“Two,” I say. “An older brother and sister. Nine and seven.”
“Kids under twelve aren’t normally allowed on the PICU. Hopefully Avery will be here just a short while and we can get her to the general pediatric floor. Brothers and sisters can visit down on that floor.”
I lightly press my thumb into Avery’s palm. It is soft and cool. “She’s just sleeping?” I ask.
“Yes, she’s just resting right now.” Meredith lowers one side of the crib, leans over, checks the IV site and takes Avery’s temperature. “One hundred and one,” Meredith reports, writing it down on Avery’s chart. “Down another half a degree. That’s good.”
Adam stands close behind me, looking down at Avery from over my shoulder. “Is she in pain?” he asks, his voice shaking with emotion.
“She’s resting comfortably. We’ll watch her carefully. The doctor will be in a little bit later to check on her again and will talk to you.” She smiles encouragingly at us and leaves the room.
Stroking Avery’s hand, I marvel at her tiny fingernails. Her face looks thinner somehow, more gaunt. How can a one-year-old be gaunt? I wonder. “I wish I could hold her,” I say. “Do you think they’ll let me hold her?”
“Ellen,” Adam says softly.
“I mean, I think if they would just let me hold her for a few minutes...”
“Ellen,” Adam says again, setting his hands on my shoulders and turning me around. “We need to talk about what happened.”
I step backward, lightly bumping into the crib; a faint squawk comes from my child, a brief, pained protest. We both watch, holding our breath as she settles back into sleep. “It was an accident. A stupid accident, Adam. I didn’t hear you, I didn’t know.” I struggle to keep my voice low. “I promise you, I had no idea that Avery was in the van.”
Adam holds his hand out trying to placate me, his eyes darting back and forth from me, to Avery, to the doorway, back to me. “I know. I know it was an accident, Ellen. But it was a bad accident.”
“Not now, Adam,” I plead with him. “Please do not do this now. We do need to talk about this, but not right now.” I am crying openly now. I can’t stand to see him look at me the way he is, with disbelief, disappointment.
A retching sound comes from the crib and instantly we are both at Avery’s side. Her eyes are woeful slits, sunken into her head, trying to open but keep falling closed. Heaves wrack her little body and a surprisingly small amount of liquid spews from her mouth. Adam hurries out into the hall to summon help, while with one hand I use a tissue to wipe away the spittle that remains on Avery’s lips and the other to try to comfort her. She is shivering; goose bumps erupt beneath my fingers and her lower lip trembles in pain or fright. Probably both.
A doctor and Meredith, with Adam close behind, come into the room. “Vomiting is common with heatstroke. So is diarrhea,” the doctor explains. She is fit and wiry, somewhere in her late fifties, with ash-colored hair cut into a razor-sharp bob. “That’s one of the reasons we need to keep hydrating Avery.” We all look down at Avery, who has settled back into a fitful sleep, a wet thumb sliding from her slack mouth then being replaced. “I’m Dr. Grant, one of the pediatric physicians on staff. Dr. Campbell, the nephrologist who is overseeing Avery’s case will stop by shortly.” I am chilled by this statement. Avery has been reduced to a case that must be overseen. “Dr. Campbell specializes in kidney function. In assessing someone who comes to us with heatstroke we watch for kidney problems, rapid heartbeat, hyperventilation and seizures. All of which Avery has displayed.”
Next to me, Adam is swallowing hard and breathing deeply and I’m worried that he might start hyperventilating. I reach for his hand, but he shoves them in his pockets, his face to the ceiling, eyes closed. The doctor must be worried, as well. “Let’s sit down for a minute and talk more,” she suggests. In the small room, even though it is set up to house two patients, Adam sits in a recliner covered in green, faux-leather material while Dr. Grant and I each pull up an institutional plastic chair. Once Adam’s breathing has calmed, Dr. Grant continues. “We’ve also ordered several tests—a chest X-ray to check for edema and acute respiratory distress, an electrocardiogram and an echocardiogram and a CT of the head to look for any brain swelling. We’ve already started running several lab tests. Organ failure, renal failure, especially, is often found in heatstroke patients.
