Shredded
Valerie Pruitt, MD
It was Labor Day weekend and a perfect day for enjoying the lakes of the Midwest. At the time, BobbieJo was a ten-year-old girl riding on a pontoon boat with her sister, dad, and uncle. Wearing her life vest, she was watching the water at the front of the boat when the boat decelerated and she was thrown overboard. She went under the boat and was ensnared in the boat propeller. Reacting quickly, her father immediately shut off the engine and raised the propeller, but his little girl was still submerged and he knew every second counted. He got his knife and cut her clothing loose from the propeller blades and dragged her back into the boat. They called 911 from the boat, and then sped to the nearest dock where they met the ambulance. She was transported to a local hospital where she was put on a breathing machine, because of a significant lung injury, and given a blood transfusion. Arrangements were then made to urgently airlift her to our facility, the nearest one with trauma care.
I was the trauma surgeon on call that evening and quickly examined her in the trauma bay of the emergency room. Her injuries were devastating. She was literally shredded, with multiple deep cuts from the propeller on her chest, chin, arm and leg. The worst slices were on her chest, where eight ribs were cut in half and her lung was protruding out of her chest. Her lung had collapsed, and we detected bleeding in her liver and a small cut on her diaphragm (the breathing muscle between the chest and the abdomen). It was evident that if she was to have any chance at all, she needed to go to the operating room immediately. In this first of what would ultimately be many surgeries, I put her lung back into her chest and repaired her ribs. I determined her liver and diaphragm would heal on their own and not require repair. I cleansed the cuts and tears as carefully as I could, but I remained very concerned that the potential for infection from the dirty lake water and propeller blades was very high.
After coming out of the operating room, I went to update her family, who had all arrived by that time. Her mother had not been on the boat but had been summoned from a leisurely Saturday to get to the hospital. She was overwhelmed with worry and fear for her daughter’s life. Her father was still shaking from the tragic events of the accident. I carefully, and as gently as I could, explained BobbieJo’s many injuries, what I had done in the operating room, and the upcoming need for many more surgeries. I tried to realistically assess for them BobbieJo’s chances for survival and recovery. The picture was not rosy, no matter how much I tried to leave them with hope.
I am a general trauma surgeon trained to provide acute and urgent care for children and adults, but the hospital we were in was not a pediatric hospital. We were in a smaller town than where this child and her family lived, and they were understandably concerned about our experience in situations like this and the quality of care we could provide. The family asked to have the child moved to a different hospital and to the care of a specialized pediatric surgeon who might be more experienced in the types of ongoing surgery BobbieJo would undoubtedly need. Frankly, there aren’t many cases like this in anyone’s experience, but I knew that wouldn’t reassure the family.
After the exhausting surgery and the immense tension surrounding saving this little girl’s life, my emotions were mixed that night. I certainly understood BobbieJo’s parents’ desire to have her in the best possible care setting and in the best possible hands. I also understood their wanting to be closer to home—our facility was more than a three-hour drive from where they lived. But I was also deeply saddened after pouring out every drop of energy, knowledge, and skill to save this child’s life, only to feel as if it hadn’t been enough to earn the family’s confidence for her future care. It was late in the evening so we stabilized BobbieJo for the night with plans to transfer her in the morning to a center closer to their home.
BobbieJo spent the night in our intensive care unit, with me checking on her frequently. There were no major crises that night. The next morning, the family had changed their mind and asked me to continue caring for their child in our facility. I felt gratified, but also somewhat apprehensive about the new and even greater responsibility of trying to bring this child back from the brink all the way to normal. She was far from normal that morning, and I wasn’t certain she ever would be again. Now that would be on my shoulders; I felt personally and completely responsible for whatever outcome she might have.
Over the next nine days I performed five additional major surgeries on BobbieJo and countless wound cleanings. And I prayed, and I cried. I have a daughter this same age and very much felt the agony this family was in. The family’s community rallied behind them, and their church held fundraisers in their hometown to help with the family’s expenses. Thankfully, after an extended time in the hospital and the care of a wonderful team of physicians, nurses, and therapists, she had a truly remarkable recovery. The family called it a miracle, and I have to agree. Every one of BobbieJo’s injuries healed without complications and none of her multiple and extensive wounds ever became infected. BobbieJo’s family spent weeks in our small community, away from home, before she was ready for discharge; her mother never left her side.
During that time and on our journey together, her family and I developed a mutual respect, admiration, and friendship. I was proud of the commitment and faith her family showed, and of the courage and spirit BobbieJo found deep inside her to get through this ordeal.
We went from a day of horror to a time of relief and gratitude.
Date of event: 1984
Kidnapped: The Story of Two Three-Year-Olds
Richard D. Krugman, MD
The lead story on the evening news was about a missing three-year-old. She and her four-year-old brother had been playing in their front yard on a warm August day when a car pulled up, the side door opened, she took off her underpants, and got into the car. Her brother raced inside their home to get their parents, but by the time they all got back outside, the car and the little girl were gone. The police were called and for the next two days, they, her parents, and the community frantically searched for her.
