Remembering a physician, suddenly taken away

Originally published on KevinMD

Our 20-bed ICU finally captured 10 intensivists — all board-certified in critical care medicine. We were fortunate enough to have one of these doctors in our ICU 24-7.

Of course, they all practiced professionally with expertise.

But I remembered this one the most: Dr. Jason McKenzie (name changed for privacy).

He easily became our friend and “go-to” person.

Clocking in at night and finding out that Dr. J was our doc, would give me great joy.

He was fun-loving and our safety net.

One minute, I’d rap a part of an Eminem tune to him, and he’d automatically complete it. Or I’d switch to a Led Zeppelin tune, and he’d stay right on track.

If we needed a central line, he would be there to insert one. During Code Blues, he’d rattle off what meds were required next.

He wasn’t just a clock-in doctor. He was here for the patients and their family, but he was also here for us nurses too.

He respected and acknowledged us, and we knew we could go to him for anything.

We’d laugh with him, hear one of his stories or jokes, and within an instant, switch gears and run a code.

One of the most important values for a nurse is to know that doctors listen to them and respect them. Dr. J was the whole package.

He talked about his wife and their two adorable children. He had love in his eyes when he spoke of them. We knew they were one lucky family!

After several years, he moved to a different city in a different state and flourished. He became the director of ICU at a large teaching hospital.

He mentored and taught many residents and interns and nurses alike. They all loved him too.

And then we got the news — news that couldn’t be true.

He was a “no-show” at the hospital for morning rounds. This wasn’t his norm.

Some of his buddies went to his house, knocked on his door … no answer.

They called the police to let them in.

And there he was.

Face down.

No pulse. No respirations.

Cold.

At the age of 47, our dear Dr. J was dead.

We found out later that he was scheduled for a stress test two months after he died.

LAD: 100 percent occluded. The widow-maker.

ICU nurses, doctors, respiratory therapists crowded the funeral parlor.

His two small children touched his casket. His wife with her head bowed, dressed in black. It was too early, too soon to be dressed in black.

Disbelief and not a dry eye.

I cried uncontrollably. I just lost my friend. My buddy. My fellow rapper.

We all lost him.

But I’ll never forget his kindness. His wit.

His expertise.

Goodbye, Dr. J.

You were one of us.

You live forever in our hearts.

You were the best.

Go quiet into the night

Originally published on KevinMD

I know what you’re thinking: She’s cold-hearted, cruel, and unkind.

But am I? Or are you?

Grandma Lilly is 87-years-old and in the ICU. She’s on a ventilator with her wrists restrained to the side of the bed. Grandma can barely see because her eyes are puffy: scleral edema. And her heart races: 140 beats per minute. Her blood pressure is low and Levophed and vasopressin drips are ordered.

Her family can’t talk to her as she phases in and out of existence. For her, end-stage renal disease means dialysis. And respiratory failure equals ventilator. She’s a brittle diabetic with uncontrolled fluctuating blood sugars.

Grandma Lilly can’t eat, and we feed her by a tube that goes into her nose and to her stomach. Tomorrow, she gets a PEG tube surgically inserted to feed her. She’s been on the ventilator too long.

Next comes the ICU package: ventilator, dialysis, pressers, restraints, trach, PEG tube.

Any second of clarity or awareness is pure brutality. There’s no pretty ending to this torture except through death.

Poor Grandma Lilly.

Oh, the memories! When we were kids, we’d chant for Grandma Lilly. She’d snuggle us up in that rocking chair and read books to us. Let us splash our feet in the puddles after a misty rain, built sandcastles at the beach, and gave us candy when momma said no.

She was our heart and soul, and we wanted her to live forever. But we don’t live forever.

There’s cruelty in putting an 87-year-old with multi-system organ failure on a ventilator; restrained, medicated, disoriented, and wishing for the tunnel to the hereafter.

“The choice can be yours”

Your memories will live forever.

The ventilator. Churning inspiratory and expiratory breaths … day after day as Grandma Lilly wishes for death.

Grandpa Joe is two doors away from Grandma Lilly.