“I also need to tell you that as a medical professional, I’m a mandatory reporter....” Dr. Grant says as Meredith busies herself with Avery’s IV tubing, avoiding eye contact with us. I know exactly what a mandatory reporter is. I’m one myself. Iowa law defines classes of people who must make a report of child abuse within twenty-four hours when they believe a child is a victim of abuse. These mandatory reporters are professionals who have frequent contact with children, including those in medicine, education, child care, law enforcement and, of course, social work.
“I understand,” I interrupt, holding up my hand to stop her. “I’m a social worker. I will call my supervisor right now. It was an accident, just an awful accident.”
The doctor nods. “I’m sure everything will get sorted out.” Dr. Grant stands and Adam and I do the same. “In the meantime, we will continue to watch Avery very closely. Do you have any questions?”
“Will she be okay?” Adam asks. “She’s not going to die, is she?” Each word is brittle, in danger of breaking. Without even looking at him, I know that Adam is trying to be strong, trying not to cry.
“Avery’s condition is very serious. The very young and the very old are much more susceptible to heatstroke and its lingering effects. The next several hours are critical, but she’s right where she needs to be.”
Dr. Grant exits and Adam and I watch silently as Meredith exchanges Avery’s empty IV bag with a full one. When she leaves, I step closely behind Adam, press my face to his back, encircling my arms around his midsection, inhaling his smell, a mixture of fresh-cut grass and sunshine. And something else, something unpleasant. Fear, I think. “I’m so sorry,” I whisper into the fabric of his t-shirt. He doesn’t answer, but carefully untangles himself from my grasp and walks out of the room, only pausing to touch Avery’s little hand as he leaves.
I pull up a chair as close as possible to Avery’s crib. I try to keep my hands on my lap, but they keep straying to stroke her forehead, now smooth in sleep, or to squeeze her hand. I know she needs to rest so that her little body will heal, so that her heart will return beating to its regular, strong cadence and her kidneys will resume carrying waste and water away from her blood, so that her temperature will fall to a tepid ninety-eight point six degrees. I can’t stop the tears—they fall freely down my face, rolling down my neck, dampening the collar of my blouse.
I don’t want to leave Avery’s side, will not leave her side. Adam’s disappointment in me is a physical ache and I wonder where he has run off to. I don’t know what I can say or do to convince him that I had no idea that Avery was in the car. That I am so sorry. I blow my nose and wash my hands vigorously in the small bathroom connected to Avery’s room.
I need to call Caren, my supervisor, right away, inform her about what has happened. My mind flashes to what my mother has said about the television reports. In a matter of hours, if it hasn’t happened already, the entire state is going to know that a social worker has left her child in a van, unattended, on the hottest day of the year. I will be crucified. Surprisingly, this doesn’t terrify me the way it should. I would offer out my palms to be nailed to a tree, gladly, if I could undo what I have done.
The door opens and I expect the nurse, but it is my husband. His face is gray, his eyes frantic. In two large steps he is in front of me and I quickly rise to my feet. “Did something happen?” I ask, fearfully looking down at Avery. She is sleeping so peacefully. Her chest is rising and falling. “Did the doctors find something out?”
Adam grabs my ha
nds in his, holds them tightly, almost painfully. “I should have made sure that you heard me.” His voice is barely a whisper. I have to lean in more closely to hear him. “I should have come out to the van to tell you that I put Avery in the backseat. I’m sorry.”
