Angels in the ER (20 page)

She led them into the hallway and as they turned to walk away, the mother covered her mouth with one hand. With the other she weakly reached out in the direction of the stretcher. She started to step back into the room, but the young man grabbed her arm and pulled her back into the hallway. And then they were gone.

I closed the door to the trauma room and walked back over to the bed. Jeff was cleaning and putting up the equipment we had used.

“Doesn’t look like SIDS, does it?” he stated.

“No, it doesn’t.”

While Jeff worked, I began to examine the young child. I checked the long bones of the arms and legs for any obvious evidence of an old or new fracture. I didn’t find any. We would have to get X-rays to be sure. And I examined the bruises on his buttocks we had noticed earlier. It was difficult to estimate their ages—probably any time over the past one to three weeks. But there was a relatively fresh one on his right buttock, and the outline of the fingers of an adult hand could still be discerned.

Jeff was standing behind me as I made this observation.

“That son of a b——,” he muttered.

“Who?” I asked, turning and looking at him.

“That guy standing in the doorway. It must be the kid’s father. And I’ll bet he’s been the one doing this. Did you watch him? He just stood there. Never so much as blinked the whole time.”

I knew Jeff was probably right. But that would be for someone else to determine.

“Call the coroner and get him over here,” I told him. “And call DSS. They need to get involved right away.”

I turned to the lifeless body of the baby, and then thought of something. “And we need to find out if there are any other children in the house.”

“I’ll go tell Amy,” he said.

While we had been talking, I had taken the ophthalmoscope from the wall and focused its beam of light through the pupil of the baby’s right eye, adjusting the distance up and down until the retina came into clear view.

Jeff was halfway to the door.

“Come here a minute,” I said to him. “Take a look at this.”

He walked back to the bed and leaned down, peering into the scope as I held it.

“Do you see the retina there, the pearly white sort of background?” He adjusted his head until the retina came into view. “Yeah, I see it. And there’s some blood vessels running across it.”

“Right—those are supposed to be there, and they’re normal. But take a look at about three o’clock,” I told him. “Tell me what you see.”

He continued to adjust his head, shifting a little to one side.

His head stopped moving. “Hmm. I’m not sure what I’m seeing, but off to the side the retina’s all blotchy. It looks like clumps of blood or something.”

“That’s exactly what it is. That’s blood on the retina. Retinal hemorrhages.”

Jeff straightened up and looked at me.

“What does that mean?” he asked.

I examined the child’s other eye, attempting to confirm that these findings were present on both sides. They were.

“It most likely means that someone has been shaking this baby. Shaking him hard enough to cause the vessels in the eyes to bleed. And when that happens, there is almost always associated brain damage. There is no way this child died from Sudden Infant Death Syndrome. It looks like he was murdered.”

Amy had called the coroner and he was on his way, as was a representative from the Department of Social Services. She had also notified the police. I walked down the hall to the family room. I would need to try to help the mother, to answer any questions she might have, and to help her contact people if needed. And I wanted a few minutes to talk with the two of them.

I reached the closed door of the family room and stopped. Looking down at the child’s chart in my hands, I scanned the record for the name of his mother. “Angel.” And the baby’s name was “Zack.” I tapped lightly on the door, opened it, and stepped into the room. Angel was sitting on one end of the sofa, her elbows propped on her knees, her head in her hands. Her hair cascaded wildly about her face,
hiding it, and her shoulders heaved with her sobbing. The young man sat on the other end of the sofa with his legs crossed at the ankles. His knees were nervously moving up and down. He slouched into the cushions, one arm resting on the back of the sofa. With his other hand, he twisted the straw that still hung out of his mouth. He looked up, and his eyes met mine as I entered.

I closed the door behind me and sat down in the chair nearest it. I looked over at Angel.

“Angel,” I began. “I’m Dr. Lesslie. I’m not sure I was able to tell you that earlier.”

At this she sat up and brushed her hair out of her face. Her eyes were red, and her face was swollen. She didn’t say anything.

I looked over at her partner. “And you are…?”

He continued to stare at me, and from around his chewed straw I was able to hear, “Timmy.” His legs were moving a little faster now, and he chewed a little harder.

“Okay,” I said, turning back to the mother. “Angel, can you tell me what happened to your baby this evening? Tell me about his general health, or about any problems he has been having. And when did you know something was wrong with him?”

Angel wiped her nose with the back of her hand and said, “He was fine most of the day. And he’s been a good baby, really he has. Never caused any problems. Then this afternoon, he got a little fussy.”

She stopped and looked at Timmy. He was no longer staring at me, but was absently gazing at the ceiling in the corner of the room. He was now sitting perfectly still.

“I think he was getting a virus or something,” she continued. “He seemed to have a little fever, and then he had some diarrhea. I didn’t have any Tylenol in the house, so when Timmy came over, I went to the store.”

“Are the two of you married?” I asked.

“No. But we’re gonna get married pretty soon. I live at home with my momma, and Timmy helps out with Zack whenever he can.”

“Is Timmy Zack’s father?” I asked, glancing at him.

“Yes,” she stated simply. His legs were moving again.

“Was your mother at home this evening?” I asked Angel.

“No, she works third shift. I called her a few minutes ago, and she’s on her way.”

