Nothing ever happens in pediatrics.
Until one night.
The night that changes my life.
2:23 A.M.
The time has been burned into my memory like a brand.
I’m half asleep in the call room. My pager goes off. I swing off my cot and hit the corridor. Dr. Pyle, an odd look on his face, waits outside the call room. “We’ve got to roll,” he says.
“Where?”
“PICU.”
“Pediatric ICU. Isn’t that unusual?”
“Extremely.”
He starts to jog, then in seconds, we’re sprinting. We arrive at the elevator. He wails at the buttons. “Elevator’s down in the parking garage. Let’s take the stairs.”
We bolt toward the end of the corridor, hit the stairwell, take the four flights to PICU two stairs at a time.
“What did the page say?” I gasp, falling half a flight behind Dr. Pyle.
He hesitates. “Infant,” he says. “Attacked by an animal.”
I stop for a split second at the landing.
“You coming?”
“Yes,” I say, and push myself to run faster.
We reach the fourth floor, burst through the door from the stairs, and crash through the doors of the PICU. A nurse points to a corner room. For some reason, perhaps because of the number of people spilling out of the room, we ease our sprint to a speed walk, the soles of our running shoes slapping on the recently waxed floor. We squeeze by two women blocking the door, one dressed professionally in a pantsuit, incongruous at this hour, the other my age or younger, dirty-blond hair, tight jeans, tight top, face fiery and scraped, eyes glassy and distant. She’s possibly high. Several people crowd around an infant’s hospital bed, a pediatric surgeon, two nurses, a respiratory technician, a pediatric anesthesiologist.
“Hey, Joe.” Dr. Pyle greets the pediatric surgeon. “What happened?”
The pediatric surgeon backs away from the crowd around the baby’s bed. He speaks out of the side of his mouth as if he doesn’t want to be heard. “I’ve never seen anything like it.” He clears his throat. “Eight-month-old boy. Mom went out to a bar. Left the baby alone in their trailer with their pet raccoon.”
I gasp.
Dr. Pyle lays his hand on my arm. “Don’t tell me. No cage?”
“Shoe box.” The pediatric surgeon pinches the bridge of his nose with two fingers. He speaks to the floor. “She comes back and finds the raccoon eating the baby’s face.”
I feel the floor sway. I reach out for the wall to keep my balance.
“My God,” Dr. Pyle says. “How’s the baby?”
“He’s going to live. Both eyes are intact. But the nose, one cheek, upper and lower lips, gone. They’re tubing him now. The plastic surgeon’s on his way. We don’t see any other injuries.” He pauses. “He’s lucky to be alive.”
“Yeah,” Dr. Pyle says. “What kind of life is that going to be?”
A rustle at the door, and the two women step in. The pediatric surgeon tilts his head toward them. “The mom and the social worker.”
“I think I can pick out the mom,” Dr. Pyle says. “Is there a dad?”
Joe shrugs. “I don’t know. Cops are on their way.”
Dr. Pyle whistles softly. “Who the hell leaves her kid alone with a raccoon?”
A commotion near the baby’s bed. The anesthesiologist finishes inserting a breathing tube and steps away. Dr. Pyle moves over to talk to him, leaving an opening to the bed. I edge away from the wall and step closer to the baby. I want to see. I take one more step.
Dear God.
The baby’s face has been torn off. There is a gaping hole where his nose used to be. He has no mouth, no lips. His gums appear through a gap in his flesh. His right ear has been ripped away, and half of his left ear hangs torn and jagged. His eyes, beautiful and blue, stare wide open. I stare into them and I say aloud, “Oh, God,” and a lump rises into my throat. I feel nauseated, and I stumble out of the room and into the hall. I bend to my knees and bury my head in my hands.
In a moment Dr. Pyle squats next to me. “You all right?”
I blow out a slow breath. “I don’t know. I honestly don’t know.” I turn my head toward him, exhale again.
His face has turned red. “In my twenty-five years of being a doctor, this is, hands down, the most horrifying thing I’ve ever seen.”
