Anatomy of a Tragedy: How the biology of the brain can shape human responses, now and forever

     Isn't it amazing how the human brain works? It truly is the last frontier of modern medicine. Neural pathways and hormonal interactions that generate emotions and promote learning are just now being more thoroughly understood. A tremendous amount of research is occurring in these areas, and the application of this information to emergency medical services is direct and meaningful.

The Scene: Part 1
     Picture the following: It's a warm summer day without a cloud in the sky. It's been a fairly slow day at the station; you and your partner have finished lunch and are settling in for your afternoon safety nap. Suddenly, that familiar sound of tones (loud enough to wake the dead) brings you to your feet, and you head out to the truck.

     Your heart quickens as the dispatcher speaks: "Medic 903, respond to 1234 Ruinurday Drive for a child not breathing." As you pull out from the station after finding the address in your map book, dispatch informs you, "Medic 903, be advised pre-arrival and CPR instructions are being given." Your partner looks at you with that expression that says, This is the real deal. It's evident his anxiety level is rising based on his aggressive driving. The residence is only five minutes from your station, but it seems like an eternity before you arrive.

     Nearing the house, you are met in the street by a frantic family member waving you into the driveway. Your partner throws the transmission into park as you are halfway out of the vehicle, reaching for the handle to the compartment containing your airway bag, monitor and drug kit. You quickly collect yourself and head to the front door. Entering the residence, you find a small, flaccid, cyanotic child lying on the floor, with a hysterical man doing the worst chest compressions you have ever seen. Nearby is a woman sobbing and screaming uncontrollably.

     The child is approximately 2 and has probably been apneic for some time. The father says he put his son down for a nap roughly an hour ago, which was the last time he was seen breathing. You slide the ET tube into place flawlessly as your partner lays down the Broselow tape and hands you the IO needle. You easily place the device, but before you get it secured, your partner has attached the patient to the monitor and discovered an asystolic rhythm; now he's handing you the first epi. As you give the first dose, you notice the pumper has arrived, and you see the firefighters coming through the door with a half-board and the stretcher.

     Things are going perfectly. It is as if you and your partner are performing a well-designed symphony without missing a note, even though you're positive the outcome has already been decided. You load the child onto the stretcher and head out to the truck. With the assistance of the fire department, you quickly make your way to the hospital, still performing at the top of your game. You unload the patient and transfer care to ED staff without missing a beat. Despite your best efforts, the emergency physician calls the code about three minutes after your arrival. This is the sad reality of what you do; although the outcome was less than optimal, you feel confident that you and your partner did everything possible to save the child.

     As you walk out to the ambulance bay, you pass the family coming in the door. You glance over and see the child's father consoling his wife. He shoots you an angry look that would melt the polar icecap. "What was that about?" asks your partner. You reply that you're not sure, but you still feel you did everything you could.

     In order for us to fully understand how this father's anger developed, we must first explore some neurobiology and the processes that occur during the body's stress response.