The baby had a seizure: Why was the mother smiling?

The baby had a seizure: Why was the mother smiling?

My first night shift in a stretch of 7 was almost over.  It was 6:15am and I had to keep moving otherwise the minute I would stop, my eyelids would drop like two ton shades and I’d fall asleep.  That never makes for a good drive home after a night shift.

“Got time to see one more?” asked Jenny the nurse.

“Do I have choice?  The door-to-doctor time storm-troopers would have it no other way,” I grunted back, eye lids drifting closed.

“Febrile seizure,” it said.

Good, this should be quick and easy, I think to myself.  We’ll give some Tylenol, reassess in 30 minutes and this baby will be happy, smiling and bouncing off the walls.  That way I can get out of here at 7am and be home in bed with my eye blinders on drifting towards sweet REM sleep at 7:20am.  My sanity depends on it.  15 feet away, I head towards the room.  Looking into room 4, I expect to see the usual post-febrile seizure toddler, sitting up in bed, recovered, awake and well appearing.  First I see the child’s mother, well put together, attractive, smiling and relaxed.  I cross the threshold to the room, look down on the hospital stretcher and I see a child, about 1-year-old, still seizing.  Still seizing?  I think to myself.  This isn’t right.

“Jenny, get in here!  We’ve got a seizing baby,” I say.  I look down at the child, who is pale, head turned to the right, with the left arm twitching violently.  “Call respiratory!  Jenny, you get the IV, I’m going to start bagging.  Someone get the Broselow tape and some Ativan.  Let’s stop this seizure.  Get some Diastat, too.  We may need it.  As I bag the child, Jenny quickly gets an IV in.  We give a dose of Ativan and the baby stops seizing quickly.  The O2 sat is 97%, the baby is breathing spontaneously and I stop bagging.  I put an O2 mask on the baby.  I feel the brachial and femoral pulses.  They are bounding.

Considering the baby has normal vitals, I turn to Mom hoping to get some history while hoping the baby will quickly awaken from the post-ictal slumber.  “Mom, hi, I’m Doctor Bird, tell me what happened please.”

She looks at me and smiles.  Her lips spread apart and reveal a soul-sucking brown smile.  Why is she smiling?  Her baby just got done seizing?  Why isn’t she panicked?  I look towards Jenny the nurse whose face is beet red and stressed like mine, after a 12 hour night.  I shoot a glance at the clock and it’s well after shift change now.  I’m fried.  I haven’t slept in over 24 hours.  I look back at Mom and I realize she’s the calmest one in the room.  There’s something really, really wrong here.  In the corner of the room is a man sitting on a chair that I hadn’t noticed before.  He’s smiling.  I look at him.  “Hey doc!  How’s it goin’?  Havin’ a good night?” he asks with a smile and a laugh as he slaps his knee.  Having a good night?  I’m having a horrible night, I think to myself, and I’ve got a seizing baby on the stretcher in front of me.  It doesn’t seem to be cramping his style too much, however.  I feel the energy drain right out of my chest.  At that moment I know exactly what the diagnosis is, and I feel like I might puke my guts out.

“Charge nurse?  Please escort them to the family consult room.  Thank you.   Suzy, call the chopper, now.  Jenny, let’s get this baby tubed.  Tell CT to clear the table, we’ll need a scan in 2 minutes.  Call PICU at —–  —— Medical Center.  We’re flying this one out!  Call social services and the police, too.”

Once intubated, stabilized and after another dose of Ativan we shoot over to CT.  I watch the image slices appear on the computer monitor one by one.  My stomach turns over.  I see just what I feared: massive bilateral subdural hematomas (bleeding around the brain).  There are skull fractures.  There is a brain that looks obliterated.

The helicopter crew arrives and prepares the toddler for transport.  As they wheel out the door with our tiny toddler in tow, Jenny the nurse, the respiratory therapist, Suzy the unit clerk, Bob the charge nurse and I all just look at each other.  Nobody says a word.  What is there to say?  We all know as much as we need to know.  Off we go, out the ED doors headed home, exhausted as the sun comes up after a very long night shift.

A few days went by.  We all tried to work through the next few shifts pretending like nothing big had happened.  It’s “just a job,” right? A few muttered comments here or there but most everyone tried to work past it.  In a case like this, despite knowing you did all you could do, it’s hard not to feel like somehow you failed, since at the end of it, a child remains brain-damaged or worse.  I tried to forget about the case and move on, but I had to get some follow-up.  In a rare slow moment, during a shift a few days later I asked, “Suzy, why don’t you call down to the PICU at —–  —— Medical Center.  Let’s see how the baby from the other night is doing.  I’m sure we could all use some good news right now.” I was hoping that my worst suspicions would be proven wrong, and my cynicism would lose out to wishful thinking.  I sat down to check the Internet for the weather while I waited.  Already up on the screen, was the local news site.  The headline said: “Shaken Baby Dies: Mom and Boyfriend Charged with Murder.”

