Five days before this story begins, where everything is upside down, and the end is the beginning.
Me, standing in my PICU, slowly approaching that cradle, then removing the medication, one by one, turning off the syringe pumps. Saying out loud the number of milliliters passed, where that line is trapped, that little division between the professional and me, the person.
Where I stopped being a doctor and became a woman holding a baby.
5.8 mL of adrenaline, and I press the off button. A little flash, and it’s over.
10.2 mL of noradrenaline, the pump light extinguishes with minimal noise.
Withdrawing treatments that stop making sense, to slow down, to give way.
A glance at the monitor to notice how nothing changes.
Without the medications, his vital signs remain the same.
The beating of that little heart is still there, strong, fast, facing the death that lurks in it, that has already taken possession of it.
We disconnect the infusion lines and the pulse-oximeter and remove the probes.
The little baby’s body remains.
It’s a blond, with snowy skin and 7 pounds of weight, despite all the liquids that swell that small face a little.
He is a precious baby, with white skin, like his mother, who looks like a girl.
A blonde foreign girl, glancing at a hostile world with her big blue eyes.
She enters with her mother, who has driven 3,000 kilometers to see this grandchild alive. She may be my age, though she looks a century older, sick at heart touching her grandson’s hair.
Her daughter holds her face and speaks to her in a soft voice in that strange language.
And she, mother and grandmother, cry quiet tears, gently resting her lips on her daughter’s forehead.
A kiss of shared sadness, the strength of the mother and daughter’s love, of the bonds. Of that child that unites them in infinite and eternal pain.
“I don’t want to stay,” says the mother, who has not yet cried.
Unfathomable sadness hidden in brief and accurate words.
Serious, supporting the grandmother who walks away slowly, while in each step she ages an eternity under the weight of life and death.
I have explained to them repeatedly that the machines maintain her baby’s life artificially.
That death already dwells in his brain, that it made its own little by little in the days after that respiratory arrest.
When he was found in his crib, without breathing, and arrested again in our emergency room.
That death had already won that first battle, even though we all resisted when her son started beating again after 45 minutes of resuscitation, just a mirage of happiness, an instant, fleeting.
Little by little, the facts of our defeat became clear until death painted its victory in the lines of an electroencephalogram, in the flows of the ultrasound, in the data of our exploration.
Under that precious little body, life escaped.
I tell her several times that I am there for them. That she can hold her son, that this is their farewell.
She caresses him and afterward leaves the unit.
I take a small sheet and remove as many signs of our treatments as I can.
His little face is clear, only with the tube connecting him to the breath of life, enabling his grandmother to meet this grandson who was born just three weeks ago, to caress his little white face.
Crying at the same time of happiness and the deepest sadness. Welcome and goodbye — the ritual of life.
I bring an armchair closer. We close the box curtains and remain in silence.
I lift the little body and gently tuck him in with the blanket to hold him in my arms, barely feeling his weight, so light, that little body.
I sit up and carefully remove the tapes from the tube. I turn off the respirator and pull out the tube, only leaving the electrocardiogram to draw in the trace of his heartbeat, his goodbye, while I hold that newborn close to my chest.
Little baby in which life still throbs in a faint farewell.
I hold him gently, caressing his forehead, hand, and tiny foot.
Silently I talk to him, rock him. He marches surrounded by love, in the warmth of a painless embrace.
The mother enters, and I hand him over to her and give her the place on the chair. She takes her baby, who hasn’t breathed but still beats in her arms, mother and child, a perfect embrace.
Invisible but indelible bonds.
At last, she cries. She covers him with love made of falling tears.
A few minutes later, his brother takes the baby from her and hands him over to me.
They leave the unit, hugging each other, and never come in again.
Distant grief from another culture, where perhaps restraint is the strength.
I stand sharing that time with the certainty of what unites us.
Without any judgment and holding their grief.
I hold that child who takes time to say goodbye.
Minutes that run with a beating heart facing an overcoming death, majestic farewell in that small body that barely had a chance, but leaves in a demonstration of the miracle of life, with an unsuspected strength.
There I am, standing — spectator of the thin line that unites life and death.
Seconds that transcend, rocking him slowly, holding him gently.
Cradling him for the last time.
I am no longer his doctor. I am just a woman with a dying baby in her arms.
And there is nothing else around.
All that I am is concentrated in that essential and beautiful instant.
His heartbeat finally slows down, the vital impulse declining very slowly, in a precious goodbye.
While his skin pales and the heat, little by little, gives way to death escaping from there.
We must say goodbye, little one, may the universe keep you. I will remember you.
Thank you for being in my arms.
When life has already melted on the flat line of the monitor, I squeeze him gently one more time and lay him carefully in the cradle.
The invisible ties to the people who accompany me give me strength.
The words in quiet tones, the orchestrated acts under the awareness that this, this precise moment, is the privilege of life.
It transcends. It remains and becomes part of us, making us grow with the destiny of others in a shared and precious humanity.
I stay there, help remove the IV lines, and clean that little body.
I thank them for making that time a ritual in which life and death have touched under our watchful eyes.
I have never held anyone in death before.
I cross self-imposed lines we draw in a vain attempt to keep us safe, unscathed, away from tragedy and death, the only way I know, with all that I am, with no division between profession and person. Woman with a dying baby in her arms.
Knowing I am vulnerable; I stop protecting myself and give myself to life. I stop running away from death.
In this story that begins at the end and will continue with me.
Sylvia Belda-Hofheinz is a pediatric intensivist in Spain.
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