He’s going to die too from cancer. But he’s led a good life. And he’s cognitive enough to say he wants to die peacefully with his family and his dog Rufus by his side.

Grandpa Joe is a DNR/DNI and has requested to be “comfort care.”

He is given a morphine drip that flows slowly through his vein for his excruciating pain from cancer.

He breathes slowly. But he’s happy and pain-free and surrounded by love. His room is dimly lit. Music seeps out and fills the ICU hallways. Frank Sinatra, Nat King Cole, Ella Fitzgerald and Billie Holiday.

A Boy Scout and an Eagle Scout, he was the only one in his family who got a college degree. We loved his campfires, the stories he told, the wisdom and gentle guidance. And here, his family sat around him. Good old Grandpa Joe. What a life filled with love. They held his hand as they told their loving stories of Grandpa Joe. They laughed and silently wept. Tears of love and happiness and letting go but knowing the pain and suffering of his cancer would be over with soon.

After several rounds of CPR and cracked ribs, little Grandma Lilly died.

Grandma Lilly left this earth tied down like a captured animal.

Grandpa Joe left this earth with quiet whispers of, “I love you.”

The choice can be yours.

Go quiet into the night.

This is our last dance.

Comfort in my final hours

Originally published on KevinMD

My name is Lucy.

I have stage IV liver cancer. I wanted everything done — even though the doctors told me this disease is terminal. My family, my church and my friends were praying for “the cure.”

Though I believed in God and the hereafter, I wasn’t ready to go. 74-years-old with beautiful children, grandchildren, and a great-granddaughter.

I woke up confused. In the background — wherever I was — I could hear music: “How great thou art.” One of my favorites.

I had a tube in my mouth, and I couldn’t talk. My wrists were restrained, and I couldn’t move. They had me tied down. Everything was blurry. My chest hurt like someone had pounded on it. People in white coats and scrubs surrounded me. I became aware that I was in a room with doctors and nurses and respiratory therapists.

A man introduced himself. He said he was a respiratory therapist, and he was going to pull the “tube” out of my mouth. The endotracheal tube. I gasped and took a deep breath, and I could barely talk.

The team explained to me that I was in the ICU. And because I wanted everything done to me, I had been emergently intubated, restrained, pain and sedation meds given through my veins continuously. My heart decided to stop, and “the team” did CPR on my fragile body. Because by now, I didn’t want to eat. I had lost over 25 pounds from the liver cancer.

I was told that some of my ribs cracked during CPR. I had pneumonia.

A palliative nurse came to talk to me within a few days. I wasn’t out of the jungle yet.

The palliative nurse talked to me about comfort, about acceptance, about peace and being pain-free and being with my family and friends surrounding me.

Comfort care. DNR, DNI.

New words for me.

I was so sick, so tired, so much in pain. I led a wonderful life.

Now, it was time for acceptance.

I remember those words from my doctors: terminal, no cure, palliative chemo … extending your life.

But at what cost?

Was it worth staying in an ICU in a comatose state? Was it worth having your chest beaten on with CPR and cracked ribs and pneumonia set in? Was it worth being tied down?

I knew the answers.

I was always stubborn. But maybe it was time for acceptance.

Maybe the prayers being sent my way were meant for a peaceful death. A peaceful entrance into the heavens.

I called my family in with my physician, my nurse, and the palliative care nurse.

I begged my family to please not put me on a ventilator again.

Please let me be comfortable.

Please make me comfort care.

DNR and do not intubate and do not treat.

I slept quietly going in and out of consciousness. My sons and daughters gathered around. They laughed and cried and told many fun stories of when they were young! My grandchildren and great-granddaughter held hands as they sang “Yes, Jesus Loves Me.”

Another favorite of mine.

And their tiny voices uplifted me and my soul.

I was surrounded by love.

This time — I was ready.

Texting and driving: what happens every day in America

Originally published on KevinMD

Jenna had it all: She was smart, pretty, inquisitive and popular, with just one more year until she graduated from high school.

She was at the top of her class and couldn’t wait until high school was over, and she could become a pediatrician just like her dad. One day, Jenna would be an MD.

