The Empty Crib (SIDS)

As a member of the ER management team, I was required to take call one weekend every other month, from 3 PM Friday to 7 AM Monday.  Call lasted sixty-four hours, and salaried employees were not entitled to compensation for their time tethered to the phone, ready to be in the ER within thirty minutes of the call. 

Early one morning, the bedside phone jolted me awake from a deep slumber, and the overly excited voice of the night nurse proclaimed,

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

I mumbled, “I’ll be right in” 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” if he or she picked up the phone.

When I arrived in the department, four night shift nurses converged on me, all talking at once, “We lost a baby at 7:00, after we called you.  Family’s in Trauma One, death papers done, just waiting for  Miranda, 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? You know the family. I’ve never met them.” 

“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 out of 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.” After dealing with many adult deaths over the years I was very fearful of this task, having never seen or handled an infant death before.

Overhearing the conversation, the ER physician, McCall, said, “I’ll be with them in a minute.  Got to sign out to Richards first so I can leave.” McCall had six young children at home.  If he could face this family, and staying overtime to do so, 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, save for the sounds of sniffles and moans. Their sad faces fixed on me as 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, or grandson was still alive, that his death pronouncement had been a mistake?       

It seemed to me I wasn’t the nurse anymore but an emotional extension of a family whom I’d just met.  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. Words to express the painful loss and anguish didn’t exist at that moment. The baby’s mother, Mom, 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 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, I was relieved Dr. McCall didn’t grill them now about whether their baby had gotten overheated or been sleeping on too soft a surface with fluffy blankets and toys.  Or whether the mother had smoked during her pregnancy. 

I was also grateful he didn’t say, “I’m sorry for YOUR loss” as though he couldn’t care less.  He was a good guy, and I know he felt their pain.

Mom looked up at the chaplain, “What do we do now?”  I surmised that her matter-of-fact tone hid a profound sadness and shock wherein people can look composed on the outside although they’re falling apart on the inside.  

Yesterday, her four-month old baby had been healthy, smiling.  Midnight check, baby was sleeping.  At 6:00 AM, Mom found him not breathing and blue.  She called 911, and paramedics arrived quickly. 

They started CPR and gave medications.  They had to give them through an IO, or intraosseous needle drilled into the baby’s lower leg bone because the baby’s blood pressure was too low.  Got a faint pulse back so brought the baby to the ER.  Sirens blaring, lights flashing, and with a police escort. 

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.  She understood I wasn’t the babysitter here who would tend to the child while Mom was out shopping.  

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 entity, holding each other up, but 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 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 practice. He instructed me, “give my deepest sympathies to the family.”  Bullshit, come in here and tell them yourself.  When I passed on the doctor’s words to the family, they asked, “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 Dr. Smith who answered right away and said he was on his way.  ME’s were not paid a lot and took the job for an interest in forensics.

At 8:00 AM, Dr. Smith arrived and handled the baby very gently.  It made me feel better he treated the little dead body with respect.  He asked me to take a rectal temperature.  I unwrapped the baby and took off the diaper. Oh no, frolicking Disney characters, this baby was really loved and well cared for.  

The infant’s temp was cold, 89.7 degrees. I gasped at how ecchymotic his body looked with the bruising as gravity pooled the blood.  I was relieved Dr. Smith didn’t ask me 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 Dr. Smith took Polaroid pictures for the infant’s medical record, he turned the developing pictures face down on the bedside table.  I asked him why, and he replied, “I didn’t want to upset you.”  How sweet that he’d noticed the tears streaming down her face and heard me stifling sobs. 

Shortly thereafter, I received a phone call from detectives at 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, over an hour away, but his parents had left the hospital. I didn’t think it normal for any baby, alive or dead, to go to a Crime Lab without her parents. 

I consulted with the hospital nursing supervisor.  She said it was okay to send the baby, no need to inform the family, but I struggled with this. I turned to Dr. Smith, who’d been so sensitive earlier.  He shrugged, “Work it out.”  I then asked Miranda to call the family at home. They were 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.  This man placed the baby in a tiny royal blue velvet body bag and then onto the stretcher for the trip. 

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, an autopsy, and a review of the baby’s health. SIDS as a cause of death is determined only when everything else has been ruled out. 

While I never saw or heard from the family or police again, I’ll always remember witnessing and sharing their heartache. Regardless of being paid or unpaid for my time, 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).