Two days later, the morning television shows were interrupted with breaking news. The girl had been found alive! Two birdwatchers walking in the foothills west of town—twenty miles from the front yard—heard what sounded like a child crying nearby. They followed the sound to an outhouse in a campground and opened the door. Down at the bottom of the outhouse, in the waste well, a little girl was crouched in a corner, shivering. Miraculously, this particular outhouse had a leak and there was no fluid in the well. Had it not leaked, she surely would have drowned.
“What are you doing there?” one rescuer asked.
“I live here,” the dazed and confused little girl said. “It’s my home.”
The girl was taken by helicopter to a local general hospital trauma center. TV cameras captured her parents racing into the hospital to be reunited with their daughter. Within a half hour after her arrival, the physicians told dozens of gathered reporters that “She was dehydrated, but going to be fine,” and “She had not been sexually abused.”
At the time, I was director of a center for the prevention of child abuse, where we were anxiously following the story on television with the rest of the city. We were grateful and relieved she was found alive, but skeptical about the last statement made by the doctors. In our experience, the kidnapping of three-year-old girls was often motivated by sexual abuse.
I, along with our child abuse prevention center, became involved in this case a week later. The police department investigating the matter wanted to show a videotape they had made of a lineup. The tape showed the girl, sitting in her mother’s lap, watching as six men were asked, one by one, to step forward and say: “Take off your pants and get into the car.”
When the fourth man finished saying those words, the girl blurted out: “Mommy! That’s him! That’s the bad man who put me in the hole.”
The question the police detecti
ve had for us was, “Is her statement reli-able?” The child psychiatrist and the attorney at our center agreed that it was reliable, but it would not be admissible in court. However, they believed a videotaped interview under the right circumstances might be.
On Saturday morning of Labor Day weekend we did a ninety-minute “play interview” with the three-year-old. I ran the video camera as our child psychiatrist skillfully asked her about her experience from the time she got into the car until she was found. She played out the events with toys, demonstrating everything she could remember, including her unmistakable sexual abuse. Months later, when the individual who had kidnapped her confessed as part of a plea bargain, his confession could have been the subtitles to her videotaped interview. The accuracy of the little girl’s videotaped testimony was perfect.
Our center treated the little girl for the next year. The following fall, she walked into our waiting area where her therapist and I were expecting her, and—now a self-confident four-year-old—she said, pointing to the psychiatrist, “You are my talking doctor! He (pointing to me) is my real doctor. I am done talking!” I was her pediatrician for the next three years.
Twelve years later, I was dean of the school of medicine. My secretary buzzed me and said that there was someone on the phone who wanted to talk with me; did I have a minute? It was my former patient, now eighteen and doing a term paper on child abuse. She wondered if she could interview me, and if so, would the next day at 4:00 work? My calendar said I had an important meeting at that time, but I said, “Absolutely.”
She came in the next afternoon and had nineteen questions for me. It took twenty-five minutes to answer them. After a pause, she looked at me and said: “My mom tells me that you and the psychiatrist saved my life. I just wanted to say thank you.” It was an amazing moment in my career—and, even though it was nearly midnight in England where her former “talking doctor” lived, we called him on the phone, woke him up, and he and our former patient had a wonderful conversation. He visited with her and her parents the following year when he came to town for a conference on child abuse.
Now, more than thirty years after her kidnapping and attempted murder, this little girl is a happily married mother of three. She has her master’s degree in counseling and a successful practice helping others. Many believe that if you were abused as a child, you will be an abuser. That turns out to not be true. More than two-thirds of abused children never repeat the cycle and many, like this remarkable three-year-old, do very, very well.
However, in our experience, it is true that all abusers have themselves been abused in childhood. Our center psychiatrist interviewed the man who kidnapped our patient while he served his sentence in our state prison. He denied being abused, but when he described his childhood and what his brothers did to him, it was almost certain he was abused. Neighbors who lived on the same cul-de-sac he lived on told us that they recall him wandering from yard to yard as a little three-year-old, seemingly “lost” or looking to get away from his house. These former neighbors told me they wished they knew then what they know now about child abuse and neglect so they could have reported the family in hopes of protecting the child.
The life trajectories of these two abused three-year-olds, who grew up a generation apart in our community and crossed paths one day in August, took them in very different directions. One went to prison, the other to a productive life helping others. One was lost to the vicious cycle of child abuse, the other miraculously saved by an unlikely convergence of Good Samaritans walking near a leaking outhouse.
These three-year-olds remind us of the fragility of childhood, and our collective obligation to work toward building a society that can better protect children from harm.
6
Mysterious Presence
We are trained to be keen observers in delivering care to our patients and, when they are critically ill, our five senses go on high alert. Subtle or dramatic changes in a patient’s condition alert us to the possible need to take action. A shift in a patient’s mood may indicate an important emotional or psychological need. The concerns of our patients’ families also rise to prominent places in our consciousness, as does the setting in which we find our patients—the clinic or hospital room, the blinking lights and beeping monitors.
