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Just a Pinched Ear?
Aaron Engstrom watched his rambunctious son, Carter, and a pack of his nephews run laughing through the house, bouncing off one another like bumper cars. They'd stuffed pillows inside their shirts and were "belly bashing."October mornings like this, with ice forming in the shallows of the Yellowstone River and the trees changing and the laughter inside the house -- that's why he moved back to the area where he'd grown up and settled in the small town of Sidney, Montana.
A few months earlier, Aaron and his wife, Annie, had left Bellingham, Washington, where he'd been taking pre-med classes and working as a tech at a busy Level II trauma center. Seeing the long hours doctors put in and looking ahead to years of school, he began to have second thoughts about his career. So when an opportunity to enter a new radiology program at the Sidney Health Center opened, he jumped at it.
Aaron smiled at the boys roughhousing in the living room. A thump to Carter's pillowed belly sent him tumbling backward into the corner of the maple TV stand. Carter covered his ear with his hand and cried.
"You okay, buddy?" 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 stand 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 pajamas, he stumbled 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 eventually stopped crying. But when the two returned to their bedroom, Annie heard a small cry. They ran back and found Carter unconscious -- and they couldn't wake him.
Aaron carried his son into their room and laid him on the apple-green duvet on their bed. He discovered that Carter had wet himself. As he changed the boy's pants, Carter's arms and legs flopped like a rubber doll's.
Aaron checked his son's eyes. Lifting one lid, he saw that the pupil was fully dilated and not responding to light. Frantic, he pulled back the other lid; the pupil was completely contracted. Uneven pupil dilation is a sign of a life-threatening head injury. "We gotta go to the hospital now," he said.
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