She began crying again, and I handed her the box of Kleenex that had been sitting on the small table.

Timmy stood up, put his hands in his pockets, and in the small space available at his end of the room, he began to pace.

“And then what happened?” I asked her.

“Well, I was only gone a little while, maybe thirty minutes. The store is just down the street. Zack was crying when I left, but he seemed okay. And then when I got home…he…he…” She covered her face with her hands and began sobbing again.

“Is that when you noticed he wasn’t acting right? That he didn’t seem to be breathing properly?” I asked her.

She nodded her head, saying nothing.

I sat back and was silent for a moment. Timmy was standing still now, studying the fire evacuation plan that was hanging on the wall in front of him.

I understood what had happened to Zack. Timmy had been left with a fussy, crying baby, and he had snapped. It may not have been intentional, but the outcome was the same. He had picked the baby up and shaken him in order to stop the crying. It hadn’t worked, and he just shook him some more. And he continued to shake him until finally he was quiet. And now it would be time for the police to take over.

But I wanted to ask them one more question. Some part of me wanted to see how they would respond.

“Angel.” I addressed her, but I watched Timmy. “There are some bruises on Zack’s bottom. It looks like he’s been spanked, and pretty hard. And more than once. Have you noticed that?”

She sat up and stared at Timmy. “No. I, uh, I have seen…he does fall a lot, and, uh, I guess he, uh, he bruises, and…” Timmy stood absolutely still.

“Angel, he’s six months old,” I reminded her. “Are you telling me he’s been walking?” I was becoming upset, and I knew it was time for me to leave. Her head hung down now, and she was silent. I didn’t need to hear any more.

I stood and opened the door. Turning back to them, I said, “Just stay here. Someone will be with you in a few minutes.”

I closed the door behind me and stood in the hallway for a moment. I was angry, and I wanted to go back into the room and grab Timmy by his throat and…But I knew I couldn’t do that. It was my job to be an ER doctor. It would be someone else’s to bring justice for this innocent, dead baby.

The sound of approaching footsteps drew my attention. I looked up and saw two police officers walking toward me.

I will never forget the look in her eyes. It’s been a little over twenty-five years, but I will never forget that look.

It was mid-December and a Thursday. Outside it was cold, and at six p.m., already dark. My shift would be over in another hour and I was trying to get the department in order for my replacement. So far, I was succeeding.

“Any big plans for Christmas?” Virginia Granger asked me. We were standing at the island of the nurses’ station, just outside her office. She had been working on the nurses’ schedule for the holiday, and I was writing up the chart of a guest in the observation unit. He had been practicing his seasonal celebratory imbibing.

“No,” I answered. “Just plan to be at home with the family. It looks like you’re having better luck with your schedule than I am with the docs’,” I said, nodding at the clipboard in her hands. Her schedule was filled except for two openings. “It looks like I might be spending some of the holiday here,” I added.

“Well, I hope not. Didn’t you work last Christmas?” she asked.

I thought for a moment but couldn’t remember. Holidays for an
ER doc seem to all run together. I was about to respond when movement in the triage doorway drew my attention. Seeing me look in that direction, Virginia turned her head as well.

Lori was walking into the department, leading a young woman who was carrying a large picnic basket in front of her. She held the basket with both hands, leaning over slightly and straining with the burden. Lori turned around and held out a hand to help, but the woman shook her head, refusing the offer. Lori caught my eye and with a slight nod, signaled she needed me. I watched as she led her patient around the other side of the nurses’ station and into room 3, closing the door behind them.

Virginia had watched all of this transpire, and she said, “Dr. Lesslie, you’d better go see what Lori needs. We’ll talk some more later.” She turned and walked into her office.

I left the patient’s chart on the counter and headed toward room 3. Something was amiss here, but if it was a significant emergency, Lori would have been more insistent in her request for assistance. And yet, my curiosity was piqued about the contents of that picnic basket.

Pushing the door of room 3 open, I found Lori standing in the far corner beside bed B. The basket had been placed on the stretcher and she was leaning over it, carefully removing a small baby wrapped in a dirty piece of army blanket.

“And when was the last time you said you fed them, Hope?” Lori asked the mother as I closed the door behind me.

Them?
I stepped over to the stretcher and looked down. In the bottom of the basket was another bundle of what appeared to be a piece of the same dirty blanket.

“An hour ago, maybe two, I guess…” Hope answered, her voice faint and her tone almost apologetic.

I took my first real look at this young mother. She was tall, maybe five-eight, and slender. No—she was skinny. Her long brown hair was matted and dirty, and it hung unchallenged into her face. She stood hunched over, staring down at her babies. Her arms were crossed over her chest and each hand grasped the opposite shoulder. She was
rocking from side to side. Her blue jeans were worn, and torn at the knees. The stained sweatshirt she wore couldn’t provide much protection from the frigid December air. She had no coat.

I glanced down and noticed she had on sandals but no socks, and her toes were blanched and colorless from the cold. Lori interrupted my observations. “Dr. Lesslie.” With her head she motioned toward the doorway. She was holding the blanketed infant in her arms.

“Hope, stand here next to your baby for a minute, okay?” she instructed the mother, nodding at the basket.