Empty Crib

Early one Saturday morning, the bedside phone jolted me awake. The anxious voice of the night nurse said, “Oh, you’re going to love this.  Lots of call-ins today. Dayshift   only has two RN’s. . .”  

“I’ll be right in.” I mumbled to make her stop talking.  Besides, I’d worked short-staffed plenty of times, and if it got too hectic I’d call in a nurse named “Someone.” 

When I arrived in the department, four night shift nurses converged on me, “We lost a baby at 7:00, after we called you.  Family’s in Trauma One. Death papers are done. Just waiting for Miranda, Crisis Counselor.  When she’s finished, you’ll need to go in and take the baby.” 

“Take the baby, where?  And why me? You know the family. I’ve never met them.” 

“From the mother. 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’ve had a bad night. We’re outta here.”

My eyes welled up with tears as soon as Miranda emerged from the trauma room and asked, “Who’s in charge? The family wants you to explain what caused this; they’re very upset.” Despite having dealt with many deaths over the years,  I feared  handling one involving an infant.

Overhearing the conversation, the ER physician said, “I’ll be with them in a minute.  Got to sign out to Richards first so I can leave.” He had six young children at home.  If he could face this family, I could also. 

At 7:30 AM, I peeked through the curtain into the huge trauma room. Nothing could have prepared me for what was on the other side.  Fifteen family members huddled in a painfully quiet circle, except for the sounds of sniffles and moans.

Their sad faces fixed on me when I opened the curtain, resigned to gracefully separate a distraught mother from her dead infant son — were they hoping I was there to tell them their son, nephew, and grandson was still alive? That his death pronouncement had been a mistake?       

I wasn’t the ER nurse anymore but an emotional extension of their family.  I’d just met them.  Too overcome with sadness, I walked over to the counter and took a box of tissues from the shelf.  I handed it to the grandmother. She nodded in thanks. 

There was a heavy silence in the room no one dared to break. Words to express the painful loss and anguish didn’t exist. The baby’s mother rocked her infant son wrapped from head to toe in a white bath blanket.  The fact that the baby’s face was covered really bothered me. My first thought — this infant needs access to airIt looks unnatural to swaddle a baby with his face covered.  Did Nights hand her the baby shrouded that way?

A few minutes later, Dr. McCall and Miranda entered 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 2,000 deaths a year. We’ll need to do more tests to make that diagnosis.  

The ER doc realized the family was overloaded and not absorbing any more information, he wrapped up, “We know this is difficult for you, the chaplain will be right in.”  

Since the family would be subjected to a police interview later, Dr. McCall didn’t grill them now. Had their baby gotten overheated. Or been sleeping on soft mattress with fluffy blankets and toys.   

I was also grateful he didn’t say, “I’m sorry for YOUR loss” as though he couldn’t care because it was happening to them and not him. He was a good guy, and I imagine know he felt their pain.

Most likely in shock, Mom looked up at the chaplain. “What do we do now?” in a  matter-of-fact tone.  

Yesterday, her four-month old baby had been healthy, smiling.  Midnight check, baby was sleeping.  At 6:00 a.m., Mom found him not breathing and blue. 

She called 911, and paramedics arrived quickly. They started CPR and gave medications. They had to give epinephrine through an IO, or intraosseous needle drilled into the baby’s lower leg bone. The baby’s blood pressure was too low for an IV line.  they got a faint pulse back so brought the baby to the ER.  A police car escorted them with Sirens blaring and lights flashing. 

Miranda from Crisis said to Mom, “You need to give me the baby now.”  Silence.  Mom froze.

At that moment, I had to act. . . but hated what I had to do. 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.  I didn’t blame her for hating this final step.  I wasn’t the babysitter here who would tend to the child while Mom was out.  

The nurse here was a stranger, going to take her precious firstborn and never give him back.  Although Mom didn’t verbalize a word, she cradled her bundle, whispered something and surrendered him to me. 

The family left the room as one, holding each other up.  I stayed behind still holding their baby.  I wanted to stop crying so paced around Trauma One.  I considered putting him down on the bassinet but was afraid the mother would return and see her son lying there alone.  I walked around for a few minutes, holding this bundle and aching for her parents.  My own child was safe in his bed at home. 

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 vanished. 

The infant’s family decided on a funeral home and signed the papers. 

The baby’s pediatrician was paged. He was at his son’s soccer practice. He instructed me, “Give my deepest sympathies to the family.”  Come in here and tell them yourself.  When I passed on the doctor’s words to the family, they asked, “Why isn’t he coming in?” 

Since the infant was a suspected Sudden Infant Death Syndrome (SIDS) case, he belonged to the Medical Examiner or ME.  The ER secretary paged him. He answered right away. ME’s were not paid a lot. He said he took the job because he was interested in forensics. 

At 8:00 a.m., Dr. Smith arrived. He handled the baby very gently.  I felt better he treated the little dead person with respect.  the doctor asked me to take a rectal temperature.  I unwrapped the baby and took off the diaper. Oh no, dancing Disney characters. This baby was loved and well cared for.  

The infant’s temp was cold, 89.7 degrees. I gasped from how ecchymotic his body looked. Bruising resulted as gravity pooled the blood.  I was relieved Dr. Smith didn’t ask me to remove the IO sticking out from the baby’s leg.  The needle had to stay until the ME determined it had not contributed to or caused his death. 

As Dr. Smith took Polaroid pictures for the infant’s medical record, he turned the developing pictures face down on the counter.  I asked him why, and he replied, “I didn’t want to upset you.”  How sweet. He’d probably noticed the tears streaming down my  face and sobs being stifled.

Shortly thereafter, I received a phone call from detectives at the city 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, over an hour away.  But his parents had already left the hospital. I didn’t think it would be normal for any baby to be sent to the Crime Lab without his parents. 

I consulted with the hospital nursing supervisor.  She said it was okay to send the baby. No need to inform the family.  I struggled with this. I turned to Dr. Smith, who’d been compassionate earlier. He shrugged, “Work it out.”  I then asked Miranda to call the family at home, and she agreed. They seemed very understanding and grateful for the call.    

Next there was discussion about which agency would transport the infant’s body to the Crime Lab.  Ambulances only became involved with medical transport if the person was still alive, and Richmond didn’t pick up its victims.  We had no policy on getting patients from the ER to the Crime Lab, so I called the funeral home director previously chosen by the family. He agreed to take the baby pro bono

A short time later, a burly funeral home director wheeled in a gurney emblazoned with the name of his funeral home on the side.  He gently placed the baby in a small  blue velvet body bag and then onto the stretcher. 

The following week, the infant’s obituary appeared in the newspaper. The parents requested that donations be made to The SIDS Foundation in lieu of flowers. 

SIDS must have been the final diagnosis, although a tough one to make. A baby is said to have died from SIDS if no other cause of death can be found after a death scene investigation at the baby’s home, autopsy, and review of the baby’s health. 

While I never saw or heard from the family again, I’ll always remember sharing their heartache. It still hurts. I was meant to be  there for these young parents during the most devastating day of their lives.  

Note:  This story was originally published in The Color of Their Eyes:  Celebrating the Art and Science of Nursing (2007).