text: Disclaimer: This story is based off a real event and personal experiences of a child drowning. Names have been removed, genders and ages have been changed, some events have been altered, and location has been left out in effort to maintain patient privacy. Child found floating face down. Bath water still warm. Mother desperately crying while trying to save her child who’s dying. Twenty-nine, thirty, off the chest, deliver two breaths. Child’s older sibling stands back and watches as she, the witness, the discoverer, the one who was supposed to be watching, calls 911. Her hands shake, voice quivers, tears drop, heart pounds as the memory of her mother continues to try CPR on her drenched brother, imprints itself. Guilt, pain, and blame is not something she can tame. Distant sirens wailing quickly turn into screams at the front door. Paramedics run in with life-saving supplies in hand. Police stand aside until it’s their turn to take the drive. Mother is pulled away from son. Her grief so heavy, it is impossible for her to stand. Pulse checked, none. Heart electrocardiogram (EKG) shows a small quivering of the heart, ventricular fibrillation. A rhythm paramedics can shock. Defibrillator charged. All clear, shock delivered, CPR restarted and epinephrine (epi) administered. Pulse checked, heart rhythm read, shock delivered, compressions restarted, epi given every three minutes, again and again as the lifeless child is placed onto stretcher and rushed to the hospital. The sound of heart monitors beeping, IV pumps screeching, call bells ringing. People coughing, sneezing, many wheezing, and the yelling of nurse, nurse, NURSE!!! Hallways lined up with patients on stretchers and chairs, every room taken except the trauma room, nurses scrambling, doctors examining, triage (front door) overwhelmed, back door (medic entrance) flooding with patient after patient. A typical day in the emergency department. Finally, a moment to breathe and a millisecond to chart. Patient disoriented to place and time. 20 gauge IV inserted to left upper arm, blood cultures and lab work drawn. Patient is tachycardic, hypotensive, and febrile. One liter of normal saline hung to bring down heart rate, raise blood pressure, and follow sepsis protocol. “Hey Dr. V, can you put- “, red phone rings. Everyone looks up, stares at each other, then stares at the phone. Charge nurse answers, we continue to stare in silence. Phone put down. Charge nurse speaks, “code coming in, three-year-old drowning, CPR ongoing, approximately three minutes out”. All eyes widen, action begins. Respiratory therapist notified; emergency department pharmacist made aware, main nurse assigned. Rest of code team given tasks. One to two nurses for IV placement and lab draws, one nurse for medication administration, one nurse to obtain vitals, if possible, and use as back up to help with other tasks, two patient care technicians assigned for CPR. Police now take the wheel. Mother and daughter questioned. Daughter explained chain of events. Mother left household to pick up daughter’s seizure medication. Mother told daughter to do the chores. Daughter was vacuuming and stopped to check on little brother. Brother found facedown in bathtub. Brother unresponsive. Mother comes home to drowned son and daughter in total distraught. Cries of grief unbearable to hear. Daughter is taken to the hospital by police. Mother placed under scrutiny. Police refuse to let mother leave for hospital. Mother is now under investigation. Code team ready, waiting in trauma room. Paramedics appear through back door. CPR ongoing. Child is moved to stretcher and code team begins their assigned duties- IV placed, labs drawn, vitals taken, pharmacist draws up pediatric doses of epinephrine, respiratory therapist connects patient to ventilator. Heart arrythmia changed. Rhythm is no longer shockable. Doctor enters room. Paramedic reports to main nurse and doctor. Report given. Three-year-old child found face down and unresponsive in bathtub by older sister. Sister did not witness how even occurred. Downtime approximately 15 minutes since medic arrival. Downtime at home unknown. Patient remained in ventricular fibrillation. Three rounds of epi given, defibrillated three times. No patient response. Daughter arrived and placed in consultation room with police officer. Triage nurse nearby kept watch, as daughter was a minor. Mother was still at home being questioned about child neglect. Despite team efforts, patient condition remained unchanged. Doctor ordered to continue CPR efforts until mother arrived. Chest compressions, epi, ventilator, repeat. The team was silent. Every one of us were lost in our emotions. Due to doctor’s orders, the code team carried on with their duties. Not a single person wanted to prolong the nightmare they became a part of, but they did anyways. Word is out. The mother has finally arrived. She is brought back to see the code team putting all efforts into saving her child. Dr. V approached mother and explained the enormity of efforts taken. Her child was without oxygen for too long. Brain death likely. Her son was not going to make it. The mother fell to her knees. Her howls of lament broke the hearts of all those around. Charge nurse assisted mother into an empty patient room. Daughter was brought back to mother. Doctor orders team to stop CPR. Time of death called. Nurses break down into tears. The doctor walks out. A solemn look on his face. Inconsolable, the mother is admitted to the emergency department. Charge nurse assigned herself to the mother. She begged for the nurse to end her misery. Her wish was granted. Temporarily. Doctor ordered sedatives and anti-anxiety medications to ease her mental anguish. Wails turned to loud whimpers. For the code team, remaining tears were wiped away. Sadness and thoughts about the situation were compartmentalized. All but the main nurse and a patient care technician walked out. They traveled back to the nurse’s station. Fake smiles on their faces as if nothing ever happened. Back to their patients, they act happy. They pretend a child never died. They tend to every patient request. They move on because they have to. The emergency department never sleeps, especially during a code. There are many orders to catch up on, medications to give, more patients to bring back to a room for treatment. The nurses who were not a part of the code show exhaustion. They ran the show while half of the staff was in the trauma room. Now it is time to help them while helping our own patients. Chaos always exists. One way or another, it is always there. It takes a toll on the nursing staff. Just like it takes a toll on the families that suffer. Nursing isn’t for the faint of heart. It doesn’t matter how strong the nurse is, eventually the suffering will break them too.