Sudden Infant Death

The bedside phone awakened me  on my day off.  The  excited voice  belonged to the ER charge nurse,

“Oh, you’re going to love this.  Lots of call-ins today, leaves dayshift ER with only . . .”  

On-call for the weekend, I replied, “I’ll be right in” and shuddered at the thought of our  ER without enough staff to care for twenty-six patients.

As soon as I arrived at the hospital, four night shift nurses all started talking at once, “We lost a baby at 6:30 after we called you.  Family’s in Trauma One, death papers done, just waiting for the Crisis Counselor.  When she’s finished, you’ll need to go in and take the baby from the mother.” 

“Take the baby, where and why me?    

“Hey, we cleaned up the room for you, it was trashed.  Replaced the meds on the code cart, ordered new trays, did the charges. We had a bad night. We’re out of here.”

My eyes welled up with tears as Crisis (social worker) emerged from the trauma room,

“Who’s in charge? The family wants you to explain what caused this; they’re very upset.” 

Overhearing the conversation, the night ER physician, McCall, said, “I’ll be in soon.  Got to sign out to Richards first.” McCall had six young children at home.  If he could face this family, so could I. 

At 0730, I approached the curtain to Trauma One, resigned to gracefully separate a distraught mother from her four-month-old dead baby.  Nothing could have prepared me for what was on the other side.  Fifteen family members huddled in a somber circle, only sniffles and moans audible.   Their sad faces fixed on me as I opened the curtain.  Are they hoping I’m here to tell them their baby is still alive?  

It seemed to me I wasn’t the nurse anymore but an emotional extension of this family.  Too overwhelmed to speak, I walked over to the counter and took a box of tissues from the shelf.  I handed it to the grandmother, who nodded in thanks.  There was a heavy silence in the room no one dared to break. There were no words to express the anguish this family was feeling. The baby’s mother, Mom, held her infant daughter wrapped from head to toe in a white blanket.  My first thought — the infant needs access to airIt looks unnatural to swaddle a baby with her faced covered.  Did Nights hand the baby shrouded that way? 

           The ER doctor and Crisis came and briefed the family about SIDS.  “It wasn’t your fault… We don’t know why it happens, maybe a lack of an enzyme in the lungs, about 20,000 deaths a year.” 

When he realized the family was overloaded and not listening anymore,

“We know this is very hard for you, the chaplain will be in” and left.

Mom looked up at me, “What do we do now?” 

Yesterday, her baby had been healthy, smiling.    Midnight check, baby was sleeping.  At 600 AM, Mom found her not breathing and blue.  She called 911, and paramedics arrived in minutes.  They started CPR and gave medications through an IO, or intra-osseous needle drilled into the baby’s leg bone.  Got a faint pulse back so transported the baby with sirens blaring and a police escort. 

Crisis said to Mom, “You need to give me the baby now.”

Mom froze.  I inched forward to extend my arms, and Mom pulled away.  Handing over the infant would mean confronting the horrible reality that her baby was dead.  She understood I wasn’t the babysitter here who would tend to the child while Mom was out shopping.   The nurse was a stranger, going to take her precious daughter and never give her back.  Although neither of them said a word, the mother cradled her bundle, whispered something and surrendered her baby to me. 

           The family left the room holding each other up, but I remained there.  I wanted to stop crying so paced around Trauma One.  I considered putting the baby down on the bassinet but was afraid the mother would return and see her daughter lying there alone.  I walked around for a few minutes, holding this bundle and aching for my own child safe at home asleep.  It wasn’t the mother who came rushing back into the room but the young father. 

He blurted out, “I can’t take this.  I can’t DO this” then disappeared. 

The infant’s grief-stricken family decided on a funeral home and signed the papers.  The baby’s pediatrician was paged, and he was at his son’s soccer game. 

He instructed me to “give my deepest sympathies to the family.”  Bullshit

When I passed the doctor’s words on to the family, they asked, “Isn’t he coming in?” 

Since the infant was a suspected Sudden Infant Death Syndrome (SIDS) case, it belonged to the Medical Examiner or ME.  The ER secretary paged the ME.  He answered and was on his way in.  ME’s were not paid a lot and took the job for the extra money and an interest in forensics.

At 0800 the ME arrived.  He handled the baby very gently.  It made me feel better that the little dead body was treated with respect.  He asked me to take a rectal temperature.  I unwrapped the baby and took off the diaper. Disney characters, how sweet)  The infant’s temp was 89.7 degrees. I gasped at how ecchymotic the body looked with the bruising as gravity pooled the blood.  I was relieved not to have to remove the IO sticking out from the leg.  The needle had to stay until the ME determined it had not contributed to the death.  As the ME took Polaroid pictures for the infant’s medical record he turned the pictures face down on the bedside table. 

I asked why, and he replied, “I didn’t want to upset you.”  How embarrassing, he’d  noticed the tears streaming down her face. 

Shortly thereafter, I received a phone call from the Police Department..  Any unexplained cardiac arrest of an infant required an autopsy and investigation.  The baby needed to go to the Crime Lab in Richmond.  That’s an hour away, how can the baby go to a Crime Lab without her parents?  I consulted with the hospital nursing supervisor.  She said it was okay not to inform the family, but I struggled.

I turned to the ME, who shrugged, “Work it out.”  I asked Crisis to call the family at home, which the did.  The family was grateful for the call and to know what was happening with their daughter.    

 Next there was discussion about who would transport the infant’s body to the Crime Lab.  Richmond did not pick up its victims. 

I called a funeral home director, who agreed to take the baby pro bono.  He placed the infant in a tiny blue velvet body bag for the trip. 

A few days later, the infant’s obituary appeared in the newspaper, and I noticed the parents requested donations be made to The SIDS Foundation. 

           While I never saw them again, I’ll always remember being a part of the most devastating time in their lives.    

Marilyn Barton, RN, BSN

Chest Pain-ER Coordinator, Riverside Regional Medical Center