My shoulders sag in relief. “We’ll get through this, okay?” he assures me. I nod, my face pressed against his chest and I begin to cry. Great, heaving sobs that I try to bite back so that I don’t disturb Avery, but I can’t. I hold on to Adam for a moment longer and then extract myself from his arms and escape to the tiny bathroom in the corner of Avery’s hospital room. I turn on the faucet to try and drown out the sound of my weeping. Adam’s words are a gift that I am at once grateful for and undeserving of. When I look up into the mirror over the sink I look wretched. My hair is standing on end, my eyes are puffy and bloodshot, my skin blotchy and the tip of my nose bright red. I look down and my knees are skinned and dotted with dried blood from where I had knelt down next to Avery after she was pulled from the van. The hem of my dress is edged with dirt and grass stains, and dry earth has wedged beneath my fingernails. I look back into the mirror and try to see what I’ve seen in the eyes of countless other mothers I have met over the years. The ones who have dipped their children into scalding hot water, knocked them to the ground, beaten them with belts. I lean in more closely to the mirror until my nose is nearly touching the glass. I search for the manic glint or the deadened gaze in the green depths of my eyes. But it’s just me. I can’t be like them, those women.
There’s a rap at the door. “You, okay?” Adam asks.
“Fine,” I answer. My voice shrill and high. Not my voice at all. “I’m fine.” I wash my face and scrub the dirt from beneath my nails. My dress is hopeless and a sweaty, acrid odor rises from me. I need a shower but don’t want to leave Avery to go home to retrieve a change of clothes.
I step from the bathroom and see that another doctor has come into Avery’s room. He is a tall, slope-shouldered man of about sixty. Reading glasses sit atop his gray head.
“Mr. and Mrs. Moore,” the doctor greets us with a nod. “I’m Dr. Campbell, the nephrologist. I’d like to update you on Avery’s condition.”
Once again we take a seat and anxiously look at the expert who can save our child. “We have Avery’s core temperature normalized. We continue to watch her closely for delayed end-organ dysfunction. This means that even though her temperature is normal and she is stabilized, she remains at high risk for multiple organ failure, the breakdown of muscles, high potassium levels, low calcium levels and abnormally elevated phosphorus levels, all which can lead to kidney injury and renal failure.”
Dr. Campbell scans our faces as if trying to glean whether or not we understood what he was saying. We both nod. “We will monitor Avery until we are sure these levels are within normal ranges and she is seizure-free.”
“How long do you think that will be?” Adam asks.
Dr. Campbell shakes his head. “It could take twenty-four hours or weeks. It just depends on how quickly Avery responds to treatment.”
Before leaving us, head bowed, Dr. Campbell rests one capable hand on each of our shoulders and I’m reminded of the faith healers who, just by touch, supposedly can send currents of curative volts of electricity through your system. I feel nothing. Adam and I sit next to Avery in her hospital room for the next four hours, speaking only out of necessity. He flicks through a stack of old newspapers, periodically sending text updates to well-wishers. Waves of tears come and go. I try to cry soundlessly, keeping my eyes on my daughter who is sleeping fitfully. Every squawk she makes sends me to my feet.
I hear a small commotion outside the room and look up to find Caren Regis, my supervisor at DHS as well as Richard Prieto, the county attorney that I’ve worked with many times. I am relieved to see Caren, but I’m puzzled about Prieto’s presence. I’m not here today to visit a neglected, abused child or here to chronicle the many indignities they have endured. The sight of Richard Prieto is alarming.
I put a finger to my lips to signal that Avery is sleeping and lead them to the hallway just outside the PICU entrance. “Hi, Caren, Richard.” I nod briefly at each of them. “What’s going on?” I ask, panic clawing at my chest. Wordlessly, Prieto hands me a piece of paper. A piece of paper that I have handed to parents countless number of times. A piece of paper that has the power to snap a mother’s heart into two jagged pieces. “Caren?” I say, looking at her in disbelief. Her gaze remains steady, unemotional, just as mine would have been if we had reversed roles.
Prieto clears his throat. “I wanted to inform you in person. We’re discussing the possibility of assembling a grand jury to determine if we will move forward with formal charges.”
I’m still looking at Caren, waiting for an explanation, the words on the piece of paper ordering me to stay more than five hundred feet away from my daughter at all times blurring. “Charges?” I finally whisper, my throat suddenly dry.
“Child endangerment with serious bodily injury. Iowa Code Section 726.6,” Prieto says.
