Angel was then, and is even now, one of the most beautiful babies I have ever seen and I have seen many in my thirty years as a child abuse pediatrician. Yet, to look at her today, asleep against her foster mother’s shoulder, one could never guess at the devastation wrought upon her.

I first met Angel, then only a few months old, in the pediatric intensive care unit just before Christmas.  She had been admitted unresponsive the night before. Her father had told the hospital staff that he had picked her up from her crib to change her soaked diaper and as he did so she slipped from his grasp and fell back into her crib.  He said she went limp and stopped breathing.  He rushed her into his car and drove wildly to the local hospital.  Eventually, Angel ended up in my hospital.

I was called in to see her after a CT scan showed subdural hematomas.  Later, an MRI found evidence of parenchymal injury. An ophthalmology exam found such severe hemorrhages retinal hemorrhages that they were visible on the MRI.

Angel’s mother was at work when the injury occurred and only found out about it after Angel was rushed to the hospital.  She told me what her boyfriend had told her, that Angel had fallen from his grasp into the crib.  She said she had no reason to believe otherwise.

I finished the interview with Angel’s mother then spoke with her father. He was anxious and somewhat furtive.  He told me that Angel had “peed everywhere,” on her clothes, in her bed.  When he went to pick her up, she slipped from his grasp and fell onto the mattress.  She immediately lost consciousness.

I ended the interview after a few more questions about the fall, and we both went back into the ICU, he to his baby’s side, me to the computer workstation to type my note. As I typed, Angel’s mother came up to me and said that she now knew what had happened.  Her boyfriend had just then confessed to her that he had shaken Angel and that he wanted to talk to me.

I went into Angel’s hospital room.  Her father was sitting on the cot with his head in his hands, Angel’s mother by his side consoling him.  He didn’t look like a bad person; perpetrators rarely do.

Before I could speak he offered, “I’m sorry Doc. I lied.  I shook her.”

I asked him why he had shaken her. “I picked her up from the crib.  She was screaming and kicking and scratching at me, and I just lost it.  I shook her.”

“Did the fall happen?”

“No, Doc. She didn’t fall.  I shook her.”

And finally “What happened after you shook her?

“She went limp and stopped breathing.  She looked dead.   I know what I did was wrong.  I’m sorry Doc.”

So there it was.  I thanked him for telling me the truth.  I told him it was the right thing to do and left to notify the police.

Months later, Angel’s father pled guilty to assault.  He said at his sentencing that he had shaken Angel and that he was sorry. He is serving several years in prison.

All of that was yet to pass.  Here was Angel in the ICU, profoundly brain damaged, never to awake, a victim of devastating violence, and for all the world she looked like a healthy, beautiful, three-month-old girl about to experience her first Christmas. Having seen too many shaken babies, it is always astounds me how normal many of these babies look, few if any bruises, no obvious fractures, nothing to suggest the violence that had been perpetrated on them. To look at her in her hospital bed, surrounded by beeping instruments and tubes, intubated, not breathing, to look at her face and body, she looked fine, not a scratch, cherubic.

I saw her one last time several months later accompanied by her foster parents.  Her functioning at a year was that of a one month old.  Her existence, like that of a light switch without nuance, flipped between screaming/arching and deep sedation.  She was quadriplegic, blind, and deaf.  Her foster parents attend to her every day and every night, ceaselessly, religiously. I am myself not religious and have never said to anyone “God bless you.” I did to them.  My eyes filling, I told them they were saints who deserved a special place in heaven.

There is something of a “debate” within the legal community and on the fringes of the scientific community about the existence of shaken baby syndrome.  One argument offered is that confessions are always coerced.  Another is that shaking cannot cause these injuries.  Those who would say such things should talk to Angel’s father.

Yet, for Angel, none of this matters.  Words and events orbit around her like so many errant planets: shaken baby prevention, child protective custody, termination of parental rights, grand jury, criminal prosecution, plea bargain, prison.  Unknown and unknowing, immutably beautiful, she spins silently within her own dying sun.

God bless you Angel and may flights of angels sing thee to thy rest.

Lawrence R. Ricci  is a pediatrician and co-director, Spurwink Child Abuse Program, Portland, ME.