L'il D is a 2 month old. For reasons unknown, his soul was born to pain. His parents' story is that they were having a party and had too much to drink. L'il D was left on an ottoman, fell, and somehow acquired massive subdurals of different ages.
The human brainstem takes care of life for months. Early eating, sucking, and regulation rely on so-called 'primitive' reflexes but it's probably more fair to think of an operating system out of the box that takes care of basic tasks. After 2 to 3 months, the cortex should take over.
For this guy, his cortex can't take over. It's gone. He's cortically blind and deaf. He probably will never eat correctly. He's sort of all done.
For both of my last call shifts I've had to deal with him spiking temps or heart rates or both, and fussing. Babies fuss, that's OK, but they don't normally spike to a BP that would be hypertensive for a fifty-year-old smoking vet. And they don't fuss like D.
Last night, I held him. Now I have three kids, so I have the part of my brain that knows how to hold babies and wants them to feel better. Because I held him, I think, I now cry more for L'il D than almost any of the other remarkable patients I've had. You should see him. His head is a bit lopsided from all the swelling. His pupils are too big and usually lazily unequal. He has a tiny little NG tube in one nostril. All of his limbs are stiff and tonic because they don't have a brain to guide them. Despite all of it, he is, somehow, consolable. He likes to be held. His rates go down. He fusses but not as hard. His cries are miniature convulsions, eyes closed, bundled.
I don't know what happened to him. It may be his parents got drunk and he was hurt by someone else, he fell somehow. It doesn't matter. There is no justice for him. He's already gone, and yet still so vulnerable for the tail of soul he left behind when he was devestated.
Here's to him, and to the foster parents taking care of him when he goes home. L'il D, we love you. I hope your soul is more at rest the next time around.
Photo Credit: Not L'il D, of course, due to HIPAA.