John E. Monaco, MD
Luckily, the plastic surgeon was available when they arrived at the ER. Little Jeremy had been visiting his grandparents from out of town. The dog that lived next door to Grandpa ("Grandpa's dog" was how Jeremy referred to him) had always been friendly. He was an Akita, so he was big, but to Jeremy he was an overgrown, playful teddy bear. So it was no surprise when Jeremy gravitated to him each time he came to Grandpa's house for a visit. And up until that day, there had never been a problem, with anyone. And as all dog owners whose dogs suddenly lose control and bite kids, they invariably say that the dog has never done that before, and they don't know where such unexpected aggression came from.
This attack, as is so often the case, came out of nowhere. Jeremy had finished petting the dog and had begun to walk away. The dog lunged after him, biting the left side of Jeremy's head. There were lacerations along his neck that were quite deep, exposing subcutaneous fat. The worst injury was to Jeremy's mouth. It was if it had been torn open. A deep laceration extended deep into Jeremy's cheek, giving his mouth the appearance of having been extended by a couple centimeters. There had been considerable bleeding initially but once he reached the pediatric floor the bleeding had subsided. In fact, Jeremy was in surprisingly little discomfort. He even asked for something to drink, which I knew would be difficult.
It was clear, however, that Jeremy was in shock. He hadn't seemed to grasp the seriousness of what had just happened to him. It was simply not part of his reality that his friend, this huge, lovable, furry animal could have intentionally harmed him in this way. And when I saw his grandfather, I realized that his shock extended to the rest of the family as well.
Grandma was strong, as grandmothers often are, and she was the one who supplied the details of his medical history. She was even able to smile, supplying me with amusing anecdotes about their grandson whom they so obviously adored. But Grandpa could not speak; he sat in the corner with a glazed expression, looking at any moment as if he would burst into tears. I glanced over at him once or twice as I chatted with Grandma. Our eyes met, but he looked right through me, never exactly fixing on my gaze.
We watched Jeremy in the pediatric ICU the first night. Whenever there are injuries like these in the vicinity of the airway, we watch patients closely, monitoring their airway, oxygenation and ability to swallow - their ability to "protect their airway" as we refer to it. Luckily, Jeremy had no problems in this department. He was, at first, interested in drinking a milkshake his Grandpa brought for him, but when he brought the straw to his lips, he thought better of the possible discomfort this might cause, and pushed it away. Grandpa's expression went from blank to morose.
The plan was to take Jeremy to the operating room the next morning where the plastic surgeon would work his magic, rendering a functional and aesthetically pleasing repair. Our plastic surgeon, to whom I refer as an "artiste," was able to do just that, and in the end, what could have been a horribly tragic story had a happy ending.
Once Jeremy was stabilized, I was sitting on his bed, having a conversation with his Mom, who had driven the normally three-hour distance from their home to the hospital in record time. She told me that Jeremy was their "miracle child." At first I thought she was referring to the fact that he had survived what could have been a fatal dog attack. She assured me that was not what she meant. It turned out that she had been diagnosed several years earlier with ovarian cancer. It had been discovered coincidentally during surgery for another problem. Jeremy was a toddler and they had been planning a sibling for him. Her tumor was removed successfully but she was told she would never get pregnant. Jeremy, she informed me, was her one and only shot at having her own child. To lose him to a dog attack would have been a tragedy of major proportions. Suddenly Grandpa's pain, guilt and horror began to make even more sense.
Jeremy did wonderfully, bounding out of the hospital after a couple days as if nothing had happened. His parents were ecstatic to be taking him home. Grandpa finally came around, too, shaking my hand with a tearful "thank you" as they left down the hall, their little caravan for Jeremy in tow. When I got to my home, I was greeted in the usual frenetic manner by our dog, whom I could never imagine hurting another soul, especially a child. Then it occurred to me that Jeremy's grandpa had probably said the same thing about the dog that lived next door to them.
John E. Monaco, M.D., is board certified in both Pediatrics and Pediatric Critical Care. He lives and works in Tampa, Florida. He welcomes your comments, suggestions, and thoughts on his observations.
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