MrBallen’s Medical Mysteries - Ep. 67 | The Endless Cry
Episode Date: January 14, 2025The parents and grandmother of an infant boy are beside themselves when the baby starts crying, and won’t stop for hours on end. They know something has to be wrong, and they’re skeptical... when the doctor says it’s just gas. As the boy weakens by the day, doctors realize that something is putting the baby’s life in danger, but what?Follow MrBallen's Medical Mysteries on Amazon Music or wherever you get your podcasts. New episodes publish for free every Tuesday. Prime members can binge episodes 65-72 early and ad-free on Amazon Music. Wondery+ subscribers can listen ad-free--join Wondery+ in the Wondery App or on Apple Podcasts. See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.
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On a fall morning in 2021, a pediatric specialist stood in an examination room at a hospital in Boston, Massachusetts.
He stared down at his two-month-old patient, being careful to avoid eye contact with the
baby's parents.
He knew how worried they were, and he felt guilty for what he was about to do.
The little boy had spent the past two days crying non-stop until he was so exhausted
from the screaming and whatever trauma was causing him such discomfort that he had finally
passed out.
But now the specialist knew he had to wake the child up, but in the most painful way
possible.
A nurse stepped up to the examination table and the specialist asked her to turn the sleeping
boy onto his side and ball him up into a fetal position.
Then the specialist rubbed a bit of numbing cream on the baby's back and gave it a minute
for the cream to activate. He finally looked up at the baby's parents
assuring them that the procedure would only take a few moments. When the mother
nodded, the specialist removed a thin hollow needle from its sanitary wrapping
and attached it to a clean syringe. And then slowly and carefully he used that
syringe and he pierced the baby's back, right
into the skin between the little boy's vertebrae.
Then immediately the child yelled out in pain and began crying all over again.
The specialist knew he had to act quickly, and so as carefully as he could, he began
to withdraw yellow fluid from the baby's spine, pulling it back into the syringe.
He wished there had been another way to figure out what was wrong with this infant, but he'd
run every test in the book and they had all come back normal, so this was the last resort.
And so as the infant continued to scream, the specialist just hoped that the lab results
from this test would be worth the pain he'd just caused.
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From Ballen Studios and Wondery, I'm Mr. Ballen and this is Mr. Ballen's Medical Mysteries,
where every week we will explore a new baffling mystery originating from the one place we
all can't escape, our own bodies.
So if you like today's story, when you and the follow button are at the beach, tell
them to bury themselves and promise you'll dig them up, but then just leave. This episode is called The Endless Cry.
On a chilly fall afternoon in 2021, a woman named Ruth Jones pushed her grandson's stroller
through the Boston Common, a beautiful city park in Boston, Massachusetts.
Ruth beamed with pride as people leaned in to get a look at 8-week- week old Tommy who was cooing and gurgling in his stroller. This was one of
Tommy's very first excursions outside of the house and he was bundled up so much
that he almost looked like a little burrito with big brown eyes fascinated
by the treetops overhead and all the new faces waving hello. Ruth walked them
around the pond marveling at all the autumn foliage in the park,
then sat down on a bench across from her favorite people watching spot,
the vintage carousel with hand-painted wooden horses and zebras.
She turned Tommy's stroller so he could see the flashing lights and hear the lively organ music,
but after a moment, Tommy started to cry. And so Ruth turned Tommy around and tried to calm him down,
but it was like nothing she could do could get the boy to stop crying.
Ruth's daughter Emily had warned her that Tommy had been very irritable lately.
So she picked Tommy up out of the stroller and cradled him to her chest thinking that might calm
him down. But he just continued to wail in her arms, almost like he was actually in pain.
Ruth then tried to give Tommy a pacifier, something he normally liked, but he wouldn't
take it, and if anything it just seemed to make him even more upset.
Ruth wondered if maybe he was hungry, but she didn't have a bottle with her, so she
decided it was time to take Tommy home.
Tommy cried the entire way back.
By the time Ruth got him to her daughter's house, his voice was hoarse.
Now at this point, Ruth did feel very sorry for Tommy.
She didn't know what was going on and obviously he was very upset.
But if she was being honest, all this persistent crying was actually now giving Ruth a bit
of a headache.
And so she carefully brought Tommy into the kitchen and she put the kettle on the stove
for tea and then put Tommy's bottle in a warmer.
And while the milk was warming, she set out a teacup, put a teabag in and also got some
honey out.
All the while, Tommy just continued to wail and cry on her shoulder.
