"There was a very good chance he could have been an organ donor," Dr. Andrew Sumner says of 4-year-old Quantae Johnson, the "Little Miracle Man" who survived a bullet in the head.
"This is a very lucky kid," says Sumner, an emergency room physician at Johns Hopkins Hospital.
Lucky because the bullet from a teen-ager's gun dodged critical areas of the brain.
L Lucky because he was shot just two blocks from the hospital.
Lucky because it wasn't Quantae Johnson's time to die.
"What saved him?" Sumner muses.
Hospital personnel played supporting roles in an extraordinary drama in which the right things happened and split-second decisions were made in the space of a crucial 90 minutes.
Neither the bullet nor its fragments did massive damage, and the slug itself came to rest at the back of the skull.
Yesterday, surgeons at Hopkins removed the bullet from Quantae's head, 10 days after the East Baltimore child was struck by errant gunfire.
Dr. Benjamin Carson, director of pediatric neurosurgeryextracted the large-caliber slug in an anticlimactic postscript to the remarkable recovery of the boy the hospital staff calls the Little Miracle Man.
Quantae, who is in stable condition today, is expected to be hospitalized two more weeks.
"Quantae's prognosis is excellent, and he is expected to recover and develop like a normal 4-year-old," says Carson.
The child was shot at 11:15 p.m. on Saturday, Sept. 7, while standing in the dining room of his grandmother's house in the 600 block of N. Castle St.
The bullet, which passed through an open window, apparently was meant for a 17-year-old next door, whose argument with another neighborhood teen earlier in the day precipitated the shooting.
Censeria Skipper, a friend of the family, heard gunfire that night as she happened to drive by.
"Part of me said, 'Get the hell out of here,' " recalls Skipper. "But then I saw people running from the house."
Skipper stopped her car at curbside, motor running, just as a woman rushed outside cradling a child in her arms.
DASH TO HOSPITAL
"Oh my God, my baby's been shot!" cried Diane Pittman, the grandmother. She climbed into the car, which streaked toward the hospital.
"I drove like a bat out of hell," says Skipper.
She knew the emergency room entrance. Skipper, a nursing student at Community College of Baltimore, works at Hopkins hospital as a clerk in the neurology department, where head injuries are treated.
En route to the hospital, Skipper tried to calm the grandmother, assess the child's breathing and keep him awake.
"Quantae, Quantae, can you hear me?" she shouted.
"Yes," he said.
Skipper raced ahead in her blood-splattered Pontiac, ignoring two red lights and thinking: God put me here to save his life.
She reached the hospital in less than two minutes.
"We need help!" Skipper cried.
A departing ambulance stopped, and a paramedic carried Quantae down a 50-foot corridor and into the Pediatric Trauma Room, bypassing the walk-in entrance and triage areas.
The child arrived so quickly that emergency room personnel were momentarily unaware of his presence. An X-ray technician saw Quantae and the paramedic in the hall and alerted the staff.
Nurse Donna Carroll rushed to meet the wounded child in the critical-care room.
It was 11.20 p.m., barely five minutes after the shooting.
EMERGENCY ROOM CARE
Carroll placed Quantae on the table, observed his shallow breathing, grabbed an ambu bag -- a device that helps patients in respiratory distress -- and began to ventilate him. She noted the small bullet hole in his forehead, and the ridge of tissue around it. Though the wound was no longer bleeding, Carroll feared the worst.
"Most kids with a bullet to the brain don't make it," she says. "A child shouldn't have these problems."
It had been a typically hectic night in the Hopkins ER: a pedestrian hit by a car, a near-drowning victim and a cardiac-arrest case, among others.
Sumner, the attending physician, was in the adjacent critical-care room when Quantae arrived. The child's eyes were closed and his respiration was sluggish -- about six times a minute, one-third the normal rate.
"In my mind he was ready for cardiac arrest," the doctor says.
Sumner was preparing to insert an endotracheal tube into the child's mouth, to aid his breathing, when a pediatric trauma team from the Hopkins Children's Center hurried into the room to assist.
Dr. Rob Greenberg, a pediatrician-anesthesiologist, and Karen Crothers, a pediatric nurse, had rushed downstairs from the Pediatric Intensive Care Unit. Running time: two minutes.
Quantae, now semi-conscious, was whimpering and struggling against the placement of the one-foot, curved air tube down his windpipe. Crothers took his blood pressure and found it stable, and Greenberg anesthetized the child so the air tube could be inserted more easily.
THE NEED TO BREATHE
Placement of the tube still was a difficult and crucial procedure: Without the device to ventilate Quantae's lungs, not enough oxygen would reach his brain, and a buildup of carbon dioxide there would greatly increase swelling.
At this point, the bullet wound was of secondary importance; the medical team simply covered it with a clean dressing. The primary task was to restore Quantae's breathing.
The insertion was successful but the child vomited. Doctors quickly turned him on his side and suctioned his airways to keep him from drowning.
