The Spanish summer holiday has begun! Paracetamol is just easing my travel-induced headache as I emerge from the shower and have my braver wife eject a tiny green frog who showered with me.
I walk onto the verandah to see a small child's limp form being gently placed on the raised pool edge 30 feet away. Moving closer I offer my services to a much relieved English practice nurse,Val, who was first on the scene. All is not well, no pulse, no respirations and no parent in evidence. We ask for an ambulance to be summoned, I compress chest and Val, fresh from her resuscitation update course attends to the mouth-to-mouth with my GP wife taking her turn.
Local resuscitation boxes × 2 arrive and we search in vain for equipment appropriate for a 6-year-old girl.
CPR continues as an agitated, pacing father arrives asking repeatedly about pulse and how things are looking; I hope my answers are calm and reassuring, I take the ‘it's too early to say’ line for the moment. Things don't look good. Darkness falls on the assembled crowd and spectacle. ‘We have asked for an ambulance haven't we?’ ‘Yes!’ comes the answer.
Distressing gurgles emit from the still form as air fills stomach and lungs.
After a long time three Spanish ambulance personnel arrive with all the tackle. Chest leads are applied — asystole. ‘Laryngo …’ is muttered by the top man who inserts an ET tube and omits to inflate the cuff until we prompt him. Much time is spent by torchlight seeking IV access as I talk with mother and father as much as possible about process and little about outcome.
The paramedics look like they might be inclined to pack it in. We quietly suggest that a trip to the hospital would afford an ‘everything-that-could-be-done-was-done’ appearance.
We pack up and go, I accompany the ‘patient’ for the rapid, police escorted, 20-minute trip to A&E with mother's tear jerking ‘you will do your very best’ ringing in my ears. A few minutes into the trip, with the language barrier still firmly in place, a few interprofessional looks is all it takes for us to agree to halt.
The Spanish boys make a show of bagging as the trolley is swiftly unloaded and disappears past the parents into a crowd of hospital staff behind closing doors. I ask for the room where relatives go to receive bad news, but clearly there is no such facility so I rejoin the numb parents and practice nurse in the tiny waiting room. ‘Things aren't looking good’, I repeat as I look earnestly into the parents' eyes.
A short time later the A&E chief summons me, the British GP, to ‘give each parent two of these’. He hands me four brown tablets. ‘What are they and what are they for?’ I ask — ‘calming down medicine’ is the gist of the reply. Issues such as informed consent, potential allergy, safety in combination with alcohol, seem of little interest to the chief whose main concern is apparently to prevent an unseemly display of emotion from the dead girl's parents.
I offer each parent one sublingual tablet and we are shown into the chief's multipurpose office. There I do the introductions; the news and the parents are broken.
My postcard home reads ‘eventful start to holiday, lovely island and apartment, lots of exploring to do … full report upon return.’
- © British Journal of General Practice, 2004.