Euthanasia?
Looking through the stats on my site meter, I found someone who was directed to my blog via a Google search for "agonal heartbeat." I imagine, given my strange mind and my stranger profession, I should expect to get hits through unusual channels. That Google page led me to a fascinating article on Highbeam.com, my new favorite place on the web. The article, The god of our undoing: the death of a child, a doctor's trial, tells the harrowing tale of a pediatrician in Washington (state, not city). He was called to the emergency room to attend a three day-old child who had stopped breathing while nursing. The child had been without a spontaneous heartbeat for over 30 minutes. Dr. Turner was originally charged with second-degree murder for his care of the child, Conor, though charges were ultimately dropped.
My gut instinct was that a three day-old child should have any opportunity for life. Then I read the story, the tragic episode, the inability to recover a heartbeat en route to the hospital, the snowstorm that prevented the child's transfer to a regional pediatric center, the return of spontaneous, agonal respirations (with a continuing, irregular, agonal heartbeat) twenty to thirty minutes after resuscitative efforts had been halted, the dreadful dilemma that faced Dr. Turner and the choice he made. It couldn't be more poignant if it were churned out of Hollywood.
I didn't know how I felt about this. For a physician to willfully and intentionally cause the 'death' of a three day-old child is such a foreign concept for me. I runs contrary to everything I value as a human being and as a nurse. How could a doctor ever do that? The fact that it was 39 minutes between the 911 call and the initiation of treatment in the ER, does not mean the child had "gone without oxygen" for that period, however. Indeed, with the effective CPR I would expect of pre-hospital care providers, an infant with a down time of 39 minutes to the ER door, would stand some reasonable chance of survival, perhaps even without truly devastating aftereffects.
I've seen enough resuscitations, even of newborns, to know that a persitent rhythm without a discernable pulse is fairly common and completely worthless. What matters is getting oxygen to that brain. If your heart can't make the blood flow as far as your femoral artery, your brain ain't getting any either. What got me was that twenty to thirty minutes after resuscitation had ceased, the child began gasping, agonal breathing.
I'm making an assumption that he was in the arms of his family and the care of the nursing staff during that period. Surely the parents, wanting nothing more than for their newborn to return and recover, would have been hyper-alert for any signs of life. I know, as a nurse who has waited for an 18 week-gestation premature newborn to pass away and watched and cared for him afterward, I, myself, would question wheter I'd seen a movement or saw a chest rise. I have trained myself to know that an isolated twitch or gasp many minutes after "death" is normal and even though my instinct would be to want to help, there can be no help for this young soul except comfort care for him and his family
Fortunately, I've never been witness to more than an isolated movement of the diaphragm. And fortunately, I've never had to do this with an infant of viable gestational age. There is nothing that can be done for an 18 week fetus except comfort care for the child and family...warm blankets, tiny knitted hats, doll clothes, tiny receiving blankets. Although these were terribly emotionally charged instances, they were some of my most rewarding in high-risk obstetrics. It becomes, despite the pain, an opportunity to help the parents adjust, yes, from that earliest moment. It gives them a chance to know and to love this child they're only gotting to meet once. It brings closure.
I used to be very particular about my photos of our aborted newborns. I wanted Mom and Dad to have something positive to bring from the whole tragic situation, some fond memory of their child during his brief time here. I was most loving in the preparation of the memento packet. I was thrilled if I could include a lock of hair, was meticulous with the tiny footprints. I baptised every pre-viable newborn for which I cared. I asked God to look after them. I looked out for their future, whatever that should be.
Doctor Turner's crime was in refusing to resume resuscitation in an infant that had had no detectable pulse for between twenty and thirty minutes with no avaiable oxygen in the bloodstream to transport to the brain. Dr. Turner placed his fingers over the baby's face and precluded another breath. He suffocated the child. But he did not kill Conor. Without oxygenation to the brain, young Conor, deprived of oxygen for the span between active resuscitation and spontaneous, agonal respirations, was already dead. If there was ever any doubt this child was a goner, doubt was dispelled once he spent 20-30 minutes (in the arms of his parents and?) under the eyes of the ER nurse(s) without regular, spontaneous cardiac activity capable of pushing oxygenated blood throughout his body.