I lower myself onto the floor. Dr. Pyle sits next to me. “There’s nothing we can do. The baby’s stable. The rest is up to the plastic surgeon. It’s all him now. So. Here’s what I’m going to do.” He studies my eyes as if he’s checking my vitals. “I’m going back over to the call room. I’m gonna try to get some rest. If I stay here, I’m afraid I’ll say something to that kid’s mom that I’ll regret.”
“I wish you’d stay here, then.”
Dr. Pyle pops up to his feet. He offers me his hand. I take it, allow him to help me up. “Take the rest of the night off, Tony. I’m dismissing you. Go home. Get some sleep in your own bed. Come back around six. Something else insane happens, I’ll page you.”
I’m tempted, but only slightly. “I think I’m gonna stick around. I want to see what the plastic surgeon can do. Besides, the call-room bed is more comfortable than my bed at home.”
His smile surprises me. “I thought you’d say that. I’ll page you if I need you.”
The baby’s mom comes out of the room, fumbles in a large straw bag, pulls out a pack of cigarettes, jams one into her mouth, and heads toward an exit door.
“I have to get out of here,” Dr. Pyle says.
I FIND A spare folding chair and camp out by the nurses’ station. I catch a ten-minute power nap and awake at 3:01 A.M. to footsteps echoing in the corridor and a nurse’s voice: “That’s him. I’ve seen him on TV.”
I look up to see a Ben Affleck clone with stubble, wearing starched scrubs and striding down the hall. He carries a small camera bag. He pulls up at the nurses’ station. “I’m Dr. Kanner. Room 411?”
“I’ll show you,” I say. I offer my hand. “I’m Tony Youn. I’m the medical student on pediatrics tonight. Would you mind if I went in with you and observed?”
He grins. “Nothing happening over there, so your attending stuck you with me?”
“Actually, he sent me home.”
Dr. Kanner raises an eyebrow.
“I wanted to see what you can do here,” I say.
“A kindred spirit? Welcome to the club, Tony Youn.”
We start toward the corner room. As we walk, the door to the stairwell opens at the far end of the hall and whistles shut behind the baby’s mom. Even from here, fifty feet away, she lasers us with her eyes. She takes a step, teeters on what I see for the first time are precarious high heels. She arrives at the room ahead of us, folds her lower back into the doorway, and presses her foot into the floor as if she’s crushing out a cigarette.
“Mommy dearest?” Dr. Kanner.
“Yes.”
“Is she drunk or a complete idiot?”
“I don’t know. I haven’t had the pleasure.”
“I’m an experienced physician. It’s possible she’s both.” Dr. Kanner quickens his pace, pulls ahead of me. I don’t know why I’m surprised, but he offers her his hand. “Mrs. Ellison?”
She hesitates, then extends three fingers with inch-long nails painted shocking pink. He tries to find a grip. She withdraws immediately as if she’s afraid she’ll catch something. “Miss,” she says, and sniffs. She speaks in a high nasally voice, a trace of a southern accent.
“I’m Dr. Kanner, the plastic surgeon. I’ve been called in to look at your son.”
“I figured. You been on TV, right?”
“Couple times.”
“I seen you.” She sniffs again, picks at something on her tongue. As she does, she sizes him up. She leans forward and reaches into the back pocket of her skintight jeans. She pulls out a photograph. “This here is Jerome two weeks ago. This is how I want him to look. Exactly like this. No scars. No nothing. Just the way he was.”
“Well,” Dr. Kanner says, running a hand through his hair.
“That’s what you do, right? That’s your job. I mean, you say you’re a plastic surgeon. Are you a good plastic surgeon?” She looks at me. “Or some kid just starting out.” Eyes roaming down Dr. Kanner’s entire body. “You look awful young.”
“I should examine your son, see what’s going on,” Dr. Kanner says.
