Dr. Sally Smith, Child Abuse Pediatrician

He was unresponsive.

He had some pupillary activity, but they...

Immediately called Johns Hopkins All Children's and sent him there for further management.

And by the time he got to the ER, the first person that saw him said his pupils were reactive.

But by the time the neurosurgeon saw him, like a half hour later, they were not.

So he was in a condition of rapidly progressing, you know, critical brain dysfunction.

Well, the control of pupils closing and opening in response to light is controlled by a deep part of the brain called the brainstem.

And when the brainstem is losing function,

the pupils no longer show that normal reaction to light.

And so that's one of the things, especially a child who comes in that seems to be in a coma, unresponsive.

In his case, he was having very infrequent abnormal breaths that he was taking.

He was like limp.

He was not responding to any kind of, they do like things that would normally be kind of painful to make kids move and he was doing nothing.

And so the pupils, as the deep part of the brain gets, the brain swells and it puts pressure on that deep part of the brain.

And as that process occurs,

it stops the normal functions in the brainstem.

So in his case, the pupils were no longer receiving messages from the brain to close and open.

His respiratory center was no longer working.

His circulatory heart kind of part of the deep brain was still functioning reasonably well.

That all changed in the subsequent 24 hours.