Hektoen International

A Journal of Medical Humanities

I don’t know how it happened

Rae Brown
Lexington, Kentucky, United States


There are angels in every emergency room. They sit above the fray and listen and learn. They hear the laments of the doctors and nurses as they try to save a child. They hear the sometimes incredulous comments of those who may be responsible, in some way, for what is unfolding below. A twelve by twelve trauma room in a busy ER; on the walls there are medical gadgets of every sort. Small for such a purpose, infantile, diminutive. Monitors that hang from the walls display vital signs; on the screens there are green and red lines that have been flat but now are not. Tubes and cuffs hang in the air draped from the bed to the monitor, ready for their inauguration. Locked cabinets filled with the most crucial items that would be needed to salvage a child’s life. A locked cabinet . . .  a locked cabinet. Then, bodies. Ten, twenty people—a riot. Noise! Shouting! A constant churn of people in motion as if guided by some greater force. Pushing. Shoving. White coats bury a stretcher outside of the room; inside nurses scratch on paper, draw up medications. Yelling! Shouting, Shouting! “Vital Signs?” “Is the tube in?” “Give me a chest tube!” Critical caregivers are outside wanting desperately to get in. “I am more important to this baby!” “No, I am!” “No, I am!” The room is so hot, so dreadfully hot!

In the center of the room sits a tiny cluster—intense, silent, grabbing equipment, prodding, feeling, looking, and listening. And in the center of that cluster, on a tiny baby bed, lay an infant, three days old with the teeth marks of a dog clearly visible around its chest and abdomen. The baby’s skin is white, opalescent white. “Where is the baby’s blood?” “Has anyone gotten a line in?”

A baby, a little cherub baby, three days old. At home he was swaddled in a blanket. Sleeping. Peaceful, innocent. Sleeping in his bed. Resting. How could it happen? How could it? It couldn’t happen. It was a baby, after all. A baby, a newborn baby.

“I turned my back for one minute.” The angels hear. “I couldn’t have been gone for that long.” “I don’t know how it could happen!” “I just didn’t think that could happen.” “I swear!” “It couldn’t have been me.” “It was our baby. Our little baby. Innocent, sweet, peaceful.”

Jagged cuts in the baby’s round head. Puncture marks oozing blood with the consistency of water. Bruising on the back, teeth marks. A tiny broken leg.

Swollen. The fetid odor of a broken body wafts through the room; or is that the smell of fifteen sweating people?

“That dog has never hurt anybody,” they say. “Our family dog. Sleeps all of the time. Loves children. Wouldn’t hurt a flea. I just cannot believe it. Not our dog. Not our baby. Our sweet baby.”

On the trauma bed lay a baby, white as new china. “Where is his blood?” The angel asks. But now white is becoming gray. “Is the tube in? Is the tube in?” “Is the gas back?” “What gas?” “We drew it ten minutes ago” “It’s on that cart over there.” My God! Why? “Does anyone have a line yet?” “Give some volume, red cells, red cells.” “Can we go to CT?” How could this happen? “It is a baby . . . never hurt anybody.”

One pupil large and one small . . . what does it mean? Clear fluid rolls out of the baby’s ears. “Get me a dextro-stick!” “What is the baby’s glucose?” “Can we get some D 10?”

A hot room, so hot, stifling, torrid. So many people. A swarm. Noise, din! Is anyone listening? “The baby is cold!” “Turn on the warmer” “Can we go to the PICU?” “What is the pressure?”

A little baby, an innocent, endotracheal tube in its mouth, intravenous fluid going in every extremity, a tiny cast on his leg. A miniature victim. A veteran, fresh from war.

The angels have seen it before. A baby, a child, a beloved gift. Innocent, with such potential. Everything they could have wanted. What they prayed for. What they yearned for. Their most precious possession. The most important thing in their lives.  How could it happen? How could this happen to a baby? “I couldn’t have turned my back.” “I couldn’t have been irresponsible.” “It wasn’t me that did that.” “It wasn’t me, was it?” “It wasn’t my fault. “It couldn’t have . . . It couldn’t have been me.” But it was, the angels know.



RAE BROWN, MD, is a professor of pediatrics and anesthesiology at a large Midwestern medical center. He often talks to the angels. This story is a composite of many conversations.


Highlighted in Frontispiece Fall 2010 – Volume 2, Issue 3
Fall 2010  |  Sections  |  Doctors, Patients, & Diseases

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