The child was dead.

I heard it over the radio first. “Not breathing,” said the dispatcher. “The ambulance is on it’s way to the house. The baby is 1 year old.”

Crap. “That child is dead,” was my first thought, even though I heard the information second hand.

I grabbed my airway card (one of three I carry in my bag) and reviewed dosages and equipment sizes for one year olds as I use the technique of denial in hoping they aren’t really on the way, that there isn’t really a one year old who is not breathing.

Moments later another call. “The ambulance is on it’s way to you.”

They literally picked the child up and ran it to the truck, driving to the hospital lights and sirens all the way. Believe it or not we were ready in the short period of time. Well, we had a room and pediatric equipment at the bedside. But we were not really ready for what we saw. My partner jumped to the head of the bed as I arrived seconds later (was this deliberate on my part?).

“This child is dead,” someone said.

In many ways, it was easy. ABC. Airway. Begin ventilations. Breathing. Check ventilations. Circulation. Asystole. Begin CPR. It was my first time doing CPR on this sized child, with my hands nearly wrapping around the whole chest, two thumbs pumping away.

My partner tried to intubate and the jaw was rigid. Her arms were rigidly fixed in the position she had been laying in the crib. Violaceous lividity had begun to settle in the back of her scalp and buttocks, a sign of blood no longer circulating and settling to the gravity dependent body parts. The child was dead.

But we continued. An interosseus line in each tibia, fluids, meds. It was like working on a doll, a resuci-doll from Pediatric Life Support class. While the body had the look and shape of a child, it was clear that this was a lifeless body.

The child was dead.

Neither my partner nor I had the guts to pronounce her DOA. So we continued with a little bit of everything until the room was satisfied we had tried every reasonable intervention including shocking her. We were trying last ditch efforts and had run out of everything. I charged the unit while the nurse applied the paddles and discharged them. A click from the machine without the typical muscular contractions and body jerk.

“Did these paddles discharge?” the nurse asked.

I increased the energy and charged it again.

“CLEAR!” Click. Nothing.

It dawned on me later why the little body didn’t jump the way it should have. There were no living cells left to contract. Rigor Mortis had set in to the point where the muscles were locked and unresponsive. It was equivalent to shocking a mattress or a log.

The child was pronounced. Dead.