April 19th, 2004

Cane Chinois

Paradise lost: The rest of the story.

For when you see my sparkling smile
The falsehood escapes you and you are beguiled
You trust me, believe me, escape for a while
The brutal clutches of truth, my love - you're soothed, my love.

I paged R to find out where he was. I've got a kid in status in the video EEG lab, R says. Come on down when you're done. I went down.
It's morbid and a little frightening to note that we as medical students cannot help but be interested and intrigued at things that one is not normally excited about. You know, O Best Beloved, you have seen, that I have compassion for my patients. But as I scampered out of the stem-cell unit and headed for clinic, four floors down and at the other end of the hospital, I was excited. Status Epilepticus: a seizure or series of seizures without a return to baseline consciousness, lasting more than 30 minutes. Practically speaking, it's status after five. And it's an emergency, and emergencies are things that you don't see very often.
I could have done without this particular emergency.

I got to clinic just as they were finally breaking her out of her status, a tiny fragile creature lying there on the bed. I "excuse me"'d my way past a man and a woman, glanced around. R had stepped out for a moment; I caught my breath.
Babies in the EEG room look like aliens; at least a dozen wires sprouting from their heads, tape everywhere. She was no exception, skin translucent, dark lashes crescent-moons over her cheeks. She will be beautiful, someday, I thought to myself. She is beautiful now. And she was, even with the sprouting wires and the dimmed lights of the room, even with the faint trembling that indicated the electrical maelstrom taking place in her head. She was beautiful.
R came back in, looks around, says "I sent dad and aunt out to the lobby, we can talk." That was when I knew, suddenly, that something was terribly wrong. So I asked the fateful question:
What's her story?
The nurses and techs looked at me. A silence hit the room like a ton of bricks before one of them spoke:
"Shaken baby," she says, softly. In a flash, everything changed.

Collapse )

And I am watching a pale and fragile infant, her head today bare of the tiny wires that monitored the neuronal activity of her battered brain. She had an EEG this morning. There is brain wave activity - mostly on one side - in response to flickering light; the pathways that transmit signals from bleeding retina to battered occiput are still transmitting. There is no rhythm of underlying consciousness on the EEG; she is on phenobarbital, a drug which should produce a sort of background static at greater than 14 cycles per second, and there are no barbiturate spindles to be seen - just a slow and undulating delta-pattern, occasionally rhythmic, flattening across her occipital lobes to a subtle wave. The reading indicates severe encephalopathy, no seizures. We have done our part of the equation, she is not seizing any more.
I am watching a child with half-moon black lashes, hair so pale and fine it makes her seem nearly bald, skin a translucent pale peach. I can indeed place my finger in hers and elicit the faintest fraction of a grip, and I fight to prevent myself from latching onto that brief reflex as a sign of healing. It is a reflex. She looks like she is sleeping, tucked under her blankets. It is coma. I brush her hair back and find it still sticky with the electrode glue. We cannot wash her, there are skull fractures.
I give her father, always at the bedside - this is still alleged, no culprits named, and he is not denied visiting rights - a sad and sympathetic smile. "We'll let the neurosurgeons know she's not seizing. That should let her brain rest some. Let us know if you have any questions, all right?" And I walk out of the door, hearing his thanks echoing hollowly in my ears and falling, acidic, on my heart.

If you shake a baby once, O Best Beloved, just once in that fit of sudden frustration and anger, you can transform a happy and healthy seven-month-old girl into a mannequin in a hospital bed. You can change a child's life forever. If there is one thing - one single thing - that you take away with you from reading these words, I beg of you, remember this:
Just once.
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