When the ambulance barrels into the reception of St.Georges Hospital, its obvious the patient is a drowning victim. It is February, the sky heavy with low, leaden clouds that promise a storm, but there is no snow on the streets of London. The wail of the siren grows louder as the vehicle pulls up outside the A&E entrance.
Looks like theyve brought someone heavy, comments the senior registrar, his voice low and thoughtful, as he watches the paramedics unload a stretcher.
The doors to the waiting area fling open and a man in a winter coat steps in, cradling a baby on his hip. Close behind him, a woman clutches her head with both hands, her face as pale as a sheet. She mouths, Is he alive? He has to be alive, right?
I am on call as a trauma surgeon. I dont relish working on a weekend; weekdays fly by, but today feels stretched. The emergency team is already gatherednurses, radiographers, lab techsso we can move quickly.
Where do you want us to take him? the father asks, his voice cracking. Please, youre the doctors, you can you can help.
A senior consultant shouts, Put the child on the trolley! Trauma surgeon, examine him now, and have the ICU team stand by.
I glance at the infant and feel a cold shock. A year ago I was on a similar shift. It was December, snow blanketing the city, when a frantic mother rushed in looking for her son who had vanished after kindergarten. We searched the whole hospital, called in the nightshift staff, and finally, in the early hours, uncovered a shallow pond on the hospital grounds where a buried sack of water had trapped the child. He was found in a blue jacket and a knitted cap, just as he is now, and the tragedy felt eerily familiar.
How long has it been since you found him? I ask.
I dont know, the father replies, the neighbours pulled him out of a ditch, still moving, and we started mouthtomouth ventilation in the ambulance.
Right, step aside, colleagues, this is the oncall team, the registrar says, moving to the side.
I pull off the babys cap and unzip his coat. His face is bluish, pupils dilated and unresponsive, pulse and breathing absent. I ask, Did you remove the water from his mouth?
Apparently not, the father says.
We begin artificial ventilation, using a bagvalve mask filled with oxygen. I turn the infant onto his stomach, brace my knee against his back, and press hard on his spine. Water gushes from his mouth. I lay him on the trolley, give a rescue breath, then deliver three chest compressions, trying to coax his tiny heart to circulate.
The cold air bites, yet I hold onto the hope that his brain may still be viablethere are cases where people have survived under ice for more than a day. The wall clock ticks slowly: two minutes, three, five, and then a faint murmur emerges, like a kittens purr.
The baby lets out a loud, ragged gasp, as if fighting his way out of deaths grip.
Get him to ICU, we need to switch to controlled ventilation; he wont be able to breathe on his own, I shout.
Is he alive? Hes breathing now? a terrified mother whispers, tears streaming down her cheeks.
Lets hope, a colleague answers, we need to call the airambulance for paediatric intensive care support.
We carry Elliot on a stretcher into the intensive care unit, the hallway echoing with a tense silence. The monitor beeps steadily, the ventilator hisses, and the infants narrow, glassy eyes flicker, indicating that his body is still fighting.
Two hours later, the airambulance team arrives. After a quick examination they declare, The child is clinically dead; his brain suffered irreversible damage during the period of drowning. Disconnect the ventilator and await the outcome.
Everyone in the room is stunned.
Hold on, the paediatrician interjects, if his pupils react to light, theres still some brain activity.
The ventilator was used while water was in his lungs, so the resuscitation we performed was likely ineffective. Hes already showing signs of organ failure, another specialist argues.
I cut in, Lets try something else. We dont have a paediatric catheter, but perhaps you have one?
Sure, we have one, but what will it achieve? the airambulance doctor replies.
Lets give it a go, the nurses chorused.
They insert a thin paediatric catheter, and as soon as the fluidbright yellow, almost like a sudden burst of sunshinesprays out, the whole team erupts in surprised shouts.
Hes alive! Hes alive! they chant.
Alright, well keep him on the ventilator for another half hour, then well see if he can breathe unaided before we transfer him, the senior doctor says.
Three hours later Elliot is stable enough to be moved to a specialised childrens hospital.
Two years pass. The memory of Elliots case lingers. One Saturday, a knock sounds at my door. A man I barely recognise stands there, his face familiar yet distant.
Do I know you? I ask.
Im not sure did we work together? Did you treat me? he replies, bewildered.
Youre the boy Elliot, arent you? I say, my voice shaking.
A bright, mischievous grin spreads across his face. Yes, thats me.
Elliot? I stammer.
Its Alex, mate. Come in, weve been trying to find you for a year. Your address kept getting lost, and you love travelling, so we finally caught up. He steps inside, and I feel a wave of nostalgia.
He recites poetry, darts around the room, examines my collection of seashells, holding them to his ear as if listening to the sea.
Dad always said you must learn to swim, or youll drown. Can you swim? he asks suddenly.
Of course I can, I reply, laughing. Enjoy your swimming, lad.
Im now a consultant surgeon at a city health centre. During a routine health checkup, a tall, impeccably uniformed officer approaches me.
Good afternoon, Dr. Michael Clarke, he says in a rich baritone, Ive long wanted to meet you.
Good afternoon, Captain Thomas Reed, I answer, glancing at his badge. Weve met before?
Indeed. He looks into my eyes, a flash of recognition sparking in his deep bluegrey gaze. Alex? Elliot? Is that you?
Its me, he smiles. Ive just returned from the Royal Military Academy and tracked you down. Wish granted. Im a navy officer now.
