from fine to not fine to very bad extremely quickly, and as I drifted in and out of consciousness the room came flooding with people. Soon enough she was whisked away with a neonatologist, and I was with another incredible anaesthetist and nurse, in a PACU that had closed for the night. Both she and I worse for wear, but alive, all because of the good fortune of first-world obstetric care.
I think about these fine lines between life and death. Sliding door moments in time that are near-misses rather than the tragic events that start and end whole chapters of your life.
Once Kate is asleep, I am overcome with emotion — both gratitude and guilt — that I am in a country where this level of training and resourcing is available. Outside of this hospital the whole world is deteriorating, and human life and human suffering seem to mean nothing to so many — it is impossible not to be weighed down by it all.
Yet healthcare workers are walking through these hospital corridors just doing their jobs, as if it is not the most profound profession in the world. Fifty of them came to the call for my Kate. I met just three. It feels unjust that I cannot thank them all personally. I hope that this will do.
Dr Kathryn Daley is a Senior Lecturer in Youth Work and Youth Studies at RMIT University, and the theme leader of the housing insecurity and homelessness theme of the Social Equity Research Centre. She wrote the book ‘Youth and Substance Abuse’, and more recently her work has been focused on issues of youth, ethics, mental health and social equity. Her work has been published in The Age, The Conversation, Mamamia, The New Daily and the Sydney Morning Herald among others.
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