The child was dead. In the end, although I might disagree with the procedure Dr. Turner used, I cannot condemn him for his decision. What he and the nurses witnessed was not life. It was reflex. Reflex is not life. I would not have put my hand over the child's nose and mouth. I would have, instead wrapped him up snugly in a blanket and held him until it had all stopped.
No moral here. Just something to think about and another little peek into me.
My gut instinct was that a three day-old child should have any opportunity for life. Then I read the story, the tragic episode, the inability to recover a heartbeat en route to the hospital, the snowstorm that prevented the child's transfer to a regional pediatric center, the return of spontaneous, agonal respirations (with a continuing, irregular, agonal heartbeat) twenty to thirty minutes after resuscitative efforts had been halted, the dreadful dilemma that faced Dr. Turner and the choice he made. It couldn't be more poignant if it were churned out of Hollywood.
I didn't know how I felt about this. For a physician to willfully and intentionally cause the 'death' of a three day-old child is such a foreign concept for me. I runs contrary to everything I value as a human being and as a nurse. How could a doctor ever do that? The fact that it was 39 minutes between the 911 call and the initiation of treatment in the ER, does not mean the child had "gone without oxygen" for that period, however. Indeed, with the effective CPR I would expect of pre-hospital care providers, an infant with a down time of 39 minutes to the ER door, would stand some reasonable chance of survival, perhaps even without truly devastating aftereffects.
I've seen enough resuscitations, even of newborns, to know that a persitent rhythm without a discernable pulse is fairly common and completely worthless. What matters is getting oxygen to that brain. If your heart can't make the blood flow as far as your femoral artery, your brain ain't getting any either. What got me was that twenty to thirty minutes after resuscitation had ceased, the child began gasping, agonal breathing.
I'm making an assumption that he was in the arms of his family and the care of the nursing staff during that period. Surely the parents, wanting nothing more than for their newborn to return and recover, would have been hyper-alert for any signs of life. I know, as a nurse who has waited for an 18 week-gestation premature newborn to pass away and watched and cared for him afterward, I, myself, would question wheter I'd seen a movement or saw a chest rise. I have trained myself to know that an isolated twitch or gasp many minutes after "death" is normal and even though my instinct would be to want to help, there can be no help for this young soul except comfort care for him and his family
Fortunately, I've never been witness to more than an isolated movement of the diaphragm. And fortunately, I've never had to do this with an infant of viable gestational age. There is nothing that can be done for an 18 week fetus except comfort care for the child and family...warm blankets, tiny knitted hats, doll clothes, tiny receiving blankets. Although these were terribly emotionally charged instances, they were some of my most rewarding in high-risk obstetrics. It becomes, despite the pain, an opportunity to help the parents adjust, yes, from that earliest moment. It gives them a chance to know and to love this child they're only gotting to meet once. It brings closure.
I used to be very particular about my photos of our aborted newborns. I wanted Mom and Dad to have something positive to bring from the whole tragic situation, some fond memory of their child during his brief time here. I was most loving in the preparation of the memento packet. I was thrilled if I could include a lock of hair, was meticulous with the tiny footprints. I baptised every pre-viable newborn for which I cared. I asked God to look after them. I looked out for their future, whatever that should be.
Doctor Turner's crime was in refusing to resume resuscitation in an infant that had had no detectable pulse for between twenty and thirty minutes with no avaiable oxygen in the bloodstream to transport to the brain. Dr. Turner placed his fingers over the baby's face and precluded another breath. He suffocated the child. But he did not kill Conor. Without oxygenation to the brain, young Conor, deprived of oxygen for the span between active resuscitation and spontaneous, agonal respirations, was already dead. If there was ever any doubt this child was a goner, doubt was dispelled once he spent 20-30 minutes (in the arms of his parents and?) under the eyes of the ER nurse(s) without regular, spontaneous cardiac activity capable of pushing oxygenated blood throughout his body.
The child was dead. In the end, although I might disagree with the procedure Dr. Turner used, I cannot condemn him for his decision. What he and the nurses witnessed was not life. It was reflex. Reflex is not life. I would not have put my hand over the child's nose and mouth. I would have, instead wrapped him up snugly in a blanket and held him until it had all stopped.
No moral here. Just something to think about and another little peek into me.
posted by Cheryl at
4/29/2006 01:09:00 AM
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