“One day at a time,” her parents always told her, even though she wanted to rush to the next stage of her life.

At the end of her senior year, the big day came: prom. Jenna had so many things to do, like get her hair done, pick a dress, and all of those things every girl going to the prom needs to do. The day before, Jenna had to put these things on the back burner since her mom cooked a mouthwatering meal for her and some important guests — her grandparents, only the sweetest and kindest people in the whole world, by the way.

Mom sent Jenna a text:

“Hey Jenna, where are you? U OK? It’s almost time for dinner. Grandma and grandpa are waiting.”

As Jenna drove home in a hurry, she knew not to look at her phone. But the text was from her mom, and Jenn knew she’d be safe as she traveled along the narrow winding road … maybe a little too fast.

She went to text back.

Forty-five minutes past since her mom texted Jenna who said she’d be home in 15 minutes. Jeff and Patty Davis now were concerned. Jeff Davis, MD, decided to look for his daughter.

He jumped into the car and took the usual route that Jenna would probably have taken home.

Instinctively, Dr. Jeff knew something was wrong. Jenna always followed through. She was always on time.

He traveled around that narrow road. What he saw left him breathless. There was a stabbing feeling in his heart as he saw ambulances, police, fire trucks and other people standing by watching. There were EMTs and paramedics standing over a crushed up body. And there was that cute yellow car Jenna got for her 17th birthday.

That car was wrapped around a tree on the opposite side of the road she was supposed to be driving on.

Jenna. His pride and joy. Pulseless, disfigured. Snapped at the neck. Lifeless.

The paramedic found Jenna’s cell phone on the floor of the car.

Jenna had texted her mom back:

“Mom CALM down. I’ll be home in 15 minu …”

This story is a composite of what happens every day in America.

My husband was dying. I was being ignored.

Originally published on KevinMD

It was a long December.

A few years ago, my husband of 37 years got his death sentence: recurrence of liver cancer with mets to his lungs and lymph nodes.

He had a “Whipple” — a surgical procedure for pancreatic cancer — on Dec 24, 2015, and the surgeon discovered liver cancer too. So it was a 16-hour surgery. We were told he might die on the table.

His eyes haunted me as I kissed him good luck for surgery. I didn’t know if this was our last moment together.

The surgery was successful, and chemo and radiation followed along with two heart attacks.

95 percent LAD and 90 percent circumflex the next year.

Each time I told him that he was having a heart attack, he would let me know that I was just causing trouble.

I never professed to be a cardiac nurse, but I knew my cardiology 101 quite well! But he maintained his arrogance and maybe his denial as he chomped away on his sublingual nitroglycerin like it was candy.

For the last six months before his new diagnosis of recurrence of liver cancer, he stayed in bed almost 80 percent of each day. There was excruciating pain in his abdomen. Narcotics would only help a little.

I instinctively knew his cancer was back, but nothing could prove it: The CAT scans were negative, MRIs were negative. But then, his liver function tests jumped up — he became extremely jaundiced.

A simple ultrasound — one of the least expensive and simpler scans — finally proved what I thought: recurrence of liver cancer.

Two drains under interventional radiology to his liver would follow. And finally, a stent placed to his liver.

He didn’t eat, and he lost over 25 pounds. The stent stayed in place, but the cancer grew larger as it spread frantically throughout his body. This left him in a skeletal state, jaundiced, barely able to talk or to walk.

And this man who was the best father to our three children, who loved his granddaughter and our daughter-in-law, who faithfully took care of his mother until her death, who was an advocate for the underprivileged, who was a leader in the under-privileged community, who worked diligently at the health department as an educator and producer and director of health films and co-founder of a health care film festival throughout the U.S and became a partner to assisting in establishing the same in England, who joyfully took our children’s friends into our house and treated them as if they were his own and took them on vacations of cruises and fun parks and beaches and volunteered with our church youth group teenagers in white water rafting events and seeing these young people off on a mission trip to Ireland to promote peace and love and encouraged education to the most underprivileged …

This man who I deemed as the last hippie on earth lay in a hospice bed restless receiving morphine and Ativan.

