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Roll out of bed. Get the kids ready. Oatmeal. Brush teeth. Books and lunches in the backpacks. Out the door and down the gravel lane to the yellow school bus. Drop Nathaniel, the youngest, at the new daycare. Rush to work. Mom’s a teacher. Dad owns a heating and air conditioning business. Just another day.

Something looked out of whack to Al Azevedo later that fall morning in 2015, a few days before Halloween. Passing by in his car, Al felt it in the pit of his stomach, a sinking feeling that has never gone away more than five years later. He and his wife had kids. The way the woman on the sidewalk was holding the little boy looked wrong.

“Hang on, hang on,” he muttered to himself, braking slightly. Strathroy, a small town in southwestern Ontario, had been home for his whole life and he was pretty sure he recognized the woman.

With one arm, the woman was pulling a red wagon. Her other arm was wrapped under the armpits of a child who was facing outwards, upper body buckled over her arm. Ahead, a second child zigzagged across driveways and up onto front lawns. Al continued slowly past, then signalled and turned the corner on the way to his house, a hot pizza box on the passenger seat, lunch for him and his wife. It was a cold day, and the little boy the woman was holding was not wearing shoes or a coat. There was a small backpack in the wagon.

“Why is the little guy not in the wagon?” Al wondered as he pulled into his driveway.

Behind Al, out of his sight, a white GMC Yukon SUV drove up the road and slammed to a stop. A woman with a mass of dark curls jumped out, had a brief conversation on the sidewalk with the woman pulling the wagon, then grabbed the child from her arms, draped his stiff form over the bucket portion of a child’s car seat, banged the door shut and raced off. The little boy was so rigid she could not buckle him in place.

It was just before noon on Oct. 27, 2015.

In a heart-pounding drive it took Rose-Anne McLellan, Nathaniel’s mom, less than four minutes to get to the hospital, her son in the back seat of the Yukon. She blew through stop signs. An elementary school teacher, Rose-Anne had been about to welcome a guest speaker to her class up the street when a call came in to the school office. Something was wrong with Nathaniel.

The caller, Meggin Van Hoof, provided daycare in her home a few blocks from Rose-Anne’s school. Rose-Anne does not recall Meggin sounding particularly concerned. A supply teacher who was in the school took over. Rose-Anne picked up her purse, told her principal it was probably nothing, but just to be on the safe side she was going to take her son to the hospital.

North Meadows Elementary School, where she taught, is half a kilometre from Meggin’s home. Rose-Anne and Meggin had agreed over the phone to meet halfway. That’s what Al Azevedo saw just before noon — Meggin pulling a red wagon, holding Nathaniel, while a toddler she was also caring for zigzagged ahead.

Strathroy, where part of this story takes place, is a sleepy town of 13,000. Farming and automotive are the industries. It’s a 30-minute drive from London, the closest city. Strathroy Middlesex General Hospital, near the centre of town, has 55 acute care beds and a busy emergency department.

“Mama’s going to get you help,” Rose-Anne said over her shoulder, braking to a stop under a concrete overhang emblazoned in red with EMERGENCY. The only other time Nathaniel had been there was when he was born 15 months earlier. Yanking open the Yukon’s back door she unsnapped the bucket portion of the child car seat and with Nathaniel still draped over the seat, her purse dangling off her shoulder, ran through the sliding doors. There was a lineup in front of the triage nurse. She put the car seat down, picked up Nathaniel and out of force of habit reached for her purse to get her health card. Nathaniel flopped over, his head swinging around loosely, alarmingly. Rose-Anne screamed. Her purse went flying.

Dr. Brian Lemenchick was the attending ER physician that day. He was working in his office at 12:13 p.m. when he heard a commotion. The job of an ER physician typically involves long periods of humdrum interspersed with bursts of action, both frightening and exciting. Lemenchick, who was fairly new at the time, hurried out of his office. He saw nurse Angela Swenson run up to a woman who was holding a child in the middle of the waiting room.

“Oh my God, oh my God,” the woman was screaming, “Help my baby!”

Dr. Lemenchick ran up, too, and together he and Nurse Swenson took Nathaniel and disappeared through the doors of the ER suite. Nurse Swenson helped Dr. Lemenchick put Nathaniel on a stretcher and get him onto Bed 6, the curtained, acute care bed for severe injuries. Nathaniel was “posturing,” alternately pushing his arms and legs outward, then pulling them in to his body. Nurse Swenson looked him over. The boy was tiny, dressed in a onesie and nothing else. She and the doctor looked at Nathaniel’s eyes, studying his pupils. They were “blown,” a medical term that means not reacting to light.

The posturing and the blown pupils were telltale indicators of brain damage. But from what? There was a red mark on his left temple. Could that be the cause? There was also a pattern of what looked like scratches on the skin around Nathaniel’s left ear. A nurse struggled to remove the onesie, hard to do because of the little boy’s contortions. Nathaniel’s body was pale white. He did not appear to be breathing.

Pam Brown was the charge nurse in ER, one of those terms that means exactly what it sounds like. She was the boss. On lunch break, as she was about to grab a bite in the cafeteria, loud cries pulled her back to her post. She saw hospital staff taking a dark-haired woman into the ER’s “quiet room.” Bed 6 was a flurry of activity. Nurses and doctors worked on the small form on the white sheet, now wearing only a diaper.

Dr. Lemenchick was at the top of the bed, holding Nathaniel’s head to protect what is commonly referred to as the C-spine. Keeping the cervical spine inside the neck immobilized is a precautionary measure to prevent paralysis. Nurse Brown started an IV immediately, inserting a needle into the bone of Nathaniel’s leg, allowing fluids to enter his body more quickly than an IV into a vein. She, too, noticed the little red mark on his left temple. She told a nurse to page the anesthesiologist on duty. She also noticed the posturing. This looked like a brain injury.

