Lifeline

Aaron Engstrom watched his rambunctious son, Carter, and a pack of his young nephews run laughing through the house, bouncing off one another like bumper cars. They’d stuffed pillows inside their shirts and were “belly bashing”.

Crisp autumn mornings like this, with ice forming in the shallows of the Yellowstone River, the trees changing, the laughter inside the house – that’s why he moved back to the area where he’d grown up, settling in the small US town of Sidney, Montana.

A few months earlier, Aaron and his wife Annie had left Bellingham, a town in Washington state, where he had been taking pre-medical degree courses and working as a technician at a busy trauma centre. Seeing the long hours doctors put in and looking ahead to years of studying, he began to have second thoughts about his career. So when an opportunity to enter a new radiology programme at the Sidney Health Centre came up, he jumped at it.

Aaron smiled at the boys playing in the living room. A thump to Carter’s pillowed belly sent him tumbling backwards into the corner of the maple TV cabinet. Carter covered his ear with his hand and cried.

“You OK?” Aaron asked, checking him over. There was no break in the skin. Carter, his eyes still full of tears, nodded, rubbed the sting away, tucked the pillow back in his shirt and ran off after his cousins.

But the fall had done more than pinch Carter’s ear. The blow against the corner of the cabinet had sent a shock through his skull and ruptured the middle meningeal artery, which runs near the surface of the brain just below the dura, its lining. Nothing but a small red mark on his ear showed outside, but inside, Carter was bleeding and the trapped blood was compressing his brain.

At bedtime, Aaron and Annie noticed their son looked groggy. Just a busy day, they thought. Dressed in red and blue Superman pyjamas, he stumbled while going to bed. “My ear hurts,” he told them. As Annie tucked him in, she suggested that he turn over and sleep on his other side, then kissed him goodnight.

Just before dawn, the Engstroms were awakened by piercing screams. They rushed to Carter’s room and tried to soothe him. He was talking and lucid and he did eventually stop crying. But as the two returned to their bedroom, Annie heard a small cry. They ran back and found Carter unconscious – and they couldn’t wake him.