And I wish his suffering would end because this is not a life.

It’s been a harsh two years. Many miles of driving back and forth to many doctors: oncologists, psychiatrist, surgeon, interventional radiology, CT scans, MRIs, palliative pain MDs, healing hands, internal medicine — and I’d begged for a DNR. I’d beg for hospice. I was told I had no say so as long as my husband said he was waiting for a cure. He wanted everything done. And I frantically explained: “Your ribs will crack with CPR, your body is too fragile, you’ll end up on a ventilator and your wrists will be tied down and restrained, and then you will die anyway.” Nobody listened.

His surgeon told him “We’ll do palliative chemo, and it’ll wipe this cancer out that has come back to your liver and lymph nodes and lungs. You’ll live another three to five years.”

And his oncologist said, “We will do palliative chemotherapy, you can handle it.”

And they demanded that he ate well and take 20 meds twice a day and take insulin on his frail body that he refused to nourish.

It was those false promises I resent from the medical profession. I told the MDs what they promised was not true. Why are we doing this?

And I was shunned and disregarded. But I knew the truth.

And here he lies in a hospice bed waiting for death with a quickly deteriorating body and mind that doesn’t know our names or his name. And we scrambled to adjust and prepare … because the truth is only five percent of people with liver cancer diagnosis survive this deadly cancer within five years.

There are no miracles.

I beg the medical community to be honest and upright and stop the fairy tales and false assumptions that everything will be fine.
False promises lead to more heartache.

I’m asking for truth.

I just wanted truth.

My husband passed away peacefully at 2:20 p.m. on December, 11 2017.

He fought the good fight, and as always we all wished we had more time left.

What man’s best friend taught me during a patient’s death

Originally published on KevinMD

Years ago in a 15-bed acute medical-surgical ICU, the nursing supervisor contacted me about a special assignment. Once I knew what it was, I said, “Absolutely.”

We were about to admit a patient in his 40s with end-stage AIDS/HIV. He asked to be a DNR, but his MD wanted to admit him to the ICU for close monitoring. But the patient had a special request. Even with IV antibiotics and pain medication running through his veins, Mr. Sam Smith just wanted one thing — his Yorkshire Terrier named Charlie. This dog that was found in a dumpster behind a grocery store was Mr. Smith’s best friend. They were always together, Charlie a few steps behind his human companion.

After Sam was admitted to ICU, I made sure he was comfortable, relaxed and pain-free. Friends came to visit, and one brought Charlie who wagged his tail and proceeded to lick Sam’s face. What a grand reunion.

I introduced myself to Sam and Charlie and watched the both of them throughout the night always making sure Sam had a blanket and his buddy was tucked in right next to him. Charlie cuddled up to his owner and slept peacefully through the night.

At 0300, I had to draw labs, and Charlie looked up at me as if to say, “Hey! Don’t hurt my master.” I explained to the dog, as if he were human, that I had to collect blood from his friend so I could get some information on his care. Charlie calmed down a little, but he was still staring at me.

Then I realized that this dog was probably thirsty. I filled up a styrofoam cup with water and gave it to him. He lapped it up and then turned to me and licked my forearm. I knew then that he was aware I was there to help both of them through this strange, sad passage of life.

Sam’s other friends would come in and out to take Charlie for walks outside where Charlie would sniff the flowers, do his “duty” on a few bushes, bark at the birds, then come back to the ICU to resume watch for his very favorite friend, rescuer, and caregiver.

Within two days, Sam became progressively lethargic, somnolent and nonverbal. His breathing became slower and slower. His family and friends were now at his bedside telling stories of Sam and Charlie. They laughed, and they cried as they told story after story of the wonderful, amazing adventures of Sam and Charlie.

Carlie was fully aware that Sam was dying. As they told stories, Charlie remained snuggled up to Sam. He licked his master on the cheek and resumed his position … right beside Sam’s heart.

After four slow, irregular breaths, Sam let out his last breath.

To say that our entire ICU staff and physicians alike were crying buckets would be an understatement.

But to say that Sam had a tragic ending would be wrong. He chose to die with his family, friends and best friend Charlie right by his side.