“Call the ambulance,” she told another nurse. Strathroy was a good intermediary hospital but she knew from experience that this child would have to be transported 30 minutes down the road, to the Children’s Hospital at the London Health Sciences Centre.

Nurses Terri McCarthy and Bill Atyeo came into the room. Nurse McCarthy had done pediatric intensive care all over the country. She noticed that Nathaniel’s knees were mottled, discoloured, kind of a marbling effect. That means the young boy had been “down,” with little or no blood circulation, for quite some time. The anesthesiologist, Dr. Elisheva Chernick, who had been in the middle of an operation and had to summon a replacement, rushed in and sedated Nathaniel, then intubated him, sliding a tube down his throat to help him breathe.

Down the hall in the quiet room, Rose-Anne sat alone. Nurse Kim Jenkins, the manager at the hospital, heard the emergency page for the anesthesiologist and knew something critical was happening. She went into the quiet room and sat with Rose-Anne, who said she wanted to call Kent, her husband. Rose-Anne did not own a cellphone. Too upset to speak, she gave Nurse Jenkins Kent’s cell number. They both waited a few seconds for Kent to answer.

Meanwhile, Nurse McCarthy, the nurse with extensive pediatric experience across Canada, walked into the quiet room. To help the team working on Nathaniel, she wanted to gather as much information as she could. Rose-Anne was crying, not forming full sentences. She was convinced her child was dead. Nurse McCarthy said he wasn’t, that a team of doctors and nurses were working on her son. What happened? the nurse asked. Rose-Anne, through tears, said the woman looking after Nathaniel had told her he fell down some stairs. Rose-Anne gave her the babysitter’s name, and another nurse was assigned to try to track her down.

Kent McLellan was in his work van in the drivethru lane at Burger King in Strathroy. Two of his workers were doing a local furnace installation, and after a quick bite he was planning to check on the job. An unknown number buzzed his cellphone. “Hello?” he said, juggling his phone and wallet as he prepared to move forward in line and pay. A female voice identified herself as a nurse at Strathroy hospital. “There has been an incident with Nathaniel,” the nurse told Kent. “Come immediately.” Kent was trapped until the line moved forward. When it did, he collected his burger and sped to the hospital. A nurse took him to see Rose-Anne. They hugged. Then the nurse took him to Bed 6.

“He was unconscious,” Kent recalls. “They had him strapped, like secured, to a stretcher. I remember leaning over him and right away I remember … His left side, I remember a bruise. And I thought, Oh man, you fell. You fell, you hit your head here. I remember because it was so close to his temple. I mean growing up I remember my dad, or somebody, saying if you get hit here, it’s bad because that’s a weak part. I’m no doctor. I looked and saw bruising here. The temple is bad. Not good.”

Doctors and nurses were readying Nathaniel for transport to London. Dr. Lemenchick was seeing something that did not make sense. Yes, there was a bruise on the left temple, but that would not account for what was obviously severe brain damage. No facial trauma. No fractured nose. No goose egg on the scalp. No depression in the skull. The continued posturing of arms and legs indicated pressure developing in the brain. Nathaniel was given medication to reduce the pressure and prevent further seizing. The doctor went to see Rose-Anne and Kent, both in the quiet room, where they had been joined by Kent’s parents. Dr. Lemenchick told them the prognosis was not good, that Nathaniel could die.

Two paramedics burst through the ER doors. Nathaniel was shifted to a mobile stretcher and wheeled out the door. Dr. Lemenchick and nurse Bill Atyeo climbed in and the ambulance sped off for the 30-minute drive. The nurse manager, who had been sitting in the quiet room, drove Kent and Rose-Anne to London in her car. They sat in the back, stunned.

From the time Rose-Anne brought her son into emergency to the time he headed down the highway, a total of just 69 minutes elapsed.

Back at Strathroy hospital, a Strathroy-Caradoc Police Service officer arrived, parked under the red EMERGENCY sign, and walked into the ER. One of the Strathroy nurses had called police, reporting that a child was being treated with unexplained injuries. The Strathroy officer spoke to the nurses on duty and then seized the onesie that had been removed from Nathaniel, sealing it in an evidence bag.

At the London hospital, a team of doctors and nurses rushed Nathaniel to the CT scan room, hoping that a series of cross-sectional X-ray images would solve the mystery of what was going on inside his head. Family began to arrive. Rose-Anne’s parents, siblings, cousins, friends.

Kent and Rose-Anne sat side by side in the Pediatric Critical Care waiting room. They used Kent’s cellphone to contact family and alert them to the crisis. Meanwhile, Kent’s parents had driven from the Strathroy hospital back to Parkhill, where both families lived, just in time to meet the three older McLellan boys at the school bus.

As they waited for news from the London doctors, a tall, balding man with a thick moustache arrived, wearing a sport coat. He identified himself as Sgt. Gilles Philion of Strathroy-Caradoc Police Service. He told the parents he needed to ask them some questions and he would speak to them individually, in a small boardroom at the hospital. Kent would have to wait in the hallway for 20 minutes so he could be one on one with Rose-Anne. Then it was Kent’s turn. As he did with Rose-Anne, Det. Sgt. Philion took Kent through the day, asking a series of what seemed routine queries. Then a more pointed question.

“Do you have a life insurance policy on your son?” the police officer asked. He had placed a small tape recorder on the boardroom table. Its red light blinked brightly.

“Do you own a four-wheeler?”

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