She was ushered into the triage room. I had seen her here before. In the car seat was her infant son born premature , now 3 months old.

I forced a concerned smile, ” so what’s going on today?” I glanced past her into the full emergency department waiting room. “Fever , he has a fever”, she glanced at the car seat then at me . I did not see an overly anxious mom, she appeared calm, even while her infant son lay screaming in the car seat. I did a quick set of vital signs, all normal. “No fever now, let’s just have the two of you head over to registration , and I will see you in  the back as soon as we get a room for you” I returned to the ED , to see if any one could be moved in or out. As the afternoon continued it wasn’t long before I escorted her back to a room, and flagged her chart as ready for the Doctor to come and assess. As I continued taking care of my other patients, I was distracted by the continuous crying coming from her room. I returned to her room , finding her son crying , as she sat calmly in the chair next to him. “Does he need to eat , be changed, … Do you have a bottle for him, can I get anything for you? ”  “No” she replied , he always cries, with that she gave me a tired smile. “Do you mind?” I gestured toward him. “Not at all ” she consented.

I removed baby from his seat, undressed him, listened to bowel sounds , lungs, ..all clear , unremarkable, dry diaper , I swaddled him tightly as the Doctor tapped gently on the door , the baby quieted in my arms , as his Mom remained seated , answering the doctors questions. “Let’s get a chest X-ray , and go from there ” out the door she went. I grumbled to myself , we were backed up , with more arriving by the minute, and she wants to X-ray this baby that shows no sign or symptom of illness.

I asked mom if she wanted to accompany baby to X-ray . No she said, I will just wait here. I thought to myself she must be exhausted.

I brought the baby to X-ray . Returned him to his mother , who placed him back in his car seat.

As I continued working , needing a bed for an incoming ambulance , I asked the Doctor if she had read the chest X-ray and if we might be able to discharge them home. “I will look at it right now”she replied . Then she asked , “Does mom seem attentive ? Anxious? Appropriate ?”  I shrugged, “I guess so, seems more exhausted than anything else… Not real high strung.”

little Poikka had almost too many fractures to count in his tiny chest X-ray . My face fell along with my heart. A Cat scan was ordered, which revealed multiple skull fractures.

we called the pediatrician who arrived and informed the mom of the discoveries . While she did not seem surprised, she also denied having any knowledge as to how it could of happened. The pediatrician informed her the baby would need to be transferred to a bigger hospital, he asked her if she understood what was happening , asked if she wanted us to call any one… She looked at me , asked if I could watch him so she could go get his father from work , and stop at Macdonalds, remarked she hadn’t had much to eat today. I told her I would , and off she went, no questions , no tears, no anger , no fear.

Everything sprang into action, transfer was arranged, CPS called, Police called, helicopter enroute for transport , I started an IV in his little arm , and  swaddled him tight as the whole process swarmed around us . Parents returned, police and CPS interviewed , report called to the receiving hospital.

As he slept in my arms I pondered the fact that without that X-ray I grumbled about ad midst my busy day. No discovery would of been made . This sweet baby would have fallen through the cracks. Another Sids case maybe.  I was asked over and over does the Mom seem attentive? What about Dad ?

The Dad seemed a bit more emotional , though had no idea how this could of happened. Mom was enjoying a Big Mac and fries.

Baby boy slept in my arms , I stayed past my shifts end to hand him directly to the flight team.

during that time as I held this injured little cherub , I wondered why doc ordered that X-ray , I thanked God for His intervention, I criticized myself for not having ears that hear, and eyes that see.

The flight team took over, as they do… They put him in their tiny transport pod, as they did he began to seize …standing in the background I whispered pull it together little Poikka … Represent, God intervened here for a reason, you must have a really special life ahead…

The flight crew stabilized him . I clocked out and began my drive home to my little farm, where things make sense. As I drove along the waters northern shore  , I was distracted by the sound and lights of the helicopter flying south. I pulled over to watch them disappear into the night . Wishing them Godspeed as they did.

6 months later the father confessed. Funny thing he seemed more attentive in the hospital then she did.