Just before dawn we received a call that an unresponsive infant was being brought by emergency medical services to our hospital. As the medical team—the pediatric resident, intern, respiratory therapist, nurse, and me—prepared for the incoming patient, an eerie silence enveloped the trauma room, an event that frequently precedes a pediatric resuscitation.

The child arrived in our emergency department pulseless and cold, with compressions being performed on him in the arms of the paramedic. Further history obtained by the paramedics indicated that the mother had left the infant alone in the home with two young children to watch the child, and upon her return the infant was found in bed not breathing and cold. As a medical team we simultaneously performed multiple procedures, (intubation, insertion of intraosseous lines, administration of epinephrine, cardiac compressions), all to no avail. Twenty minutes after he arrived, I declared this 2-month-old child dead with a high suspicion of abuse or neglect. Everyone vacated the room almost immediately, except for the nurse, who never left the child's bedside. I asked her why she needed to stay, and she looked at me and smiled. "Why of course, to be with my patient a little bit longer."

I knew the difficult part was yet to come: telling the family the bad news. The mother was still at home being interviewed by police. The father had arrived from his place of employment to the emergency department minutes after death was pronounced and not knowing the condition of his son.

The father and I sat with the chaplain to explain what we had done for the baby. I could tell from the stunned look on his face that he knew before I finished my story that his child was dead. Despite this I said in a muffled voice, "I am so sorry your child passed away."

We walked slowly back to the resuscitation room. The infant, who only moments ago lay covered with blood and secretions oozing from every orifice, had been transformed. The nurse had never left her patient, tending to him, cleaning him, wrapping in soft blankets, and now presenting the body to the grieving father. He seemed relieved to see his baby, not alive, surely, but at peace and thus the man could begin the mourning process. I again left the room to tend to the busy emergency department; seeing patients somehow seemed to blunt my emotional response to what had just happened. As I listened to a resident present the next case, I saw the nurse carry the blanketed body of the child to the morgue.

As I reflect on this episode, I realize that our medical resuscitation of this child was futile, as has been shown in children who present to the emergency department in full cardiac arrest. But it was the compassionate work of the nurse that ultimately made the difference in how we performed our job.

Next time, I may stay a little bit longer to be with my patient.