He tries to step past her, but Miss Ellison reaches her arm across the doorway, blocking him at the neck. “You do this shit all the time, right? What do they call it? Face-lifts? You gonna fix my baby’s face, right?”
He hands her back the photo. “I’m going to do the best I can. But I understand your baby has had some major deforming injuries.”
She blinks, either not understanding or in deep denial.
“Your baby is severely deformed,” Dr. Kanner says slowly. “I can only promise you that I will do my very best to make him look as good as I can. As good as humanly possible.”
“Well, Dr. Kanner, that sounds like a load of shit. How old are you? How long you been doing this? This your first time? You are a doctor, right?”
She practically spits these words in Dr. Kanner’s face. I smell the alcohol on her breath then. Dr. Kanner was wrong. She’s drunk, an idiot, and an asshole.
“I’m a board-certified plastic surgeon,” he says. “You can look me up. I’ve had all the necessary training and years of experience, and I’m here at three in the morning to take care of your baby. If you want me to go home, you’ll have to take that up with the hospital administration. Right now I’m going to do my job, which is to figure out what I can do for your baby. Now, if you don’t mind, Miss Ellison, get out of my way. Please.”
A stare-down.
After ten full seconds, Miss Ellison drops her arm with a slap on her thigh and moves aside, allowing Dr. Kanner and me to pass.
I follow him to the foot of the bed. He scans the baby’s body, moves up, and lowers his head over the baby’s face. He studies every inch, as focused as a camera, then goes to the sink in the room. He scrubs his hands, pulls on sterilized gloves. He nods toward the supply cabinet. I pull open a drawer. He nods again, and I open some gauze packs and tubes of antibiotic ointment. He walks back to bed, peels open the baby’s eyes, murmurs something that almost sounds like a prayer, then squirts an entire tube of ointment over the remains of the baby’s face, laying gauze over the exposed areas.
“I’m going to take some pictures in a minute,” he says. He drops his hand onto the baby’s forehead and caresses his few thin blond hairs. “I’m gonna do my best, little man.” He stands straight up, erect as a sergeant, yanks off his gloves, and shuffles into the far corner of the room. He reaches into his shirt pocket, pulls out a pen and small notebook.
“Let me give you an idea of what we’re going to do.” He looks up at me as if in afterthought. “You had any experience in plastic surgery?”
“No. I’m in my third year, last rotation. I’ve finished general, but we didn’t spend any time on plastic surgery.”
“Yeah, I know. I think you miss out. My humble opinion. But that’s what fourth year is for.”
“Choose my own adventure.”
“Exactly. We’ll talk. Okay, let’s see what we can do.” He begins sketching the baby’s face on the pad. “You draw?”
“I do, actually.”
For the second time since we’ve met, he lifts an eyebrow. “That will serve you well. There. Our first issue is that he’s got a lot of growing to do. That makes the reconstruction even more complicated, as if it weren’t complicated enough. For example, I could re-create his nose by flipping down the skin of his forehead.”
Dr. Kanner draws an outline of a nose on the baby’s face. “But the reconstructed nose probably will not grow with him in an anatomically proportional fashion.”
“So, we’re looking at further nose reconstruction as he gets older.”
“That’s almost a given. Our first priority here is to get coverage of his open wounds.”
“I see. That way he won’t have exposed cartilage and other organs of the face.”
“Yep. We’re going to need to bring in tissue from another part of his body to remake his lips and mouth. I won’t be able to reconstruct his lips and mouth perfectly—”
He sketches in lips and mouth. As I watch Dr. Kanner draw, I realize I’m no longer tired. Despite the horror of the baby’s mutilated face, I feel a kind of thrill, the thrill of possibility, the thrill of hope. For a brief single moment I imagine that I am Dr. Kanner. I am sketching the replacement face for the eight-month-old child, and I am the one accepting the responsibility for rebuilding his face. I wonder how that would feel.
Dr. Kanner snaps his notebook shut. “Time to talk to the mom again.”
We step into the corridor, eerily vacant except for one nurse at the nurses’ station. We head in that direction.
