Nobody likes kids in this job. Nobody. Really sick kids are bad news. I know for a fact that I’ve got one coming for me, the city is too busy for me to miss them, statistically.

I dodged my last one rather neatly, he died on my birthday, he went down for a nap and didn’t wake up. I wasn’t there, I’d swapped my shift with Divert who’d offered to work it so I could go out that night and get honking drunk. Which I duly did. While she was doing two-fingered chest compressions, I was necking gin and tonic. I owe her.

We all shudder when we read in the papers about a kid who’s died, the Service is like a workplace with omni-present tragedy; it’s our bread and butter, but it doesn’t make it easier. You see the headlines and wonder to yourself “Who got that? Which one of my friends had to deal with those parents? With that floppy little doll-limbed body?”

They’re not babies, though, nor children. They’re “paeds” or “neonates”, we depersonalise them, remove any fragments of human from them, they’re just an algorithm to be worked on, numbers to check and actions to take, not a little person, absolutely not one of them. Start thinking that way, they tell me, and you’ll lose the plot and be no use to anyone, least of all your patient.

I’ve run it over with my colleagues, in my first few months I was scared of admitting that jobs had shaken me, that I was still trembling inside over the events I’d seen or dealt with. It was only once I settled in that I realised you gain no respect by being a hero, by closing it away and stone-facing your workmates. Respect is gained by showing that you’re human, by returning to the messroom with a cup of tea and bawling your eyes out, if necessary. “You’ve got to talk about it, son, if you don’t it’ll eat you from the inside out.”

I’ve voiced my concerns about dead kids to my colleagues, revealed my fear that they’re waiting in the wings for me. They nod, empathise, clap my shoulder and tell me I’ll do just fine. I wish I had their faith. Last week I used one of my days off to attend a Neonatal Resuscitation course at hospital, run by the staff of the unit I spent time in earlier this year, it was a great event. We’re trained to perform NNCPR at College, but relatively little time is spent on it, so to dedicate an entire day to the subject really let me get my teeth into it, to understanding the physiology of what’s involved.

“They’re not just little adults” trainers bleat again and again, but when I’ve pressed people in the past on why they’re different from adults, the answer always runs to “They compensate for blood loss differently.”

There must be more to it than that?

There is, it’s completely different.

In cardiac arrest, for instance, adults tend to suffer cardiac events <i>first</i>, their hearts stop and as a result, they stop breathing. Neo-nates, on the other hand, have lovely shiny new hearts with no harm or damage done to them by crappy diets, alcohol or smoking. Conversely, their hobbies include “eating, sleeping, crapping and apnea”. They just stop breathing.

For no apparent reason.

Bastards.

In a an adult resuscitation situation CPR is performed to maintain the supply of oxygen to the brain, CPR on its own is unlikely to make any great difference to a patient, it’s a space-filler, oxygenating the brain to stop it from turning to mush until the heart’s rhythm can be restored through shocks and drugs.

In kids, however, the heart has done nothing wrong, it is, in fact, the innocent victim in the situation. It has no plaque, no fatty deposits on it’s arterial walls. It’s sitting there, minding it’s own business when the newborn stops breathing, denying the myocardium (the muscle of the heart itself) of oxygen.

The heart can deal with this, briefly, it has reserves of glycogen which it can run on for a while and the neo-nate’s brain is much more resilient to hypoxia than in the older child.

In this situation the heart gradually slows down until its contractions are present, but ineffective. So with neo-nates, CPR isn’t the space-filler, as the heart is absolutely fine; it’s just unable to work effectively through lack of oxygen.

Push enough oxygen into the kid’s lungs and pump their heart and the heart will ‘pink up’ and clatter along, reperfusing the kid and making them (hopefully) wake up and scream.

Dancer.

So I spent the day learning all of this, practicing the skills and reprogramming my brain to think about things that I’d never consider in the field, like putting a hat on the kid before doing anything else.

I argued with them on this one, until they pointed out that a kid losing heat is about 30% harder to resuscitate effectively.

I left the education centre with a pat on the head and a deep faith that, having gone out of my way to acquire them, I’d never have to use these skills.

Ambulance personnell are superstitious as sailors, firm believers in the talismanic properties of skills and equipment “Let’s make sure we’ve got a BVM, if we’ve got it, we’ll not need it.”

But within days I was battering through traffic to the lassie mentioned earlier (smoking, phone calls) when I suddenly realised that I had no fear of the job, either she’d deliver and the baby would be fine, she wouldn’t deliver and we’d get her to the maternity hospital where there are lovely midwives or she’d deliver and the baby WOULDN’T be fine.

And I know now that I can deal with that; medically at least.