15February Night shift, Royal London Hospital, Emergency Department.
The February air was heavy, a leaden sky threatening a storm, yet there was no snow on the streets. A siren wailed down the corridor as an ambulance pulled up outside the reception area.
Looks like theyve brought in someone serious, the senior registrar muttered, his voice low and thoughtful.
The doors burst open and a flood of voices filled the hallway:
Open the doors, bring him straight in!
The reception doors swung wide and a man staggered in, a little boy cradled on his shoulder. Close behind them, a woman clutched her own head with both hands, her face ashen, her voice trembling.
Is he is he alive? Please tell me hes alive.
That very morning I was the oncall surgeon. I dislike working on my days off; weekday shifts fly by, but a weekend night feels endless. The wards are full, the radiology is humming, and the lab techs are all present, so we usually get answers quickly.
Where? the father asked, his voice cracking. Where do I take him? Please, youre a military doctor, you can you can help. He began to sob.
The team snapped to attention.
Put the child on the trolley, barked the senior consultant. Oncall surgeon, examine him, and have the ICU team ready.
I stared at the boy and felt a cold shock. Exactly a year ago I had a similar night. It was December, snow blanketed the city, and a frantic mother had rushed in looking for her son who had disappeared after a brief visit to the park. After hours of searching we found him in a frostbitten ditch, still wearing the same blue jacket and red cap as now. He was already too late.
How long have you had him? I asked.
I dont know, the father replied. Neighbours found him in the canal, still showing signs of life. They performed mouthtomouth and chest compressions in the ambulance.
Alright, step aside, colleagues, the consultant said, turning to the nightshift team.
I removed the childs cap and unbuttoned his jacket. His skin was a grim blue, pupils wide and unresponsive, pulse and breathing absent.
Was any water removed? I asked.
It seems not, the nurse answered.
We began artificial ventilation, filling his lungs with humidified air. I turned him onto his back, placed my knee against his spine and pressed firmly on his chest. Water spurted from his mouth. I laid him on the trolley, gave a forced inhale, then three rapid chest compressions, trying to coax his tiny heart into action.
The cold may have preserved his brain a bit, I thought, recalling stories of people rescued from snow drifts after many hours. The wall clock ticked slowlytwo minutes, three, fivewhen suddenly a faint sound emerged, like a kittens purr.
The boy let out a hoarse, adultlike gasp, as if fighting his way out of deaths grip.
Take him to ICU, we need controlled ventilation; he wont be able to breathe on his own.
Is he alive, doctor? his mother, who had been silent, cried out, her voice shaking. Did we save him?
Well see, my colleague replied, call the airambulance for paediatric intensive care support.
We carried the boy to the intensive care unit, the atmosphere thick with anticipation. The monitor lights flickered, the ventilator worked tirelessly, keeping his fragile body alive. His narrow, skyblue eyes showed a faint reaction, suggesting some brain activity.
Two hours later the airambulance team arrived. After a quick assessment they delivered their verdict:
The child has been in clinical death for too long; his brain is no longer viable. Disconnect the ventilator and wait for the outcome.
A stunned silence fell over the room.
Our paediatric specialist spoke up, I heard, if the pupils are dilated and unresponsive, the brain may still be alive.
Not necessarily, a senior intensivist replied. We need to know how long he was submerged. The water in his lungs indicates that resuscitation in the ambulance was ineffective. Hes already developing irreversible damage; kidneys, livereverything is failing.
I interrupted, Lets try something. We dont have a paediatric catheter on hand, but perhaps you have one?
The catheter is available, but will it help? the airambulance doctor asked.
Lets give it a try, the nurses chorused.
They threaded a thin paediatric catheter, and as soon as it entered his line a bright, strawcoloured spray erupted, splashing the team.
Hes alive! Hes alive! we shouted in unison.
Well stay for another half hour, then well wean him off the machine. If he breaths on his own, well take him home.
Three hours later the boy, now called Alex, was stable enough to be discharged.
Two years have slipped by since that night. The memory of Alex stays vivid. One Saturday, a knock sounded at my door. A man stood on the doorstep, his face familiar yet aged.
Do I know you? I asked, surprised.
You might have treated me, he said, or we worked together. Come in.
Youre not a stranger, are you? That boy do you remember him?
From behind him a smiling childs face appeared. It was Alex, grown a bit, his eyes bright.
Alex? I whispered, stunned.
Yes, Alex, come meet your benefactor, his father said, apologising for the long silence. We couldnt find you after the incident. We traveled across the country, but finally were here.
I welcomed them in, feeling a mixture of disbelief and relief. Alex recited poetry, raced around the room, examined my collection of seashells, pressing them to his ear as if listening to the sea.
Dad always said you must learn to swim or youll drown, Alex said suddenly. Can you swim?
Of course, I replied, my voice shaking with emotion. Enjoy every stroke, lad.
Now Im back on the wards, earning a modest salary of £45000 a year as a consultant surgeon. During a routine health checkup, a tall, impeccably dressed officer in a navy coat approached me.
Good afternoon, DrMichael Benson, he said in a smooth baritone, Ive long wanted to speak with you.
Good afternoon, Captain Thomas Grey, I answered, glancing at his badge. Do we know each other?
More than you think.
I studied his face, the deep blue of his eyes catching a hint of something familiar.
Michael? Alex? I asked, uncertain. Is that you?
Its me, he smiled. Ive just returned from the Royal Military Academy and found you. My wish is fulfilled. Im a Royal Navy officer now.
The nights events drifted through my mind as I closed the diary, grateful that a child once thought lost had resurfaced, reminding me why I chose this demanding path.