Once Tommy's bottle was warm, Ruth tried to give it to him, but he was so upset he wouldn't
take it.
And so now Ruth was sort of out of ideas and really didn't know how to calm Tommy down.
So she just began walking around the kitchen, patting her grandson on the back, and doing
everything she could to be motherly, but Tommy just kept on wailing and wailing.
And then Ruth remembered that her daughter and son-in-law had said something about giving
Tommy something sweet when he had been really upset these past couple of weeks.
But Ruth looked around the kitchen and couldn't find anything that fit the description and
didn't feel comfortable just giving him something random.
And so ultimately Ruth just sort of walked around the kitchen as Tommy screamed for the
next few hours until finally Ruth's daughter Emily came home and took Tommy from her.
Six days later, Ruth was at Tommy's pediatrician's office, holding the crying baby to her chest
while trying to fill out a clipboard of check-in forms.
Over the past week, Tommy's meltdowns had gotten longer, louder, and more frequent.
Ruth and Emily were both worried that something was genuinely wrong with him and so Emily
had scheduled this doctor's appointment for Tommy.
But today, Emily had to work, and so Ruth had taken the baby.
When they finally got called back to the examination room,
Tommy's crying only seemed to get worse.
And so the pediatrician, upon seeing Tommy, sort of furrowed her brow,
as she began conducting a routine physical exam.
And as she did, Ruth explained
that these crying fits had been going on like this for a full week. The pediatrician nodded
as she touched the right side of Tommy's abdomen, and as she did, Tommy wailed harder and louder
than Ruth had ever heard. She jumped to her feet out of instinct, genuinely horrified by the noise
coming from her grandson. But the pediatrician just shook her head and said not to worry, she now knew what the problem
was.
There was gas stuck in his tiny stomach.
The pediatrician then showed Ruth some exercises to do on Tommy, and she literally began peddling
Tommy's legs and folding them up and down and rubbing his stomach to help him pass the
gas.
And as she did that, in demonstration for Ruth,
it did seem like Tommy was calming down just a little bit. However, by the time Ruth and Tommy
were back home again, Tommy was wailing all over again. And so Ruth carried him up to the nursery
and ran him through all those exercises she had been shown on his changing table,
and he did pass some gas and he did start to quiet down and for a second Ruth felt relieved like they were on to something that they had
really figured out what was wrong here and they were slowly making it better.
But the second she picked Tommy up again he started to cry again. Ruth was at a
loss she just couldn't seem to keep him calm. She paced the hallway with him and
she also just stopped and rocked him back and forth,
she carried him up and down the stairs, she sang lullabies, but nothing worked.
A few hours later, when Emily got home from work, Ruth almost cried with relief.
She handed Tommy off to Emily the moment her daughter stepped through the door.
Ruth was obviously still very concerned for Tommy, but she also desperately needed a break
from the constant crying.
It had just gotten worse all afternoon, I mean his screaming was relentless.
And now as she walked outside down towards her car she could still hear him crying in
the house.
And as Ruth drove back to her home, all she could think about is what's going on with
Tommy.
Half an hour later back at Emily's house, Emily sat in the nursery with Tommy trying
to feed him.
Downstairs she could hear her husband Dave in the kitchen making dinner.
And even though Emily was hungry, she knew she had to give Tommy his own dinner before
she could eat.
And that was proving much more difficult than usual.
Now Tommy had always been a fussy baby, but nothing like the last week.
The only time Emily noticed her son seemed even remotely calmed down and happy was when
he was nursing or when they dabbed a trace of honey on his pacifier and actually got
him to use it.
And so Emily rocked Tommy and finally he did latch on and he began breastfeeding and at
that point he did sort of quiet down.
Except as he was eating, Emily noticed that he was not latching onto her breast as firmly
as he usually did.
As the minutes went by, she noticed that he seemed to be drinking less and less milk too.
She wondered if maybe it was just because he was so tired from all the crying. A minute later he'd stopped drinking completely
and was fast asleep. Emily thought that maybe he wasn't all that hungry so she
put him in his crib and joined Dave downstairs for dinner. The next morning
just before dawn Emily was back in Tommy's nursery back in the armchair she
used for nursing but Tommy was not latching.
No matter what she did, she could not get him to begin to breastfeed.
Not even in the weak way he'd done the night before, it was just like he wasn't doing
it.
She knew Tommy had to be hungry, but she had no idea how to get him to actually eat.
At this point, Emily felt like Tommy's behavior was more than just typical baby fussiness.