“I know the code,” I say sharply to Prieto. Iowa Code Section 726.6 is the child endangerment section. If the child suffered death, it would be a Class B felony, with a maximum of twenty-five years in prison. I turn back to Caren and lower my voice. “Caren, is this necessary? You know me....” I try to hand back the piece of paper. Prieto pushes it back at me.
Caren straightens her spine and her face resumes the professional mask I am used to seeing. “You know how it works, Ellen. We’re going to pass the DHS investigation to Peosta County to insure an unbiased examination of the facts.”
I scan the piece of paper that Prieto has pressed into my fingers. “Oh, no, no, no,” I cry in disbelief. “A protective order? Are you telling me I can’t see Avery?” My voice cracks. By the look on Caren’s face she understands that this is killing me. I wonder where the assertive, decisive woman I was just a few hours ago has gone. I should be demanding to see my daughter, but I feel unworthy, so afraid. “What about Leah and Lucas? Can I still see them? You can’t keep me away from them, can you?” Of course I know they can keep me away from my other children if they think that they will be endangered in my care. For the first time the implications of what I’ve done and how it could impact Leah and Lucas hits me. How will they look at me, what will they think of me once they learn the details of what happened to their sister?
I want to scream at Prieto and Caren. I want to ask them how they can live with themselves knowing that they are keeping a very sick little girl away from her mother.
“Richard, can you give us a second?” Caren asks Prieto, who looks suspicious but pulls out his phone and walks away. “Ellen...” The impassive expression remains on her face but her voice softens. “We have to go by the book on this one. I know it was a terrible accident. Richard knows that it was a terrible accident, but we have to investigate carefully and thoroughly just as we would if it was anyone else. In fact, we have to be more thorough.”
“Caren, what’s going on? Avery could die and you’re telling me I can’t be there with her. What if Avery is crying for me? I can’t go to her? What about Lucas and Leah? Are you keeping them away from me, too? You can’t think I’m a danger to them?” I’m so afraid of the answer. I know the process very well.
“You will get an FSRP just like anyone else in this situation,” Caren explains.
I shake my head unable to believe what I’m hearing. We will be assigned a Family Safety, Risk and Permanency caseworker or a FRSP. An in-home provider whose job it is to make our lives very uncomfortable. FRSPs are young, overworked and underpaid. Most have an undergraduate degree in some kind of human services field, but they are not experts. They are not counselors and they get sent out into homes to be the eyes and ears of the department. The FRSP assigned to us can drop in at any time of the day or night. She can enter our home, ask to see any part of the hous
e. She can come to see what we are making for dinner, come to see if the house is clean, if the beds are made. She can talk to Lucas and Leah without us being present. Most importantly she checks to see if the children are safe. It can be excruciating for families, but there is a reason for it. I just can’t believe it’s needed in my case, for my family.
As if reading my mind, like she has always been able to do, Caren tosses me a scrap of hope, lowers her voice to a low whisper. “I know this was an accident, Ellen. I will do anything in my power to help get you through this. They have twenty days to investigate this and I’m positive they will find in your favor.”
“Caren,” I plead, reaching for her hand. “I need to be with Avery. She could die.”
“Twenty days,” she says, gently pulling away from me.
“What if we don’t have twenty days?” I say again, more desperately. “I need to see her. Please,” I beg.
Caren lowers her eyes and takes a short, harsh breath and raises her hands helplessly. “I don’t know what else to tell you. For now the right thing is for us to follow procedure.”
“The right thing is to let me see Avery. I’m her mother—she needs me!” I am crying openly now. No one walking down the busy hallways of the hospital even slows down or casts a sympathetic eye toward me. Everyone is either immersed in their own personal medical hell or so used to the daily dramas played out within these corridors they don’t even notice the sobbing woman begging for permission to see her children.
Prieto is walking back toward us. “You need to leave right now,” he says sternly, looking around to see if anyone is listening. “You need to stay away from your daughter and the PICU until the investigation is complete.” He sighs. “And get a lawyer, Ellen,” Prieto advises. “You’re going to need a good one.”
They leave me standing there by myself and I sink onto a padded bench beneath a window that looks out over the hospital parking lot and cry.