Dark hair was matted to the little girl’s head. Her lips were dried and cracked, her eyes sunken. Amina was gaunt, and less than fifth percentile for height and weight. Despite her olive-toned skin, she was pale. She lay lifeless on the morgue table.
I sharpened my pencil, preparing to take notes. Feeling sluggish, I thought about stopping for a cup of coffee. Having not slept well the night before, it might help. My youngest son was the same age as this girl, four years old. In the wee hours, he had crawled into my bed, snuggling against me under the down blanket.
“Mommy?” he whispered, his small hands touching my face. He felt warm like a space heater. His cheeks were wet from crying.
“What’s wrong, honey?” I said. The bedside clock read 2:02 AM.
“I had a bad dream,” he said, gulping breaths between words.
“Shh, it’s not real,” I said, wrapping my arms around him. We talked about thoughts and visions until we drifted off to sleep. The alarm woke us at 6 o’clock. For my son, nightmares were imaginary monsters under the bed, made real by two older brothers telling R. L. Stine stories after dinner. For me as chief medical examiner, they were embodied in a child’s corpse.
I skipped the coffee and did what I had promised Amina’s family – a quick yet thorough examination. They were Muslim and it was customary to bury the dead as soon as possible. The autopsy took under an hour. With a child this small, the dissection was uncomplicated. Without disease, the tissues cooperated with me. Every organ was in its proper place – no scarring, no tumors, no bleeding, no trauma. The only abnormalities were an empty stomach and collapsed bowels from 24 hours of vomiting and diarrhea. The intestines were pencil thin and devoid of any contents – completely purged. The internal findings confirmed what I had seen on the outside of the body – severe dehydration.
Earlier that day, I met with Munir, the father, and extended family in their small two-bedroom apartment. Amina’s mother, Nejra, sat on a worn sofa in the living room, head bent down, ready to collapse into herself, Munir by her side. Six other relatives were clustered on kitchen chairs hastily pulled into a semi-circle around the couch.
Munir told me, through an interpreter, about the rapid illness. Amina had gotten sick more than a day ago, in the middle of the night. She threw up the homemade broth she’d had for dinner. Throughout the morning and afternoon, she had unrelenting bowel movements, more liquid than solid. Then the fever started and even sips of water made her gag.
In the evening, the parents and sick child made their way to the nearest emergency room, a mile from their home, via the bus. The hospital was unfamiliar territory, as was most of the city. Amina’s family was part of the diaspora from the civil war in the Balkans, and recent refugees to Syracuse. There was no translator in the ER; no one understood this Bosniak girl. The nurse practitioner gave her an antibiotic for an ear infection and sent her home.
This family had survived disease, and famine. They escaped ethnic cleansing, their village burned to the ground. Yet Amina died of an illness that modern medicine can cure. A simple intravenous line could have replaced the lost body fluids and essential salts. Without them, the heart stops.
“What did they do for her at the hospital?” I asked. “Did they give any saline into her veins? Check her blood pressure and pulse? Give her medicine to stop her vomiting?”
As the representative from the refugee center translated my questions into Bosnian, Munir shook his head with each one. None of those things. I would confirm his story later when reading every word of the one-page medical record.
After the ER visit, at home, Nejra took Amina into her arms and crooned to her. The child’s fidgeting slowed, and they fell asleep entwined. The mother was grateful that her daughter had stopped needing the bathroom. In the morning, Amina’s face felt cool and Nejra thought the fever had broken. But there was no breath, no heart beating in the thin chest. Then Nejra screamed a primal sound that woke Munir and the entire house of aunts, uncles, and nephews.
After the autopsy, I did two more things for Amina. Carefully turning her body, I pointed her head toward Mecca. Then retiring to my office, I filed a complaint of negligence to the disciplinary board of the hospital and the state.
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