That night, I learned that there are words with special meanings, like compassion, friendship, and dedication.

And a small dog named Charlie taught me what unconditional love means and that death is a continuation of life.

We don’t live forever, but our memories do.

Keep love in your heart, and you will live forever.

Charlie went home with his other caregiver — Sam’s partner.

A nurse returns from vacation. And she’s thankful to the ICU she came back to

Originally published on KevinMD

I’m in the ICU and was just back from an incredible tropical vacation. Nine days of vegging out on the beach. The glistening ocean was just steps away from the five-star hotel I was staying in, where doormen greeted me with fruity daiquiris and a staff that couldn’t wait to serve my every whim.

I was in paradise, and far, far away from the reality of my day-to-day existence as an ICU nurse.

I was nowhere near the code blues, the sputum plugs, nor the bowel movements that dripped onto the floor. I was also far away from demanding family members, management, and that plastic smile I was forced to don in situations with them.

Vacation was over, and I was back. Although this was my profession and I was highly skilled, I secretly wished I never came back.

But here I was. Day one. My assignment? Another old person. An 82-year-old lady with stage 4 lung cancer. Another little old lady gasping for air with her old friends praying over her as if she were already dead. They would visit and sometimes sing gospel music from days gone by as they all swayed.

One day, the patient, Gerde (short for Gertrude), asked me to her lipstick on. And I did.

She asked me to fluff up her soft white hair.

And I did.

She asked me if I wanted to learn to crochet.

And I said yes.

And in between her ABG’s, adding IV antibiotics, giving her nebulizers and putting her on high-flo oxygen, she taught me to crochet.

She taught me even though she knew she was going to die. She knew it was time to go.

And in the dread I felt from leaving that tropical vacation and having to face this assigment, how did I find the most precious lady on earth who could not wait to reunite with her husband.

Within three days, she taught me to crochet a scarf as beautiful as any scarf available in an upscale department store.

She asked me to hold her hand as her final request. She was ready. I sat beside her and held her small, cold hand as she drifted off to the hereafter.

Her face glowed as she left this earth with a smile. No one blinked when she died, nor when they saw me crouched down with my head low in front of the computer with tears rolling down my cheek.

I was no longer sad I left my vacation. I was thankful that I left that tropical island to come back home to a little old lady who gave me bountiful blessings is just three days.

Who is alive: man or machine?

Originally published on KevinMD

He had cardiomyopathy and CHF for over 20 years. At the time, doctors told him he could die at any time. That was 20 years ago. His EF was 10 percent — barely livable.

Two decades later, this admit kept him on a see-saw with respiratory distress, a bad heart, bad lungs, atrial fibrillation with RVR and heart rate in the 140s all day long. He progressed from nasal cannula to Optiflow to 100-percent BiPAP. A Cardizem drip was added to no avail. His next step would be intubation.

I pulled his wife outside of her husband’s room. And I told her that he wasn’t doing well and we may have to progress to a ventilator, and not to let him drink anymore — aspiration and aspiration pneumonia.

I could see the years of suffering on their faces. The dedication and love they had for each other.

His wife agreed. But 20-minutes later, she came to talk to me.

“We don’t want a ventilator. We’ve dealt with this for over 20 years. He doesn’t want a ventilator,” she said.

I grabbed our intensivist and gave her the heads up. She talked with the wife and the patient who both requested a DNI.

The patient stated he would go through one round of CPR … just one round. A strange request, I thought.

The MD added DNI to the patient’s chart.

An hour later, his wife came to talk to me again, “This doesn’t make any sense to not put him on a ventilator but to do CPR and crush his ribs and hurt him when we know he has a bad heart and lungs. I think it would be cruel! He’s ready to die. He told me so. We don’t want to see him suffer anymore. He just wants to be pain-free. No more pain and suffering.”

I could see the years of suffering on their faces. The dedication and love they had for each other.

Back in the day, we had a universal policy: All or nothing. Either a full code with CPR, intubation or nothing at all. Now patients and families can choose. There are different variables: no intubation but do CPR. Or give ACLS meds but no CPR. Many of these variables/ protocols make no sense to me, but the families and patients get to choose.

