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Humpty Dumpty had a Great Fall

It was 9pm in Children's Emergency and I'd just sent a frantic text message to some of my paeds friends: "I'm in ED right now with BB (my 10-month old son) who had a fall while being carried by his father. It's quite worrying, GCS has been low since the fall and I'm sure there is skull fracture at the very least. Waiting for CT now. Pls pray."

Less than an hour before, we had been at a New Year's party, a large, 2-generational party with a convivial atmosphere at the house of a family friend. I had been debating when to take our leave as it was past BB's bedtime. The rest of my family, baby in tow, was now outside enjoying the view of a pond which formed the centrepiece of the outdoor dining area.

The first I knew that something unexpected had occurred was when my mother carried little BB into the house and laid him on the sofa. He was unnaturally quiet and still. It turned out that he had been in my husband's arms when my husband had made an ill-advised attempt to step over the pond. The gap was too large, he had misjudged and stepped into the pond and fallen, and the baby had landed on dry ground with a sickening crack as his head hit the concrete.

There was no whimper or sound from BB, and he was very pale. I thought he might be dead. The first thing we saw was an indentation on the top of his head which struck me as a possible depressed skull fracture - a "dent" sustained by striking a nearby table leg. Then I realised the main injury was a huge boggy haematoma on the occiput, which had borne the brunt of the impact.

Could this be the end of our journey with our son? Would he ever wake up - and if he did, would he still be BB as we knew him?

Even before I could open my mouth to speak, one of my mother's best friends, half of a paediatrician husband-and-wife team, was at the scene, and she gave voice to all our thoughts: "Let's bring him [to A&E] now, shall we?" I scooped up my lifeless son, and we left the party immediately. My distraught husband was not in a fit state to drive, and we headed for the nearest A&E (providentially nearby) in a car driven by the paediatrician husband.

I prayed aloud in the car. There was not much that could be done except to keep calm and make sure that he got timely care - and a CT head - as fast as possible.

When we reached the hospital, at my words "I think there may be a depressed skull fracture" we were immediately shown into the CE trolley area. BB started to cry irritably when we put him down on the trolley, and the colour came back into his face. However, it was not normal crying - he would cry a bit, then fall asleep, then cry again. GCS was 10: E1V3M6. Thankfully, he was moving all 4 limbs. Aside from the huge occipital haematoma and the linear dent on the vertex, there were no other visible injuries excepting one little avulsed toenail.

As a reward for being a fairly calm and non-hysterical medical parent, I was allowed to accompany BB to the scan room. I had a look at the quick view - no ICH, thankfully, but I was fairly certain there would be fractures on the bone windows. While waiting for the formal CT Brain report, BB vomited out his dinner, and then, to my great relief, opened his eyes and gave the world a baleful glare, before crying himself irritably back to sleep.

Indeed, there were bilateral comminute occipital fractures and the Neurosurgeons came to see BB before we were taken to Paeds HD where we were to spend the night. In such a time, to hear the voice of an old friend over the phone was a great comfort, and I was thankful for the texts and calls which came from my supportive friends, one of whom called all the way from Japan!

My husband and I spent a largely sleepless night taking turns to watch over BB in the adult-sized HD bed and carrying him whenever he woke up to retch and cry. I was already post-night shift and it was my second sleepless night in a row, but I found myself Googling "paediatric post-traumatic seizures" instead of sleeping.

Thankfully, the rest of the stay proceeded without incident. BB was pretty much his usual self by the next morning, except extremely cranky and probably feeling like he had a massive hangover. BB's worried grandparents - all 4 of them - helped to hold the fort on the second day of his stay while his tired parents caught up on sleep. After a second night spent in the GW we were discharged.

Although BB continued to be a bit wobbly for a few days, he was soon back to his normal self. My parents just hosted a thanksgiving dinner party last weekend, to celebrate the fact that BB lives, and thank some of the friends who were involved on that day, including the hosts of the house that we were in when the accident occured and the paediatrician couple who sent us to hospital.

* * *

It's now been more than a month after the fall happened. Here's some of what has changed:

1. I was about to write an article for the Residency blog about going back to Residency as a parent after a long period of no-pay leave (which indeed I have enough thoughts on to fill several articles), but this incident happened one month into work - I had to take a couple of days emergency leave just as I was about to resume duties as a senior Resident. There is no better way to illustrate the unpredictability of being a parent than to begin by narrating this story.

2. Lo and behold, after 2 nights spent in hospital and mama on hand to give BB comfort, co-sleeping and breastmilk on demand, it was as if we had never sleep trained. 4 months of sleep training, evaporated in an instant! All of us were reluctant to put BB through sleep training again now that he was older/in the age of separation anxiety/just restored to life after a harrowing experience. As a result, BB's mama and papa are now getting less sleep than we used to, and back to co-sleeping for a larger fraction of those nights that she is not on night shift. Which perhaps is as it should be, anyway, now that mama is back at work and doesn't see as much of BB as she used to. The great thing is that BB's papa is finally sleep trained, and he is able to function as the go-to parent when BB's mama is at work, which ultimately means a lot less stress for me.

3. I learnt that far from being able to protect BB from danger by staying at home, I could be in the same house as BB and still be powerless to prevent an accident through no fault of my own. This in fact made me feel less guilty about going back to work. I felt that the accident was a clear signal to me to stop worrying about the fact that BB was spending the bulk of his waking hours with his Nai Nai (paternal grandmother) instead of with me, because much as I worried that Nai Nai had ways of doing things which were quite different from "my" way, this accident helped me to see things in perspective: that as long as BB grows up healthy and sound in mind and body, small differences in preferred methods between caregivers are not so important.

4. As a result of 2 and 3, I feel more liberated from the pressure on myself to do things in a certain way, less rigid and more accepting of the fact that there is no one right or wrong way in many aspects of parenting. I also feel less guilty about taking time out from BB to get other things done and not spending every free non-working moment with him, which is as it should be, and yet it was hard for me to let go till after this incident. I guess some parents might have responded to the accident in the completely opposite way, but this is the lesson I've drawn from it!

5. Ultimately, I thank God, the author of life and death, who decided not to take BB home on that day but preserved his life and his neurological function. The CT scan of BB's occipital fracture looks pretty much like what one would get when one smashes one end of a hard-boiled egg onto a hard surface. Yet he was spared an intracranial bleed and (so far, at least) there have been no sequelae from this. I believe it was a miracle that BB survived. Having seen his pale and lifeless body and then have him restored to us again, to continue to wiggle in our arms and grow day by day in mischief and in size, is a great second chance, a great privilege and a great happiness.

The dent on BB's head which I'd initially thought was a depressed fracture proved to be merely a skin indentation - we asked the Neurosurgery Prof about it, but there was no corresponding injury on the bone windows. More than a month later, the indentation is still there as a testament to our little one's Humpty Dumpty experience. I like to think of it as the imprint which BB's guardian angel made when helping to break his fall!

* * *

BB is now nearly 1 year old and has lived to tell the tale (one day) of his near-death experience. He continues to be a joy to his parents by day and a voracious feeder by night.