From the very first I liked him. Paul was a bouncy, broad-smiling, 5-year-old, trusting and innocent. Born with a D-transposition of the great vessels, he had undergone a Senning repair not long after birth. All had been well for years when suddenly he would feel a pounding in his chest and then lose consciousness. The episodes were becoming more frequent and lasting longer. Through Holters and EP study we found he had atrial flutter and sick sinus syndrome. We placed a pacemaker and started him on drug therapy. The episodes stopped.
Young Paul soon became my favorite patient. I looked forward to his visits, where he would jump into my arms, hug me, and kiss me on the cheek. He would present me with pictures he had painted, and I would present him with a pen or mug advertising some product. "How's my little buddy?" I would ask as he charged into the clinic. "How's my big buddy?" he would respond as he bounced into my arms.
Then, one morning when Paul was 7, I received a stat call to the emergency room. Paul had collapsed at school, a paramedical squad was bringing him in. He was in full arrest; I was there the moment he arrived.
The code team, with me directing, worked like a well-oiled machine. Everything went like clockwork, except that Paul wasn't coming back. As the moments wore on I began to feel a growing sense of desperation, which shortly became a sense of panic. I ordered more magnesium to be given. As CPR continued onward and almost an hour had passed, my thoughts began to run wild. "Oh G-d," I pleaded in my thoughts, "Please not this one. Not him." I began screaming in my mind, "Paul, don't die!" Suddenly, without even realizing it, tears welling up in my eyes, I was screaming out loud, "Paul, don't die! Oh please don't die!"
The code team was shocked at my outburst, and one of my colleagues put his hand on my shoulder saying, "I think I better take over." Yet, no sooner had the words left his lips when someone shouted, "Hey, there's a rhythm!" We looked at the monitor. Slowly at first, then with increasing frequency, QRS complexes started to appear. "There's a pulse!" one of the residents cried out, "I've got a pressure!" said another. Within moments his vital signs had stabilized. Then, for what seemed like an eternity, no one spoke, me staring at Paul, and they staring at me.
Paul began to move, and gag against the endotracheal tube. He opened his eyes, turned his head, and looked straight at me. The head nurse gasped, dropped her clipboard to the floor, and made the sign of the cross. The resident who had first felt a pulse, a young Arab, looked pale, and uttered, "Allahu Akbar" (G-d is Great), while my colleague muttered over and over, "My G-d, My G-d. . ." I took Paul's hand, leaned over to kiss his forehead, stroked his hair with my hands, and wept.
Shortly thereafter he was moved to the ICU, extubated, and made a full recovery. For the next several weeks I was the focus of a number of good-natured jokes, the principal one being that before anyone could end a code they had to page me to come and yell at the patient not to die. After a while, people began to forget the event. After all, they said, it had just been coincidence, the code team had done well, the drugs just needed some time to work. Perhaps, perhaps . . . . But those of us who were there will somehow remember it differently.
I spoke with Paul that next day after the code. He was still groggy, yet hugged me tightly, I asked if he could remember anything that had happened. He sat still for a moment, collecting his thoughts. "It was dark, and I was floating, like I was underwater or something. I wanted to move but I didn't know where." He paused for a moment. "Then I heard someone calling my name, and then I was moving toward it and it got lighter and lighter." His little boy eyes stared deep within me. "It was you who called me wasn't it?" "Yes Paul," I replied, "It was me." "We're still buddies, right?" he asked. "We're still buddies," I said, and held him tight.
That was all many years ago. Most of the people who were there that day have moved on to other positions, other places. But Paul and I are still here, and we're still buddies. He has blossomed into the fullness and energy of young manhood, while the lines on my face have grown deeper, and my hair continues to turn gray.
When I saw him last in the clinic we spoke of cars, colleges, and careers. He proudly announced to me he would choose a pre-med program. "How did you happen to choose that?" I inquired. "Oh," he replied, "Let's just say it's a calling." And at that, we both laughed ....