“Tony, if you want, call me and we’ll have coffee,” Dr. Kanner says. “This is not the time to talk about it, but plastic surgery covers a lot of territory. The obvious elective-cosmetic stuff to stuff that’s, well, like this. Here’s my card.” He zips open his camera bag and hands me a business card.
“I will call you,” I say.
At the nurses’ station, Dr. Kanner scans the hallway, shrugs in confusion. “Where is she?”
“She went home,” the nurse says.
It takes us both a while for this to sink in.
“She went home?” Dr. Kanner says.
“She said she was tired.”
Dr. Kanner raises his index finger as if he’s a student in class with the right answer. Then he forms a fist and knocks softly on the nurse’s desk.
“Yeah,” the nurse says. “I know.”
“Well, I’m going to go back to the room,” Dr. Kanner says.
“I’d better head back over to pediatrics. Thank you, Dr. Kanner.” I offer my hand.
He grips it firmly. “Call me,” he says.
FOUR A.M.
Back in general pediatrics. Slouching toward the call room. I walk in a kind of dream state. Images bombard me—the baby’s face, Dr. Kanner’s cool confidence, the unbelievable reaction of the baby’s mother, the idea that I might want to look into becoming a plastic surgeon—
But I can’t shake that baby’s face.
How much can Dr. Kanner do? What will happen to that poor kid?
A baby’s shriek jars me.
The shriek builds to a frantic cry.
I stop at the nurses’ station. A beleaguered nurse takes her time before she raises her head and sprays me with attitude. “Yes?”
“I don’t mean to bother you, but that baby—”
“We’re monitoring him. He’s not in any distress.”
“He sounds like he’s in distress.”
“He’s not. Look, we got a lot of sick kids up here. We’re not a babysitting service.”
She turns away from me. I’m not even remotely pissed. Two weeks away from completing my last rotation, I get it.
When you constantly have to function on zero sleep, you sometimes get a little testy.
The baby’s crying intensifies to a piercing wail.
I follow the sound.
I come to the door of his room, slide the chart out of the plastic holder on the wall outside, flip through it. Daniel Kwan. Thirteen months old. Half Asian, half Caucasian. Diagnosed with a respiratory syncytial virus infection.
In English—runny nose, wheezing, hard as hell to breathe.
I push the door open with my shoulder and walk in. Daniel, frail, small for his age, wearing a hospital gown and a diaper, his head reared back as he howls, a mop of brown hair sticking straight up, stands inside his crib, his tiny hands gripping the metal bars. He is alone in the room.
“Hey, buddy,” I say. I reach my arms over the crib.
He stops crying, takes a step back, wheezes, sniffles, studies me with uncertain wide brown eyes.
“I’m Tony.”
He gurgles, then holds his arms out and waddles over to me. I lift him out of the crib and press him against my shoulder.
“Rough night, huh? I hear you.”
He whimpers, revs up, starts to wail.
“Hey, hey, it’s okay. I got you.”
I find a blanket lying on a rocking chair facing the window. I grab it with two fingers, drape it over Daniel, and sit down with him on the rocking chair.
His crying hits overdrive.
“It’s okay,” I say. “Shh.”
I start to hum the first song that leaps into my head, the only song I can think of—“Every Rose Has Its Thorn” by Poison.
“You like metal?”
Daniel wails.
“Me, too. All right.” I rock him slowly to the rhythm of the power ballad, humming the chorus.
“‘Every rose has its thorn,’” I sing.
Daniel stops crying.
“‘Every rose has its thorn, just like every night has its dawn—’”
Daniel coos. I fight to remember the rest of the lyrics, can’t, so I repeat, “‘Every rose has its thorn, just like every night has its dawn,’” over and over, softer and softer, until Daniel, precious baby, yawns, coos again, and fades into a sleep so deep that he snores.
“Oh, man. I saw some stuff tonight, Daniel. I saw some stuff.”
I clutch him into my chest and rock him slowly.