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January 24, 1986

Three Feet Tall and Thirty Pounds

JAMA. 1986;255(4):533. doi:10.1001/jama.1986.03370040109035

We met late one night in the pediatric intensive care unit. He was the patient; I was the intern. Earlier that day he had been exploring his world with a vigor that only a 3-year-old could know. He had found a parked motorcycle, tried to climb aboard, and succeeded only in pulling it over, pinning himself beneath it. He was found moments later, nearly lifeless. The wonders of basic and advanced life support restored his heartbeat, but he was still in a deep coma when he arrived in the ICU that night.

At first glance he seemed the prototypic 3-year-old: three feet tall and thirty pounds. He was just beginning to lose his toddler's potbelly. Blond and fair skinned, he had blue eyes that hours before must surely have twinkled with warmth and excitement. But now they were glazed, his stare empty and searching. His brain had begun to swell,