I agreed with Mrs. Smith and explained to her as we were surrounded by three respiratory therapists that by not intubating but doing CPR one time was like giving him a car but telling him he couldn’t have any gas.

The respiratory therapists agreed.

I introduced the thought of morphine in small amounts. A 2 mg IV push helps with breathing and anxiety and air hunger.

She agreed. And Mr. Smith was made a DNR/DNI.

The man’s family came from near and far. His sons, daughters, sisters, brothers, his buddy from elementary school, his favorite chaplain and his wife. They all sat by his side and kept vigil. They shared stories of Mr. Smith as they laughed and cried.

As Mr. Smith nodded in and out of consciousness, they held hands and hugged one another as a tear rolled down Mr. Smith’s cheeks.

We made Mr. Smith “comfort care.” And that’s what it means: providing comfort at end stage lung, kidney, heart, liver diseases, terminal cancers and multi-system organ failure.

Morphine was given as needed for comfort.

And we watched Mr. Smith drift away from our universe — the inevitable.

I cry as I write this. But I rejoice in knowing that we did not torment this man with CPR, cracked ribs, ventilator, wrist restraints, central lines and dialysis.

I remember something my husband once said to me,”Who is alive: man or machine?”

One and done: a heroin and fentanyl cocktail

Originally published on KevinMD

There was her 28-year-old daughter lifeless in an ICU bed.

Her name was Tricia, and she had dabbled with drugs since she was 15. As a child, she was artistic, adventurous, and always found excitement with other kids who tended to do risky things. She’d justify their behavior and say they were more fun and had better personalities.

Eventually, her mom and dad moved to a small town thinking it would be a safer environment. But when Tricia started middle school, she again sought friendships with those “bad kids” on the edge.

It was as if she was heading down a path of destruction her whole life.

But her unsavory friendships didn’t keep her from excelling scholastically. Tricia was quite the student: she was smart, absorbed information in a flash and had a mind like a computer that was always on. And she was especially good at biology and chemistry. In fact, she obtained a bachelor’s degree in chemistry — she was that smart.

After college, she landed a decent job. A job that paid the bills and her drug habit.

Heroin costs less than Percocet pills on the street. But there was also a new way to get high in town. The “ultimate high.”

The combo: Heroin laced with fentanyl.

ER docs and nurses call this mixture “one and done.”

But that didn’t matter to Tricia or the crowd she hung out with. Even though they heard that this combination killed, they were willing to take a chance. They knew it wouldn’t happen to them.

After all, weren’t they invincible?

Apparently, they weren’t.

A car sped up to the ER entrance, and Tricia was pushed out right before her “friends” put the pedal to the metal and took off. Workers later said it was too late to capture the license plate. All they knew was that it was a red Mustang. Other than that, the occupants of the vehicle were a mystery.

There was her body on the cold pavement. No pulse. No breathing.

“Code Blue” blared throughout the hospital.

CPR, intubation, central line, loads of normal saline, Levophed, and vasopressin — it took over 20 minutes to gain a pulse on Tricia. They found opiates in her blood.

Her “friends” had thrown her wallet out when they dumped the body. That’s how the hospital identified her.

But her mother already knew something was up. It was a week since she last heard from her daughter, and Tricia usually called every other day. After dealing with Tricia’s friends who “knew nothing,” mom called the police who heard of the dump and referred her to the hospital.

The ICU nurses understood she was dead. It was just a matter of time after so many hours of ineffective “Code Cool” protocols. We lowered her temperature to preserve her vital organs, but it was too late. She was down for too long.

Her mom rushed in, shook her beloved daughter’s arms and screamed, “Wake up, Tricia! Wake up!” The only movement was a decerebrate response.

Tricia moved her mom thought.

“She’s moving!” her excited mom yelled to the nurses. But we had to explain to her that movement from decerebrate response is one of the worse signs of neurological damage.

Tricia’s body was rigid with head and neck arched backward.

After EEGs, MRIs, cold caloric tests and failing “Code Cool,” the promising, smart, adventurous woman with a chemistry degree was pronounced brain dead.

