2 year olds shouldn't die.

It was one of those days where things are amazing and awful all at the same time. Today I took a kid who twenty years ago would have spent his life pooing into a bag and created a brand new rectum for him. He won't even remember this first year of his life when his non-functioning rectum meant that he was dependent on an ostomy. And that was amazing.

Imagine if this kid had grown up with an ostomy. We all know how cruel kids can be. The nicknames would have been awful, and would have haunted him in everything he did. I mean, who would go to prom with the kid that everyone calls "shitbag?" It's nice to think that it would have made him a stronger person, a better person. But that's more often the exception than the rule. Fortunately we don't have to wonder about any of that because we took the ostomy and reconnected it to a newly created, functioning rectum. I can honestly say that I helped make this kids life better.

Unfortunately there is a 2 year old girl lying in our PICU for whom I can not say that. She was ejected from her car seat in a motor vehicle collision and suffered multiple skull and head fractures, she was bleeding into her brain and she was taken to the nearest hospital. A rural hospital. They did CTs of her head and body and intubated her. Then they kept her there for EIGHT hours before sending her to us. Who are we? We are the only level 1 pediatric trauma center in the state. We are where she should have been sent the SECOND she was stable. We should have been notified of her the second she rolled into their emergency department. We would have had her on a chopper and in our trauma bay in an hour.

Instead she was transported to us by ground and that delayed her definitive care by another 3 hours. Do you know what happens when a 2 year old bleeds into their brain for 11 hours? They stop clotting. They start oozing from orifice. Their core temperature drops. They become hypotensive and tachycardic. They become unresponsive. Their pupils dilate. They lose their basic brainstem reflexes. They die. That's what happens. And we all stand there incapable of saving her. All of us, interns, residents, attendings, nurses we try to put in lines and get her blood products and warm her up, and raise her blood pressure and slow her heart rate. We call in ENT, Neurosurgery, Optho because we know our limitations. The pediatric surgery and pediatric critical care attendings do all the procedures because she isn't someone that can afford a resident mistake.

This isn't a learning experience for us. This is a desperate attempt to save someone who can't be saved. Because the thought that this little girl is going to die no matter what we do isn't something any of us can bear to entertain. So the attendings pull out all the stops because at some point they know they are going to have face her parents. And when they do they are going to have to look them in the eye and say "we did all we could."

But none of that is going to change the end result. Right now that little girl is lying in a PICU bed. She is intubated, sedated, paralyzed and receiving enough blood products, fluids and medications to keep her heart beating. But, neurosurgery already told us what none of us want to face. She is brain dead. We're keeping her body alive even though what made her who she was is gone. Someone will talk to her family about her donor status. And maybe some part of her will go to another little girl. Maybe that's a silver lining. But it doesn't change the fact that 2 year olds shouldn't die.