Quantae then was rushed to another room 30 yards away for a CAT scan. His limp body was placed on a table that slid through a doughnut-shaped device, as physicians studied TV monitors that fed them images from inner space: pictures of the youngster's head.
It was 11:45 p.m.
Crothers, the nurse, was writing reports close by when the first pictures appeared. She heard Greenberg say, "Oh, that's a shame," and she looked up. The doctor was shaking his head.
And Crothers thought about the person who had fired the gun: What kind of a monster would do this?
SWELLING IN THE BRAIN
The pictures showed fragments of bone and metal lodged in the right side of Quantae's brain. Worse, there was considerable swelling inside the skull.
"The fragments looked like salt specks peppered into the brain tissue," says Greenberg. "Things just splayed out, and everything in their way was disrupted.
"There wasn't much hope. The brain doesn't offer much resistance to bullets."
Alarmed by the speed of brain swelling, doctors increased the dosage of drugs to help alleviate the pressure. Intense pressure inside the skull can squeeze the brain through the opening at the top of the spinal cord, causing death.
Next, Quantae was moved to the Pediatric Intensive Care Unit in the Hopkins Children's Center. Crothers held his hand on the elevator and spoke to him softly.
"We're taking you upstairs where your mommy can see you," she said.
Crothers brushed her hand against his face and said, "He's a 4-year-old baby. If he can hear, he's got to be scared."
In the Children's Center, Quantae was met by a nursing team that attached him to seven electronic monitors. A hollow screw placed through his skull helped gauge the child's brain pressure.
Crothers studied the small form in the bed. Everything about him was pale, from his lips to his fingernails.
"Our object," says Crothers, "was to get him through the night."
Meanwhile, nurses fussed over the 4-year-old, cleaning him and wrapping his head in gauze.
They did a nice job of making him look like a child as opposed to a specimen with a lot of tubes in him," says Greenberg. "That's important for the family, but it's important for us, too."
It was 12:45 a.m.
Greenberg and Crothers stepped into the hall to meet Quantae's family. His mother, Carmelita Allen, appeared dazed. As for the grandmother, Diane Pittman, her clothes were covered with her grandson's blood.
Greenberg spoke gently, choosing his words carefully.
"He may not be the same little boy you knew, but we don't know that. We'll take it step by step, hour by hour."
L Silence. The boy's mother rocked back and forth in her seat.
"I just want my baby to live," she said. Doctors feared that the damage to Quantae's brain might be massive and irreversible.
Crothers led the mother inside, where she was allowed to hold her son's hand for 15 minutes.
Crothers remained at the child's bedside all night, checking vital signs, administering antibiotics and updating his charts.
Around 4 a.m., she thought something had stirred beneath the cloverleaf of tubes.
Quantae's feet had twitched. Or had they?
Crothers blinked and looked again. The boy lay still. It's late, I'm tired and it's been a busy night, she thought.
Quantae wriggled his toes.
Crothers turned to another nurse in the unit.
"Kathy, did you see that?" she asked. "He's not supposed to be doing this, from his CAT-scan."
Quantae's ankles quivered.
A physician noted the child's movement. Then, suddenly, Quantae's eyes opened wide and he began kicking and thrashing his arms. He tried to pull out his breathing tube.
Crothers was ecstatic. By 4:30 a.m., Quantae was following verbal commands, squeezing her hand, raising his foot and sticking out his tongue. Though he was glassy-eyed and sleepy, his movements were positive signs. Nurses began calling him the Little Miracle Man.
When Crothers finished her shift at 7.30 a.m., she grasped the child's hand again.
"See you tonight," she said.
Then she went home and cried.
About 8 a.m., doctors decided to see if Quantae could breathe on his own. They removed the air tube, and his breathing was fine.
THE ROLE OF FAITH
Later, while explaining the night's dramatic turnaround to Quantae's elated mother, Greenberg posed a personal question.
"Do you go to church?" he asked.
"Well, keep doing that," he said.
Then Greenberg went home happy.
"I'll take it," he said of the recovery. "It doesn't come in a bottle, but I'll take it."
Other hospital officials echoed those sentiments.
"It's a miracle that this child woke up this fast after having a bullet in his head," says Dr. David Nichols, PICU director at the Children's Center. "But to expect the next child to have the same outcome is both unrealistic and irresponsible.
"The key is to prevent this type of injury. We have to redouble our efforts to get guns and drugs off the streets, and criminals behind bars."
Says Nichols: "I feel a great sadness, knowing we'll have to answer to our children someday about why we can't protect them."
For Skipper, the nursing student from northeast Baltimore, the joy of helping save a young life is tempered with the constant fear of being caught in a shootout between teen-age gunslingers on city streets.
"Genocide is climbing -- it's climbing," she says. "If you get in their way and you get hit, tough luck. So many families have lost children to cross-fire. It's sad."
RACE WITH DEATH
Care, and luck, saved Quantae
KINDER-CARNAGE -- Special Report