Another one down.

One and done — the ultimate high.

Death.

Was it really worth it, Tricia?

Heroin and fentanyl. They call it “Theraflu,” “Bud Ice” or “Income Tax.” And it’s happening across the country in cities and town big and small. Some are lucky. Some get to the ER in time. Naloxone (Narcan) IV push can reverse heroin. But when it’s laced with fentanyl the chances are much slimmer like Tricia’s case.

Should you know someone or YOU are that someone, get help. Get treatment. Go to rehab. You can start over.

Do something or accept and expect that you might be six feet under.

Remember, it’s one and done.

A toddler, his dad, and the unthinkable

Originally published on KevinMD

The toddler was a curious, rambunctious, talkative three-year-old who loved to explore.

Every week, he’d wait for Sunday to come, because Sunday was he and his dad’s special day. Mikey and his father adored each other.

Whether Mikey and his dad were doing “horseback rides,” playing basketball, or just sitting on the rocking chair for story time, whenever they were together there was fun, love and a forever bond.

Mom called them “the twins.”

One particular Sunday, “the twins” packed a picnic lunch with a bag full of breadcrumbs for the ducks. And Mikey couldn’t wait to feed those ducks! Dad loaded up the truck, and he and Mikey set off for their favorite park.

They sang their favorite song on the way: “This little light of mine … I’m gonna let it shine.”

When they arrive, it was a beautiful riot of spring: flowers reached for the sun, the air seemed to pierce through the fluffy clouds and the ducks waddled over and ate the bread crumbs Mikey had tossed to them.

Dad spread out a quilt on the grassy area under a tree where he and Mikey ate peanut butter and jelly sandwiches as they talked about the clouds and, of course, the ducks.

When lunch was over, Dad turned on the radio, and they listened to music. Tammy Wynette, Patsy Cline, Hank Williams, Johnny Cash and old gospel tunes — the good stuff.

Dad closed his eyes, but only for only a second. Mikey saw dad sleeping. Dad had such a beautiful smile, he thought.

Curious Mikey heard the ducks quacking and wanted to pet them. So he went down to the pond and got very close to the water. Then, one of his little feet slipped on a slick, wet rock.

At the hospital, things were quiet in the ER. The nurses were snacking on treats their families brought them after church. Sunday was always a good day for the nurses and staff. Church folk stopped by to visit loved ones and sometimes brought treats for the workers.

This particular day was eerily quiet, though. One of those “quiet days” that was almost unbearable. It was such a tranquil and peaceful Sunday that it almost “warned” us that something bad was going to happen. Amid the snacking and the chatting, there was a sense of doom.

A truck sped up to the Emergency Room doors. A frantic father carried his three-year-old son out of his truck and screamed, “My son, my son, help my son!”

Mikey was blue and lifeless as he lay on the ER stretcher. “Code Blue, Code Blue,” paged loudly and quickly throughout the hospital. Surgical nurses on their break ran out to the ER; respiratory therapists reported STAT to the ER. This small country hospital had only two MDs that day, and they dashed down the stairwell to the ground floor ER.

Mikey’s dad told the story gasping and hyperventilating.

“I fell asleep. I fell asleep … it was only seconds.”

Mikey had roamed off, and he slipped on a rock and fell into four inches of water. He couldn’t get up, and his mouth filled with pond water as he desperately gasped for air vomiting and aspirating until he was unconscious.

When Dad woke up, all he could hear was silence, but Mikey was never silent — until then.

We performed rapid CPR compressions between oxygenating him. Mikey was in pulseless electrical activity (PEA).

No pulse. No heart rate. No breathing.

Dad leaned over the ER sink, hung his head and began vomiting while he cried, “My son! My son!”

Despite our IV doses of epinephrine, rapid CPR, pleading with God and despite wanting to pretend this nightmare never happened — Mikey did not come back to life.

There he was blue and lifeless with vomit on his little T-shirt that read, “I love daddy.”

This was over twenty years ago, and the vision is ingrained forever in my brain.

Some things we cannot erase — ever.