next blasphemous text
previous blasphemous text
The Night I Lost My Faith
by R. David Lee, MD

I'd always been a man of faith—a born-again, Sunday school-teaching Christian who believed that his religious grounding made him a better doctor. But a dead baby can change everything.

Returning home after a long day at the office, I called the hospital switchboard to sign off from call duty. Still, minutes later, the phone rang.

"We need you here now!" Rick, the charge nurse quavered. "We have a dying baby."

I raced along winding country roads. I wasn't a pediatrician and I wasn't officially on call, but neither mattered. In the medically underserved community I practice in, family docs are expected to wear many hats, especially in emergencies. Still, minutes away from becoming a pediatric intensivist, I realized I hadn't assisted in a pediatric code since I was a resident.

I'd witnessed my fair share of pediatric tragedies, although mostly from a distance. As a third-year medical student, for instance, I'd stood on a step stool to get a better view of the residents and attending physicians as they struggled unsuccessfully to save a toddler who'd been struck by a car. Three years later, I was moonlighting in a rural ED when we had a dual trauma code—two young children murdered by their psychotic father.

How did my faith fare during tragedies like these? Back then, I managed to redirect my anger to an inattentive driver or a mentally ill father, or to some other responsible human agent.

As long as I could find "meanings" for deaths, I was able to put a cushion around my God's role. I ignored whisperings in my mind that suggested that God was either responsible or He was irresponsible.

The second I set foot in the code room I knew that I was in way over my head.

On the stretcher lay a neonate, her eyes closed, two IVs in place. The nurse anesthetist had intubated her and someone had administered atropine. The monitor showed sinus rhythm at a rate of 50. I confirmed the bradycardia and ordered chest compressions.

"We've called the chopper," the ED doctor said. "They're putting a crew together, and will call us back."The 90-minute ambulance ride to the university would be a 15 minute trip by helicopter.

"Do we have a history?" I asked, examining the baby.

"Two-week old, discharged from another hospital this afternoon," the doctor replied. "Spent the last week there with fevers of unknown origin, but septic workup and cultures were negative. Her pediatrician discontinued antibiotics this morning, and she became afebrile. She was discharged home, with a presumptive diagnosis of viral syndrome and drug fever."

As he spoke, I checked the baby over, looking first for signs of abuse. No bruising, bony deformities, bulging fontanel, or retinal hemorrhages. I turned to other matters. Femoral pulses were good with chest compressions, absent without. Abdomen and thorax were grossly normal. There was no withdrawal reflex when I pinched her tiny feet, but her pupils were responsive. Her skin was cold and mottled, but with no obvious rash.

"Mom and dad had only been home from the hospital a couple of hours when mom noticed that the baby felt cold," the ED doctor continued. "She attempted to get a rectal temp, but the thermometer didn't register. That's when she called the other hospital's ED, and they told her to bring the baby right in. En route, dad noticed the child wasn't breathing, so he started CPR. Since we're closer than the other hospital, mom came here. Total down time was about 10 minutes before we got her tubed and the atropine on board."

"Let's get a blood gas," I said, stepping out of the room.

A race against time When I returned, I was surprised to see Jill, the head of respiratory therapy, at the baby's bedside. She was trying, unsuccessfully, to do a blood gas on the child's right femoral artery.

"You're supposed to be on vacation, aren't you?"

She smiled crookedly, indicating that Rick, the charge nurse, was taking his usual casual approach to the work schedule.
"Mind if I try the other leg?" It would be my first blood gas on a neonate.

She nodded, and I positioned the ABG syringe, but obtained only a drop of what I hoped was venous blood.

"Blood sugar's nine," I heard someone say, and then ordered a nurse to add more dextrose to the mix of naltrexone and dextrose I'd ordered moments earlier. I'd figured they couldn't hurt even if hypoglycemia or narcotics didn't enter into the equation.

Suddenly, Rick's voice broke through the code room din. "There's a thunderstorm over the mountain, and the chopper is grounded. The university has a peds team ready to come by ground. They should be here in 90 minutes."

"No," I shot back. "We can get there in the same amount of time, and I can run the code in the back of the ambulance just as well as I can here. Jill, will you ride with me?"

She smiled her assent, and Rick announced, "We'll have a driver for you in five minutes."

"Great," I said. "Are the parents here?" Rick said they were, and I left the code room to talk to them.

"I'm Dr. Lee," I began. "We need to get your baby to the university. She's in extremely critical condition. The helicopter can't fly tonight because of the weather, so we're taking her by ambulance. I'm going to ride with her. Would you like to see her before we go?"

They said they would, and I led them toward their daughter. As we walked, I cautioned them: "We have a lot of tubes hooked up to your little girl. We're doing CPR. This is going to be scary.

"What's your baby's name?" I whispered as I pulled back the curtain, exposing a drama no parent should ever see.
"Her name is Lisa," the mother said.

