This patient, this beautiful 4-year-old boy, was brought in by helicopter from the scene of a head-on auto collision. The nurse recounts the familiar story: an unrestrained back-seat passenger, found under the front dash in the crushed plastic and steel mess. He was extracted with pneumatic jaws and immobilized on a board. Ringer's lactate brought the blood pressure up. Oxygen through an endotracheal tube pinkened his lips. He did not move then and does not now. His pupils do not shrink from light. His skull is in pieces and his brain on CT scan is distorted, cut by white jags of hemorrhage. The flurry of deep-line placements, roentgenograms, burr holes, and blood tests have settled into routine intensive care. Pressor drips infuse. His vital signs are stable now.
Bandaged and crying, his parents are led to him. Their shock, guilt, and grief are the same as they are every time,
Victor T. Wilson. Custodian. JAMA. 1987;258(14):1898. doi:10.1001/jama.1987.03400140060025