“You know what Suzy?  Hang up the phone.  We don’t need to call.  I’m sure everything turned out just fine.  You all did a great job with that baby,” I said.  I headed to see the next patient, chief complaint: “Itchy nose.”

“Hello, Mrs. Jones, I’m Dr. Bird, how can I help you today?”

“BirdStrike” is an emergency physician who blogs at WhiteCoat’s Call Room at Emergency Physicians Monthly.

Image credit: Shutterstock.com

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  • http://twitter.com/sarasteinmd Sara Stein MD

    I’m sorry. I had a similar experience with a 5 yr old boy years ago, and even though we did EVERYTHING not to send that kid back home, we couldn’t get enough evidence. 2 weeks later he was back, but it was too late. I remember the hair standing up on the back of my neck when I met the mom and boyfriend, and feeling time stop. We do what we can, and sometimes, we can’t do what we wish. The only solace is to know we go through it together – as physicians, nurse, therapists, PA’s, clerks, social workers, police, etc. We are a team of emotional pain and support.

    That smile and lack of eye contact, the disinterest, even disdain…it’s unimaginable and unforgettable.

    May his spirit live on in the itchy noses of the world.

  • http://www.facebook.com/people/Jason-Simpson/100001631757606 Jason Simpson

    You have a responsibility to burn those MFers to the ground. Dont make the mistake of assuming the PICU doc will testify to these evil acts in court — YOU NEED TO BE THERE to make sure these scum get the maximum punishment possible.

    Far too often docs dont want to go to court and want to stay out of it.

  • Docbart

    Very chilling. Hard to know what makes people lack that be that way.

  • dr shafiq chughtai

    well doc i must say well done………….there are very few occasions when we are told that we did well.Instead some times those who escort these kind of patients are taunting us, insulting us !!!!! thats not a very good feeling at all.Off all the places i have worked, the most stressful is emergency.
    i agree those responcible should be brought to justice.trauma and general surgeon, shafiq, pakistan

  • http://twitter.com/rhon91 Rhonda Lustig

    Reading this story made me physically ill. A smiling mother as her baby is seizing because of the head trauma sustained from their very hands? That is just evil. This is why I could never work the ED, not sure I could keep my professional composure in those instances. I would have nightmares. Thank God for those that can and do work the ED.

  • militarymedical

    I’ve “been there, done that” too. It’s been about thirty years, and I still remember that child’s last cry, the parents’ nonchalance and my own fury. It feels no less strong today, having read this. This will live on for you, and it will change you.

  • letlifehappen

    As a DV survivor, I know what it was like to be beaten and have a loaded gun in my face on more than a few occasions but if you ask me, that pales in comparison with having to treat a child that has been abused. I don’t know how you ever forget that. I never thought about this from your perspective so I thank you so much for sharing this story. I know that I will never forget this.

  • http://twitter.com/katakombe Lis P

    my first child had colics as a baby and screamed a lot. did i say a lot? well, he screamed all day long, every day. the only times he was silent was when he was drinking and when he was sleeping. and he didn’t sleep all that much. still doesn’t. he is three now.
    so, with all the screaming i thought i might go insane on a daily basis. i dreaded leaving the house because all people i passed would stick their head in the stroller and look at the screaming bundle in there and give me unwanted advice. “oh, poor thing is hungry” they would say just minutes after his meal. “he is probably just tired” they would say. no, he isn’t. he’s screaming. there is nothing i can do about it. i’ve tried just about everything.

    so, i stayed home a lot, with my screaming baby. not exactly healthy for my sanity. but at least nobody told me how i should handle my baby. so, i can totally understand why a parent might feel like throwing their kid at a wall. i’ve felt like that multiple times. it was a mixture of anger, frustration and fatigue. not a nice feeling.

    so i did what every sane parent does in a situation like that (or at least what i thought they would do): i placed him carefully in his crib. went out of the room. closed the door behind me. went into the room on the other end of the house. closed that door behind me too. then i screamed in anger, sobbed from fatigue and banged MY OWN head against the wall from frustration. did this for 5-10 minutes until those extreme emotions subsided and the only thing that was left was a slightly throbbing headache.

    then i went back to my still screaming baby, gave him a tummy massage with fennel oil, fed him, changed his diaper, packed him into the stroller and went for a walk until he had cried himself to sleep.

    i can totally understand what makes a parent go bonkers and want to hurt the baby. i can’t for the life of me understand how one can go ahead and actually do it. i would never have been able to even scream at him, let alone beat, shake or throw him.

    each time i read about something like that happening i hug my (now two) boys tightly and tell them i love them. it’s just so, so sad.

  • http://www.facebook.com/miriam.anixter Miriam Anixter

    I am so sorry. I guess we’re supposed to call it “nonaccidental trauma” now.