Friday morning, three days ago, was the worst day (so far) of my nursing career.

Friday morning, three days ago, was the first time I had to lay a dead child into the arms of its mother.

He was seven - he would have been eight in two weeks. He had Hunter Syndrome with some severe deformities and an extremely enlarged heart. His cardiologist had told his mother he would likely die in his sleep one night.

Unfortunately, that's not what happened.

He had an asthma attack at home - he had severe asthma. His mother gave him a dose of his asthma inhaler, and he stopped breathing. She called 911.

Due to his mouth and throat abnormalities, not really apparent from the outside, the paramedics couldn't get him intubated. By the time he arrived in the ER, he had not been breathing for almost 10 minutes and the EMS crew was doing CPR on him.

His skin was white, his lips were purple, and his belly was distended from all the air that had been forced into it. Our MD and an anesthesiologist tried to intubate him to no avail; finally an emergency tracheotomy was done. The cardiac monitor showed a flat line - asystole. Despite medications and compressions and ventilation and prayers, he was gone.

My friend LeeAnn and I were the only ones who tended to him afterward. After the coroner had seen him, we removed all the tubes, lines, wires, cleaned up the blood, washed his face. We took off his dirty diaper and put him in a fresh pair of 'big boy pants' - the first and only pair he will wear. We dressed him in a gown, cleaned the room, removed all distressing evidence of how we had violated their child.

Then we stood and waitedfor the parents

Disbelief, denial, anger and guilt. Parents crying, afraid to touch their child. Self-recrimination.

his mother didn't want to see the tracheotomy, so I bandaged it up and covered every trace. I told her she could hold him, so she dragged a chair to the edge of the stretcher and sat there, unsure of how to proceed. I picked her dead son, seven years old, would have been eight in two weeks, up in my arms and laid him in her lap. She held him and wept and kissed him while her husband stood by and wept and tears rolled silently down our faces. Her husband didn't want to sit and hold him; he cried out that he wanted to hold his son in his arms, so once again I picked up the child from his mother's lap and placed him in his father's arms. He embraced his dead son, rocked him, patted his back and sobbed. Finally they laid him back down and kissed him goodbye

I never want to have to do that again. I know I will though. I need to be there for the parents, for those left behind. He looked so peaceful, with a half smile on his face. But his mother is going home to an empty house with no birthday party in two weeks, and no more little-boy smiles.