"Come here and give Lisa a kiss before we leave," Jill said.

Mom leaned over her newborn child, weeping, ignoring the CPR, ignoring the endotracheal tube, ignoring monitor alarms, ignoring frantic medical professionals. For one moment, it was just mother and daughter.

"Be strong little angel," she wept. "You have to be strong . . . for mommy. Oh God! Be strong, be strong, be strong."
She kissed Lisa one more time, and then looked at her husband, who was sobbing. He remained where he was, shaking his head vigorously.

"Give your little girl a kiss goodbye before we take her," Jill urged him.

But the father remained immobile, without the strength or courage to do what his wife had just done.

Jill left the baby's side, walked over and put her arm around him, gently pulling him toward his daughter. "Kiss your little girl before we take her. Please. You have to do this."

Trembling, Dad leaned over his little girl, the daughter for whom he would never have a cute nickname, the daughter he would never give away at her wedding, and kissed her quickly.

As he did, my eyes met Jill's. We knew that he and his wife would probably never see their Lisa alive again.

We made the trip to the university hospital in less than an hour. En route, Lisa's condition deteriorated rapidly: Hematomas spread across her tiny body like a rash. Blood oozed out of every pore and orifice.

Holding the ET tube in place with my left hand, I squeezed the Ambubag with my right, and then rested it on Lisa's forehead. As I did, a hematoma developed beneath it. Disseminated intravascular coagulation laid to rest any question about my patient's prognosis.

On the elevator, I studied my gloved hands, which were dripping with Lisa's blood. I watched Jill's fingers compress Lisa's bruised and broken chest. I had kept her alive long enough for some other doctor to call the code.

As we entered the PICU, a swarm of neonatologists and pediatric intensivists surrounded us, transferring Lisa from stretcher to incubator. I recounted the history of the case while one of the specialists took over the code.

"Start an epi drip and give her some bicarb," she ordered a nurse.

Suddenly, as if on cue, Lisa's heart monitor flat-lined.

"Oh," said the specialist, turning to me with tears in her eyes. "You've come all this way, and you've tried so hard."
She looked back at Lisa's dead body.

"Let's give three milligrams of epinephrine, one to ten-thousand bolus." She paused and shook her head slowly.
Everything gradually stopped. Ventilations halted, chest compressions ceased. A nurse turned off the monitor. Quiet fell around Lisa's body.

And then Jill pushed her way to Lisa's bedside. As we all watched, she used a damp cloth to wipe the blood from the infant's delicate skin. Next, she wrapped her in a receiving blanket, snuggling the baby's tiny body to her chest. A nurse brought her a rocking chair, and Jill sat, gently rocking, while we all stood around. I didn't move until someone told me the family had arrived.

I'm not a stupid man—I know how believers and disbelievers would interpret the events of that horrible evening. An atheist would say that Lisa's death didn't destroy my faith, but rather served as a final crack in an already shaky foundation. Believers would tell me that instead of trying to decipher the meaning of Lisa's death in the cosmic scheme of things, I should just accept that God sometimes permits bad things to happen for reasons beyond our comprehension.
Though I lack the insight to answer either party, I do know that the emotional investment I bring to many patient encounters is as much a liability as an asset. I search constantly for answers, but I can't fathom why this one particular death has affected me to this degree; why this one baby's death has destroyed part of my identity. Regardless, life is much simpler now that God is no longer in the equation.

I searched longingly for a divine presence as I led Lisa's parents to the room where Jill was holding their lifeless baby, but I sensed nothing but an infinite void. Mom gently removed Lisa from Jill's arms, dropping to her knees and beseeching a divine benefactor for help. I knew, at that moment, no one would hear her.

A world without God? Perhaps all doctors, like me, are one dead baby away from atheism. Medicine, after all, is a profession that leaves all of us who practice it so spiritually vulnerable.

But a world without God isn't necessarily a world without hope. When Jill nestled that lifeless baby in her arms, steadfastly refusing to allow any of us to dehumanize the child, I saw real kindness in her tears. When the attending pediatric specialist called me two weeks later with the autopsy results (disseminated herpes simplex), she displayed an enviable human and professional decency. And when Jill and I returned at 5:00 that morning to the hugs and well wishes of staff, I felt surrounded by people of goodwill. And I got a message to call Rick, the charge nurse, at home. He was still awake, waiting for my call. There was no mistaking the love in his voice as we spoke.

There is kindness in this world. There is compassion and decency. In a universe of death and suffering, there are things that make existence worth our while. In the heart of each person there is a penchant to make one's environment a better place. There does not need to be a God if we choose to exercise our proclivity for decency.

If God is nothing more than an intangible concept that motivates our hearts—a synonym for "love" and "kindness"—He is more powerful than I ever imagined as a believer.