Walking into our paediatric assessment unit to get a prescription script, I could see a mother running towards me. She was smiling and waving hands and she gave me a warm hug. She said, "thank you so much, and it is great to see you again". She read my bemused expression and told me, “I am Robert’s* mother, remember a few years ago you resuscitated him with your team, and he had to be shocked!”
It all came back instantly, how at 3am on that eventful night, we were trying our best to resuscitate Robert. He was three months old and was found to have a heart rate of 240 beats per minute. The electrocardiogram did not look anything close to supraventricular tachycardia. We tried all options, and nothing was working. I was a final year trainee at the time.
The crash call had gone off at 11:20pm, 10 minutes before I was going to handover to my fellow registrar. I was already thinking of the journey home, a late-night snack (you are allowed one on late shifts, aren't you?), and having the television all to myself. But instead, I arrived on the scene in resuscitation and, being the most senior decision-maker on the shop floor, I took over.
There were loads of people, lots of noise. This was not the simulated practice scenario a week ago...
Things were not looking good. A pale, shut down three-month-old with tachycardia and low blood pressure. I quickly looked around and it was all a bit chaotic. There were loads of people, lots of noise. This was not the simulated practice scenario a week ago where adenosine worked like a treat; I had asked for a large IV cannula in the brachial artery, and two doses via a three-way tap did the trick. I was grateful for that practice scenario, and as the famous adage says: "The more you sweat in training, the less you bleed in battle."
On that night in resuscitation, multiple attempts for access failed, but access through intraosseous infusion was secured. Senior help was requested, and anaesthetists were on site. It was decided we needed to shock Robert. The tertiary cardiologist arrived with the intensive care team. I gave them a quick handover, and they took over. Then I focussed on my task on speaking to parents, telling them what was happening and being realistic with outcomes.
Robert was eventually cardioverted, back down to a normal heart rate, and transferred to intensive care. He made a full recovery with no complications. His diagnosis of atrial flutter undoubtedly caused a flutter in all our hearts!
I never felt I did anything out of the ordinary, but that note from the family and picture of Robert has stayed on my notice board.
Much to my surprise, a few months later, a note was left for me in the doctor's office. The envelope said, Chief executive's office. I thought it must be some organisational information. I was wrong, and there was this wonderful photograph of Robert with the most delightful note from parents commending the calm and professional approach to his resuscitation and how grateful they were.
I never felt I did anything out of the ordinary, but that note from the family and picture of Robert has stayed on my notice board. I since have collected such cards from other families and treasured them. When they are days of despondence, and I feel worn out, I go back to these notes to remind myself what a fantastic thing it is to be a paediatrician. We all are making a difference in our little way, and as St David, the patron saint of Wales, said, "Gwnewch y pethau bychain mewn bywyd". "Do the little things in life." Small actions, big impact.
Pramodh Vallabhaneni is a clinician-educator currently working as a consultant paediatrician in Swansea. Current academic roles include Lead for Education and innovation: School of Paediatrics, HEIW, Lead for child health speciality attachment, Swansea University Medical School.
- *. Names and other information that could identify someone have been changed.