No one knew if Juan Pedro and Guillermo Timoteo Nino-Brown would survive.
On the afternoon of April 24, the two brothers were rushed from their home outside Quincy, Fla., to a hospital with severe brain trauma. Wielding a knife and a pair of scissors, their mentally ill mother stabbed both boys in the head.
Twenty-month-old Juan Pedro took the brunt of the kitchen knife. Guillermo Timoteo, 8 months old, was pierced through the ear with the shears.
When they reached the hospital, the blades were still stuck in their skulls.
"You don’t see injuries like this that survive transport to the hospital very frequently," said Dr. Narlin Beaty, endovascular neurosurgeon at Tallahassee Memorial HealthCare (TMH) in nearby Tallahassee, Fla.
Both boys' injuries extended from one side of the brain to the other, endangering major arteries.
The scissors piercing Guillermo Timoteo’s ear moved the artery that supplies blood to the brain stem and spinal cord out of place about a centimeter from its natural position.
Juan Pedro's case was more complex. The kitchen knife cut the boy’s external and internal carotid artery which supply blood to the brain, neck and face. His jugular vein was also at risk. The toddler was deep in a coma and hovering near death.
His infant brother, however, was awake and alert. A hospital staffer who provides emotional support for kids put Mickey Mouse Club cartoons on her phone for the baby to watch and stay calm.
In the emergency room, triage caters first to the patient most likely to survive. Guillermo Timoteo would be the first to be treated by Beaty.
The surgeon is familiar with young patients, and he had worked at the prestigious Johns Hopkins Hospital in Baltimore. But this “was something else.”
"I have done endovascular work on a child before,” he said, “but never in a traumatic setting like this."
‘Please baptize the child’
Removing a foreign object from the human body is notoriously risky. But endovascular medical techniques, used to treat strokes, have improved the odds of success.
In the boys’ cases, Beaty and his team entered through their legs and up into the brain. They used small medical coils and balloons to protect vessels and arteries from rupturing as the blades were pulled out.
"With every movement of the object we could watch it under live imaging," Beaty explained.
The X-rays could be spun for a 360-degree view. With barium-infused catheters in the arteries, each movement could be seen on the X-rays through what's called a fluoroscopy. Later, brain drains were placed on the boys to drain cerebral spinal fluid after the objects were removed.
"Maybe 20 years ago, maybe 10 years ago, you’d have seen these injuries and you’d have thought to yourself, ‘These can’t be helped,’" Beaty said.
That night, Guillermo Timoteo made it through. His brother was next, and their grandmother, Gail Brown, feared the worst.
Brown is a recovery nurse and former neurology nurse. She has been working at TMH for 41 years. All the scenarios, thoughts of all the things that could go fatally wrong circled in her head.
Brown stopped the medical team as they began the complicated extraction of the knife from Juan Pedro’s head.
"Please baptize the child," she cried.
The surgeons, nurses and physicians put down their scalpels. The group of about 20 staff stood in silence in the operating room. They quietly said a prayer.
Dressed in his robes, scrubs and a mask, a pastor walked into the room. He blessed the sterile water and sprinkled it on Juan Pedro.
The spiritual ritual completed, medical science resumed.
"It was like the moment of truth — whether he was going to live or die," Beaty recalled, the stoic physician letting tears fall. "And I don’t think anybody knew. We had done everything medically possible."
The knife came out with little bleeding. There was no further damage to the endangered artery, no blood loss.
That night, dozens more medical personnel — doctors, nurses, technicians, specialists — converged in the hospital and others stayed long past their shifts to care for the boys and sit by their bedsides. An estimated 50 medical professionals from many departments tended to the kids that night.
“It was a miracle that these kids lived,” Beaty said. “Even with the best care they didn’t have to survive. And so, definitely, medicine played a role. And I feel like there was a higher power that was there to help.”
"I think something magical happened that day," Beaty added. "This is one of the days that you’re reminded why you do this."
'Richly blessed'
Juan Pedro will celebrate his second birthday Saturday. Guillermo Timoteo will celebrate his first August 10.
Nurses and other hospital staff gathered at TMH two weeks ago for a reunion with the little boys. It was complete with bubbles and colorful play mats, toys and tricycles. They played and laughed.
“I look at them doing normal things that kids do, and I can’t believe that April happened," their grandmother said.
After the boys were stabilized, they stayed at TMH for about a week before being transported to Johns Hopkins All Children's Hospital in St. Petersburg, Fla., for further treatment and monitoring by pediatric specialists.
They now travel to visit the hospital every five weeks. They're slated for six appointments in two days later this month. Regularly, the boys see a speech therapist for swallowing issues from all the ventilation, a neurologist and Guillermo Timoteo sees an audiologist.
"The baby? I mean, when you look at this baby there’s no outward signs of trauma whatsoever," Brown said. Beaty added he may be able to hear.
His brother has some slight weakness on the right side of his body, Brown said, but it's only noticeable when he's tired.
"I still bought my lotto tickets, but I won the lottery on April 24," Brown said, pausing to look at a photo of the boys. "They lived."
Last weekend, Brown's friends and coworkers held a fundraiser and celebration at the American Legion Hall at Lake Ella in support of the boys. Their mother, Carolyn Denise Brown, who has a history of mental health problems, is being held at a state hospital after being found unfit to stand trial on attempted murder charges.
The boys are in the foster care of an aunt, a fast-food worker, and her husband, a construction worker. The Havana couple also has two teenagers of their own.
"They’re very hard-working, caring individuals," Brown said. "But they can’t do it alone."
An online fundraiser was started to help and has already generated almost $10,000 in donations. Medical bills are covered by Medicaid, Brown said. Funds would help with day-to-day expenses.
"These boys, for all their trauma,” she added, “are going to be richly blessed.”
WSBTV
