Introduction - Part Two

There is never a single reason that motivates us to change our behaviour ;and apart from becoming a parent myself,there were two specific events that focused my attention and really motivated me.

The first involved the death in our Unit of the daughter of a friend who was both a paramedic and a pilot for our Flight for Life service.

The second involved a doctor walking into a room and saying to the family of a child, “I'm Dr Smith...you're kid's dead”...and walking straight back out, leaving the nurses, as usual, to deal with the family and the practicalities of the death.

I decided to draw up guidelines to cope with the sudden death of children- the unexpected death, the random death. The death that occurs when logic and love scream out that it is impossible for your child to die before you.

There was at the time any number of hospice workers and writers from all backgrounds dealing with “chronic death” , the type of 'predicted death' or 'statistically probable' death where for example, where a child was diagnosed with (the then ) largely life-threatening and life-limiting diseases of leukaemia and cancer.

(Earlier diagnosis and new treatments have altered the face of childhood oncology in the intervening years.)

In the same way that Emergency Medicine is often seen as “not real medicine” by the Physicians, so too, “acute death” was, – and I believe still is-, often not seen as “real death” by the Hospice movement.And the academic theorists and social workers, psychologists and priests who most often write about bereavement.

The Protocol was designed to help both the family and the staff by trying to cut down the ‘feelings of unfinished business’, which result from an unexpected death.

It was designed to be practical, neutral and “free” of any particular cultural or religious bias; to involve the parents and to benefit the staff.

The Protocol has, over time, been expanded to deal with inter alia, stillbirth, miscarriage and neonatal death.

The Hospice or bereavement movement at that time had largely sidelined these particular states-of-bereavement and the parents I interviewed for the pathway, reported that they often felt shunned by both EMS staff and mainstream bereavement practitioners.

This emphasis on children is partly to do with the fact that I worked in a Paediatric Emergency Unit for so long.

This inevitably, and necessarily, changed my view of Emergency Medicine.

Children are so often injured or killed or die due to forces outside of their control, be it their drunk, abusive parents; or simply their own joyful lust for life hindered by their limited cognitive abilities and perceptions of actual and potential hazards

Whilst it is “often difficult to accept death in an acute care setting, the feeling that death is unnatural is even stronger when the patient is a child .”

For a number of well documented and sometimes bizarre cultural reasons, children in most of the world continue to have a very low status, despite what you might think from a cursory reading of western-focused and digitally-obsessed media.

Sociologists will link this to lack-of-earning-power; lack of productive capacity; lack of physical power; and of course their sex and colour.

No doubt in South Africa, the years of apartheid legislation with its subtle (and not-so-subtle) psychological messages on human worth must also take some blame.

But of course this is not just a South African condition, as any cursory reading of international newspapers will testify.

Whatever the case, I believe fundamentally that irreparable damage is done to any society that does not value its children.

I also believed that with some few exceptions, that the EMS response to the critically injured child was minimal and was often performed by inadequately trained and supervised staff.

Compounding this is that as the variety of medical technology proliferates, is that there seems to have been a corresponding decrease in the human relationships and interactions which were peculiar to medicine in general and paediatrics in particular.

As I have a fundamental belief in the Rights of Children and in the belief that they have special needs even in death, I felt that developing an interest in this area would be of some value if only to myself.

These are briefly the reasons behind the book. What then is the purpose of the book?