“I’m going out to the truck. I’m pretty sure we have a smaller blade, Doc,” said one of the medics who had hung back to watch the code and help out if needed.

In seconds, he returned with a Miller 0. As I began again, I thought to myself, This has to be better. Certainly, now I could advance without breaking his little baby jaw. I gently inserted the blade, and still it seemed too big. I met resistance right at the tongue. I couldn’t stretch the mouth. I couldn’t bruise the gums. I couldn’t force the blade back and up. Once again I tried, and once again I failed.

“Doc, do you mind if I try?” the same paramedic inquired. I didn’t look up. I just stepped aside.

“Pam, what’s the time?” I asked.

“Time for another epi, Doc. Ten minutes.”

“Okay, please give another,” I directed.

I asked the medic if he was ready to try for the tube, and he said yes. “Please hold compressions one moment for intubation,” I announced to the crew.

The medic drove the blade between the jaws and cranked forward. The corners of the mouth stretched taut, the skin ripping at both corners, thereby permitting the blade. In the same swoop, the neck craned forward, allowing the passage of a small breathing tube. At the medic’s first attempt, the tube was in.

We continued the fruitless attempts at resuscitation for another ten minutes.

It was finally time for the inevitable end to the code (one that could easily have been called soon after the infant’s arrival), wherein I pronounced the time of death. The code had, in actuality, ended long before the baby was rolled into the department. The child had died at home. The time I called in the ER would simply be a formality.

I looked around at the team and said, “Guys, this kid is really gone. Does anyone have any further ideas before we call the code?”

“No, Doc. There’s nothing else to do,” one of the nurses said.

One by one, the members of the team shook their heads.

“Any objections to my calling the code now?” I asked. I got a chorus of “No, Doc.”

We took our hands off the baby, the bed, the monitors. I checked the nonreactive pupils and the chest—no breath sounds, no heartbeat, no life.

“Time of death, one forty-one a.m. Thank you, everyone. Thank you for all the hard work. Is the family here?”

“They’re out in the waiting room,” Pam said.

I sighed and shook my head. “Okay, so who’s gonna go out with me?” I threw off my gloves and mask as I exited the room.

Deb stepped forward and rubbed my arm, signaling support for my efforts and that she’d be the one. The doctor typically doesn’t speak with the family alone. They often need more time and support than any ER physician is able to give between patients, so usually a nurse or hospital staff member comes along for the discussion. During the day, it’s nice when a chaplain or social worker is available.

Now we were heading into the hardest part of the code, the part that had no algorithm, no script, the raw part that never feels good.

“By the way,” I said, as I stopped and turned back to the group. “Did we ever get a name on the baby?”

Wendy got up from her desk, which was situated at the front of the ER between the Resuscitation Room and front entrance just kitty-corner to both, to answer, “Baby Christopher Tally. I verified it with the parents. Everyone’s out there. Want me to go get them? You could take them to the back office to talk.”

“Thanks, Wendy. It’s okay. I’m going out.” Then Deb and I headed to the waiting room.

A crowd of people filled the room. A person I figured was the mother was wringing her hands, a trail of tears blazing down her cheeks. She and a man I assumed to be the father were standing near the door, holding each other up. His eyes were red and puffy.

Parents know. They know the way we know life is gone as the gurney is rolled through the ambulance doors. Parents know because these angels whisper their last words in their ears and butterfly-kiss them good-bye. The others in the waiting room were sitting or pacing, both fearful and hopeful in their anxiety.

“Hello, I’m Dr. Harper,” I said. “Are you the Tally family?” They all stiffened.

The mother’s eyes were clouded with grief. “Yes,” she whispered.

“Please come with me,” I said.

An older woman among them stood and told everyone but the parents to stay in the waiting room. She was authoritative, an upright and strong presence. I figured she was the grandmother. The husband supported the mother on the right side and the grandmother on the left as they ushered Mom through the waiting room doors and into the front of the ER. The curtains in front of the Resuscitation Room, which was just feet away, had been drawn so they could not yet view the scene.

“Would you like to come with me to the room right over there where we can sit?” I asked.

“No,” the mother whimpered. “Please, please, just tell me now,” she implored.

If she hadn’t been held up on both sides, she would have tumbled to the floor. She began to wail and sway.

“Jessica, please, please let the doctor talk,” her mother said as she stroked her daughter’s hair.

Deb asked again, “Are you sure you all don’t want seats?”

“Nooooooo, teeeelllll meeee!” the mother shrieked as she clutched her chest.

Her mother embraced her and turned toward me. “I’m sorry. It’s okay. You can tell us.”

“I’m very sorr—” I began, but before I could finish the word, the mother fell to the floor.

She had already known, but the words were irrevocable confirmation. The father collapsed as well and lay embracing her on the floor. The grandmother gasped, clasping her left hand over her mouth and holding her right hand to her breast. She stood tall. Her watery eyes held fast.

There was no space between the mother’s cries for me to say anything, no space for words.

I could not share the thoughts that were circling in my mind: There was no space in their grief. I couldn’t tell them, I’m very sorry you lost your angel baby. I’m very sorry he died while you were sleeping and you didn’t get to say good-bye. I’m so sorry that he was already dead when the EMS team arrived and that despite that thirty-five minutes of squeezing his tiny heart and pumping it full of enough drugs to jump-start a car, we couldn’t summon him back to life. I’m sorry I couldn’t intubate your baby. I’m sorry. It’s just that when I propped up his tiny head and inserted the laryngoscope blade, I felt I was hurting him. I’m sorry that the last thing his little corpse experienced was prodding and poking and pressing and tearing. I’m sorry that your beautiful boy is gone. I’m sorry that I can’t tell you why, and I’m sorry I can’t make it hurt any less.

“I’m so sorry. I’m so very sorry,” I said into the space. Everyone else in the front end of the department was silent. The only sound was the parents’ wailing and a distant shuffling in the back of the ER. Then the mother tore back the curtain and ran to her baby, spilling once again to the tile beneath her feet. The father was not far behind, crying and pacing and barely able to support his own weight against gravity.

“How did this happen? Why did this happen? He was perfect! He was perfect! Nothing was wrong! Nothing was wrong,” the mother yelled up to the sky, invisible beyond the hospital ceiling.

The grandmother walked to her side and collected her daughter from the floor.

A call came in at Wendy’s desk: the mother’s obstetrician phoning our department. Wendy answered it and walked over to the mother.

“Mrs. Tally, a Dr. Thomas is on the phone for you. Would you like to take it?”

“Yes, yes,” the woman managed to say, and followed Wendy to the phone. She grabbed the receiver in her right hand, cradling her head in her left hand as she braced herself against the section of the counter encircling the doctors’ and nurses’ station that was in front of Wendy. “Dr. Thomas! I don’t know what happened! I don’t know what happened!” Then she listened for a moment and responded. “I know, I know . . . I know . . .” She dissolved into sobs. “There was nothing wrong the whole nine months . . . I know . . . I know . . .”

The grandmother had just returned from the waiting room, where she had gone to notify the rest of the family. I walked over to her.

“I’m very sorry,” I told her. “Do you have any questions? Is there anything we can do for you?”

“Do you know what happened?” she asked.

“I know that when EMS responded to the nine-one-one call, Christopher was not breathing and his heart was not beating. He was not alive at that time. EMS worked really hard to try to bring him back. They gave him medicine to try to start his heart again and make him breathe, but they were not able to bring him back. When he arrived here his heart was not beating and he was not breathing. He was not alive. We continued these efforts when he arrived, but we were not able to bring him back, either.”

She stood facing me, heartbroken, silent with grief.