Yet there are times when our five senses may not be enough. Times when something beyond our awareness may be even more important in coming to grips with unfolding events.
Date of event: 1996
The Boy Who Saw Heaven
Joanne Hilden, MD
The mother of a five-year-old boy suffering a relapse of neuroblastoma, a very serious type of childhood cancer, was in clinic with her son to discuss options, none of them very good. His tumor was not re-
sponding to the latest round of chemotherapy, which included medicines with more serious side effects, given only when more standard treatment doesn’t work. He was a quiet child, her only child. His grandmother sometimes came to clinic with them, but not this time.
The tumor had come back after multiple rounds of chemotherapy, and the child was noticeably weak. He had been through many lengthy and difficult experiences with his disease and his therapy, including several long hospitalizations with fever and severe blood infections. As his oncologist (cancer doctor), I tried to counsel his mother that since the tumor kept coming back on chemotherapy, she should consider the use of a gentler form of chemother-
apy intended to slow the growth of the tumor, rather than still hoping for a remission or cure using high-dose chemotherapy. I told them that with the high-dose approach, we would again be harming the boy’s immune system and making him susceptible to serious infections as he had been before. The gentler approach, I explained, might allow them to enjoy some time out of the hospital before he died.
The mother’s desire was for continued aggressive treatment, trying everything we could to achieve remission or cure and, following her wishes, that is what we did. During the period that followed this new round of aggressive treatment, the little boy was again hospitalized with fever due to extremely low blood counts and infections. He was bedridden with very little energy and did not talk much, requiring high doses of morphine for pain.
As his care team, we became accustomed to this child sleeping most of the day and being in pain when he was awake. The Child Life team at the hospital was not able to get him to play during those awake periods. We visited him many times during the day. His blood cultures grew bacteria again, requir-
ing IV antibiotics. Any discussion of getting him home into a hospice-type environment where we could make him more comfortable was met with instant resistance by the family who wanted to try everything possible to fight the cancer. So the hospital became his new home in this end stage of his life.
It was a Friday and we saw him at the end of morning rounds. The room was somber, with his family there in deep distress and sadness due to the child’s obvious deterioration and failure, again, to respond to treatment. He was lying very still, breathing quietly. His room was near the nurses’ desk, so the sounds of a busy hospital were present.
Then suddenly, this frail and previously motionless child sat up in bed. He sat straight up, and looked right past us all. His blank expression turned slowly into one of absolute joy. It was a slowly dawning, big wonderful smile; his eyes especially seemed peaceful and happy. His smile grew bigger and bigger, with his eyes still looking right past us.
Some sort of instinct filled me. I took his hand and put it in his mother’s hand, and said, “Mommy’s here.”
As I and the three other caregivers in the room witnessed this little boy’s sudden, mesmerized behavior, we felt as if we were in a state of suspended animation. No one wanted to do or say anything to interrupt the moment. To this day, I cannot remember how long his fixated glow lasted, but the next thing he did was simply lie down. He then took his last breath, his hand intertwined with his mother’s.
Every last one of us believes we watched our little friend see heaven that morning.
Date of event: July 1994
The Man All Dressed in White
Kathleen Farrell, MD
I was a second-year resident at a large Midwest children’s hospital on call overnight in the pediatric intensive care unit. A two-year-old near-drowning patient was admitted with pneumonia due to inhaled pool water, resulting in severe respiratory failure. The chest X-ray showed a complete “white out,” meaning all the air spaces were completely filled by fluid.
After stabilizing the patient with a breathing tube, mechanical ventilator (breathing machine), sedation, oxygen, and intravenous fluids, I and the medical student working with me that evening sat down with the family to learn what had happened. The little boy had toddled into the deep end of the swimming pool at a family reunion that evening where none of the family members knew how to swim. The medical student asked who lifted the toddler from the pool and the five-year-old cousin proudly piped up, “I did!”
Indeed, the uncle confirmed he saw her bring the toddler to the surface in the shallow end of the pool and he, the uncle, then immediately started CPR (cardiopulmonary resuscitation). Our medical student asked the five-year-old, “What made you go get your cousin in the bottom of the pool when you don’t know how to swim yourself?”
She answered excitedly, “That’s easy, the man all dressed in white told me to.”
We were stunned by her answer. Our astonishment continued through the evening as we watched how quickly the patient improved after arriving entirely nonresponsive and in severe respiratory distress. Overnight, our patient easily weaned off the oxygen and ventilator, and was up playing in bed, talking, entirely back to normal. The chest X-ray was now also normal, no traces of fluid. Impossible!
That morning on rounds, our medical student described to the team what the cousin had stated and how amazed we were with the toddler’s seemingly miraculous improvement. At the end of the presentation our supervising attending physician said, “Great, he can transfer out of intensive care to the floor. Let’s make sure the family gets swim lessons, so next time we don’t have to rely on the angels to save him.”
Miracles We Have Seen Page 20
