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Boy in the Stream

When a neighbour pulls an unconscious toddler from an icy steam, the little boy’s family fears the worst. But one doctor won’t give up hope.

Boy in the Stream

It’s the first warm day of spring 2015, and the March sun pours over the ridge that borders Doyle and Rose Martin’s rural property outside Mifflinburg, Pennsylvania, US. Yesterday it rained all day, melting the better part of the long winter’s snow, and what the rain left behind, the sun is taking care of today. Water seeps and trickles down the surrounding slopes, swelling the normally humble creeks until they nearly jump their banks. The stream that runs through the Martins’ yard is usually ankle deep and lethargic, but today it courses angrily beneath the footbridge at startling speed, up to a man’s waist and frigid.

The Martin boys will not squander such a lovely afternoon. After the school bus drops them off, they barge outside to ride bikes, gathering sticks to build a fire. They are what people in some circles call free-range kids; the Martins have eight, and in keeping with their own upbringings, Doyle and Rose expect their children to learn independence and responsibility, the older ones looking after the younger. Today, Gary, 11, and Greg, seven, are playing with little Gardell, who is not yet two. Doyle, a truck driver, is out on the road. Rose works in the kitchen, where she can frequently check on the boys through the window.

Suddenly Greg bursts through the door, his face streaked with tears. “I can’t find Gardell!” he screams. “He was just with me!”

Rose and her two eldest, Gloria and Grace, charge outside, shouting Gardell’s name. Just to make sure, they check the two outbuildings, but everybody is thinking about that raging stream. Rose calls emergency services, and the girls call their father. The property echoes with the family’s frantic shouts for Gardell, as mother and children scramble along the banks of the brook, sickened by the speed of that icy grey water.

 

Randall Beachel is washing dishes at his kitchen sink when he looks idly out the window and sees Grace and Gary Martin running alongside the stream where it exits their property. Something’s wrong. Grace is barefoot, no jacket. They’re yelling. He steps outside. “What’s wrong?” he calls to Gary.

“We can’t find my little brother!”

Randall’s heart sinks. He runs back inside, tells his wife, Melissa, what’s going on, and pulls on his shoes. Together they rush outside and down the road to where the stream passes through pastureland some 200 metres downstream of the Martins’ place. Randall holds the strands of electric fence wire, ignoring the shocks, as Melissa climbs through. When they reach the brook, Melissa goes downstream and Randall begins following the brook back toward the Martins’, scanning the water’s surface. After a moment, he sees a tiny pair of navy-blue boots partially obscured by brush. A step or two farther, and he sees the whole picture: the little boy, still clad in a hooded snowsuit, hanging bizarrely on his side in the middle of that rushing stream, his face turned away from the current.

Randall plunges into the brook, gasping involuntarily – the water temperature is around 2°C – loses his footing, and blunders into a deep hole. Recovers himself. Pulls the limp little body off what turns out to be a grassy underwater knoll. Staggers back to dry land, shouting, “I found him!” even as he turns the kid over to see if he can drain the water from his mouth and lungs. An ambulance is coming up the road. Randall raises an arm, and it stops.

A paramedic races across the field. Randall hands the little boy over and stands watching as the rescuer rushes back towards the ambulance, performing CPR as he goes. When Randall reaches the road, the ambulance staff have torn off Gardell’s clothes. One of the paramedics has placed a mask onto the little boy’s face and is hand-pumping air into his lungs; the other is rhythmically compressing the tiny chest to force blood through the body. That’s all Randall sees before the vehicle turns around and speeds toward town. As for Rose, she never gets so much as a glimpse of her son.

The ambulance is taking him to Evangelical Community Hospital in nearby Lewisburg, she learns. Within minutes, her sister and brother-in-law arrive at the house, and together they speed toward the hospital. As they rush into the emergency room 15 minutes later, Rose is told they’re transporting Gardell by Life Flight to a trauma centre. Through the windows of the waiting area she can see the chopper on the heliport, its interior illuminated, medical workers hunched over what must be Gardell’s body. Her brother-in-law is a paramedic, and he can tell they’re still doing CPR in there – after all this time! – but he says nothing to Rose.

Mike Lesher, the paramedic who first carried Gardell to the ambulance, heads back to the station. The CPR has gone on for more than an hour; typically rescuers give up after less than half that time. “If he survives,” Lesher remarks, “it will be a miracle.”