And so when her husband appeared in the doorway a moment later, she told him they had to go
to the emergency room.
A few hours later, Dr. Ann Brogdon walked down the hallway of her Boston area pediatric
hospital.
She could hear her new patient screaming from inside the small examination room.
And when she walked inside, she saw the patient's parents, Emily and Dave, who told Dr. Brogdon
that their son, Tommy, had basically been crying non-stop for days.
Dr. Brogdon went straight to work.
She knew that Emily and Dave were new parents, and so she really wanted to put them at ease,
because Dr. Brogdon assumed this was just, you know, child fussiness.
So, she gave Tommy a routine physical examination, checking his reflexes and taking his vitals.
And as she gently poked and prodded him, she asked Emily about his medical history.
And everything Emily said sounded typical and healthy.
She told the doctor that she had a routine vaginal delivery after an equally normal pregnancy.
Tommy had no known allergies and he wasn't on any medications except for vitamin D supplements.
He was also still wetting his diapers regularly, though his last bowel movement had been two
days earlier.
Tommy didn't have all of his immunizations just yet, so he was susceptible to pneumonia, influenza type B, and whooping cough, but Tommy's symptoms seemed more like a gastrointestinal
problem than any of those diseases.
And unfortunately, Dr. Brogdon's physical examination wasn't giving her any real clues
either, and so she told Tommy's parents that she would just have to conduct a little bit
more testing. An hour or so later, Dr. Brogdon looked at Tommy's test results on her tablet. Tommy
had tested negative for a whole bunch of diseases, RSV, influenza types A and B, and even COVID.
So his distress probably was not caused by a viral infection. Tommy's blood levels were
also all normal, which ruled out other things like appendicitis,
pancreatitis, liver disease, or some kind of obstruction in his digestive system.
Dr. Brogdon's physical exam had also already ruled out the possibility of child abuse,
and it was unlikely that a breastfeeding infant could have ingested poison.
So what was going on here?
Dr. Brogdon decided to ramp up her efforts.
Something was obviously wrong with Tommy, and it couldn't just be a case of bad gas.
So she ordered a urinalysis, an ultrasound of his abdomen, and an x-ray of his chest.
She hoped one of those more advanced tests might finally solve the mystery around what
was going on with Tommy.
When Dr. Brogdon opened the door to Tommy's room an hour later, the sound of his wailing
immediately filled the hallway.
And inside the room, Emily was pacing back and forth with Tommy in her arms as his screams
echoed off the walls.
Emily and Dave looked utterly miserable, totally sleep deprived and confused and nervous.
And unfortunately, Dr. Brogdon didn't have anything really positive to say,
which only made it that much harder to deliver the news.
She still didn't know what was wrong with their son.
His chest x-ray came back normal.
His ultrasound and urinalysis were also normal.
And yet he was still crying.
Emily and Dave were heartbroken. They couldn't
believe that nobody knew what to do here. But Dr. Brogdon promised them she was
doing everything she could to help and then she told Emily and Dave that she
was going to admit Tommy to the hospital.
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Four hours later, one of the hospital's pediatricians, Dr. Christopher Reynolds, entered Tommy's
hospital room.
He'd read in the clinical notes that Tommy had been crying for days, so he was surprised
to find that the room was actually silent when he walked in.
Emily and Dave were inside the room sitting on the bed, Dave was holding Tommy who was
nearly asleep.
After more than six hours of uninterrupted crying, it seemed like the little boy had
finally tired himself out.
Dr. Reynolds hoped that was a
good sign. The doctor introduced himself and reached for the baby to do a physical exam.
He'd already scanned Tommy's case file and knew that despite crying for days, Tommy was mentally
alert. But when Dr. Reynolds took Tommy and fully woke him up and tried to get his attention,
he noticed that Tommy did not seem to focus on him.
At first, he wondered if maybe it was because the boy was just so sleepy, but the more he
examined the child, the more he began to realize that Tommy seemed to have no energy at all
and his reflexes were quite slow.
It was like his reactions were on a time delay.
Dr. Reynolds knew Tommy had to be tired, but this was something else.
Dr. Reynolds immediately ordered an MRI to see if there was something wrong with the
child's internal organs.
Unfortunately that scan showed no abnormalities, but it meant Dr. Reynolds had to order more
testing to figure out what was actually going on here.
He told Emily and Dave that he wanted to test Tommy's next stool sample.
And in the meantime, he also wanted to perform a lumbar puncture, or spinal tap, just to
make sure that Tommy was not suffering from an infection in his brain or spinal cord.