A moment later, the helicopter lifts off. Rose watches through the window, tears stinging her eyes; she has missed her little one again.


Dr Frank Maffei is preparing for his evening rounds in the paediatric intensive care unit at Geisinger Medical Center’s Janet Weis Children’s Hospital in Danville, some 24 km from Lewisburg. He gets a call from the ER downstairs: toddler on his way via Life Flight, full cardiac arrest. Worse: CPR ongoing for more than an hour, to no avail. Not promising.

Still, Maffei and his colleagues leap into action. Upon Gardell’s arrival, they run a breathing tube down the boy’s throat, and four residents line up on his left side to continue CPR: two minutes of chest compressions, move to the back of the line. It’s critical to get Gardell warmed up, so even as the limp little body jiggles and jolts under the force of the chest compressions, other doctors and nurses carefully insert an IV and two catheters to send warm fluids into his body, which is at only 25°C.

A resident turns to Maffei. “At what point are we going to stop?”

“We’ll stop if we warm him to 32.2°C and he’s still unresponsive,” Maffei says.

“What about a pH?”

The resident is referring to the acidity of the blood, which spikes when a person stops breathing; a pH lower than 6.8 is considered incompatible with life.

Maffei hears himself answer, “6.5.” It’s an outrageous threshold. A few minutes later, the pH comes back at 6.54. No heartbeat, no breathing, and a low pH. The boy is dead.

Maffei has been doing this work for 25 years. Objectively, he knows that it’s all over. Yet he can’t shake some strange, subjective notion that Gardell is still in there. “Keep going,” he says.

Now it’s after 8pm, and Gardell remains unresponsive. The doctors move him to the operating room and prepare to put him on a heart bypass machine. They’ve got his temperature up to 28.3°C, but the machine will allow them to warm his blood externally and recirculate it, speeding the process. A surgeon stands scrubbed and ready to cut into the little boy’s chest.

“Let’s just do one more pulse check,” Maffei says, laying his fingertips against Gardell’s femoral artery. To his amazement, there is a pulse. His colleague Dr Rich Lambert checks the brachial artery – there is a strong pulse there. Excited, they monitor Gardell’s pulse for more than an hour in the operating room, then transfer him to paediatric intensive care.

Maffei steps out into the waiting area to meet Rose. “Gardell’s alive,” he says. “However, we have to understand that he’s alive after essentially being dead for an hour and 41 minutes.” He needs to manage her expectations: Gardell’s oxygen-starved brain will probably be forever damaged. It’s anyone’s guess as to when – or whether – he will wake up and what function he’ll have when he does.


Now it’s the small hours of the morning. Doyle Martin has returned from the highways, and he and Rose are sitting over Gardell’s bed. “Gardell,” Doyle says as he always does when he reaches home, “I came back from trucking to play with you. Do you want to play?”

And to the eternal astonishment of all, the boy opens his eyes and turns his head toward his father – the boy who, eight hours ago, was dead.

Gardell stays in the hospital for two more days under light sedation. He’s kept at a cool 32.2°C to prevent his brain tissue from swelling. He begins opening his eyes more frequently, obviously aware of his surroundings. The breathing tube is removed. He’s weaned off the sedation. On the fourth day, a Sunday, he returns home. Within a week, he’s playing with his siblings. “You’d never know anything happened,” Rose says.


So how did a little boy who, by every objective measure, was dead for nearly two hours come back to life unscathed? To the Martins and many others, Gardell’s survival was simply a miracle. Rose points out that his pulse returned just as local church groups were meeting to pray on his behalf.

Physiologically, the key to Gardell’s survival was the fact that he nearly drowned in ice water. “Hypothermia imparts a degree of protection from the detrimental effects of low blood flow and low oxygen,” Maffei says. The severe cold stopped Gardell’s heart, but it also saved his brain, just as you might put an amputated finger on ice until you can reattach it. At a higher temperature, Gardell’s brain cells would surely have died for lack of oxygen; as it was, they could wait – at least for an hour and 41 minutes. But no-one involved in the rescue has ever seen such an extreme case.

Randall Beachel, the neighbour who pulled Gardell from the stream, sometimes looks over at the Martin place and chuckles at the sight of the youngster kicking dirt around in the garden or chasing his brothers. It’s simple to him, too. “It’s truly a miracle,” he says. “Truly a miracle.”



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