The spinal tap procedure did not take very long, but Dr. Reynolds knew it was very difficult
for Emily and Dave to watch.
The doctor had placed Tommy in the fetal position on his side and then inserted a long needle
into his spine to draw out the spinal fluid.
And even though he had placed numbing cream on the injection site, Tommy's cries were
still ear splitting the instant the needle broke the skin.
Thankfully, it was all over in just a few minutes.
Once Dr. Reynolds had the spinal fluid sample, he sent it for testing right away.
And this time, Dr. Reynolds did get a useful clue.
The spinal fluid analysis showed an elevated protein count, which could mean Tommy's body
was working overtime to fight off some kind of infection.
But since they had already ruled out a lot of the more common infections, Dr. Reynolds
was now worried that Tommy might have meningitis or inflammation in the brain.
Bacterial meningitis, especially in children, is extremely dangerous.
It can cause long-term problems with seizures, brain damage, it can even be fatal.
And so even though the doctor didn't know specifically what kind of infection the baby
was fighting, what he did right away was just put Tommy on antibiotics to try to kill whatever
bacteria was causing the infection. About an hour later, Dr. Reynolds checked in on Tommy to see if
the antibiotics were kicking in. But as soon as he examined the little boy, he could see there was a big problem.
Tommy was really struggling to breathe,
and whenever he breathed in,
it almost sounded like he was grunting.
In fact, Tommy was fighting so hard for oxygen
that Dr. Reynolds could see his rib cage
straining against his skin with every breath.
And there was a faint blue tint growing around Tommy's lips,
which truly scared Dr.
Reynolds because that meant the baby was not getting enough oxygen.
And so he immediately put Tommy on supplemental oxygen and instructed the nurses to rush him
to the intensive care unit.
Moments later, the hospital's pediatric critical care specialist, Dr. Cassandra Pierce, examined
Tommy in the pediatric ICU while his parents, Emily and Dave, stood by at the foot of his hospital
crib.
Dr. Pierce thought Tommy's cry was more weak and pained, and in fact it sounded more like
a snore than a wail, like it was taking everything out of him just to make a sound.
To Dr. Pierce, that was a sign of an airway obstruction.
So she turned Tommy onto his back, and when she did, she noticed his eyelids were drooping
and his head sort of bobbed strangely up and down on his neck.
Dr. Pierce knew she had to act quickly, and so she called for an intubation kit, and right
away a nurse came back with one.
Then Dr. Pierce took the hollow tube and slid it down Tommy's throat past his vocal cords
all the while Tommy was jerking in discomfort trying to pull away.
But once the tube was all the way in and Tommy stopped thrashing, Dr. Pierce hooked it up
to a ventilator, a machine that would now breathe for Tommy so his body could rest and
get the oxygen it desperately needed.
But even as the child's chest began to rise and fall in a steadier pattern, Dr. Pierce
knew Tommy's lungs were still at risk to collapse.
But just then, the heart rate monitor by Tommy's bedside began beeping.
Tommy's heart began beating much faster than normal.
Then another monitor began going off, signaling that Tommy's blood pressure was rising too.
It was like his entire body was panicking even though he was lying there quietly.
Thinking fast, Dr. Pierce turned to the nurse and asked her to start Tommy on continuous
infusions of opioids and drugs called benzodiazepines which would hopefully get his body to relax
and relieve his pain until she could figure out what was going on.
Also, Dr. Reynolds administered Tommy a sedative and lower dose painkiller.
An hour later, Dr. Reynolds was leaning over Tommy, testing his reflexes, and they remained
very weak.
In fact, overall, Tommy was just growing weaker by the minute.
Further analysis had been conducted on Tommy's spinal fluid and it had come back negative
for meningitis.
On the one hand, Dr. Reynolds and the rest of the medical team were relieved that the
boy did not have meningitis.
But on the other hand, at this point, they still just didn't have a diagnosis for Tommy,
which was making caring for him nearly
impossible.
It's like in some ways just having a diagnosis, even a bad one, would sort of be an improvement.
They'd at least have the ability to try to treat something, but without a diagnosis,
they were just sort of left scratching their heads.
Dr. Reynolds went back to Tommy's medical history and looked for anything that somebody
might have missed.
But there was nothing that stood out.
The child had no neurological deficits, he had no swelling in his heart or lungs, there
were no gastrointestinal issues or urinary issues.
On paper, Tommy should be fine.
And yet, he continued to get sicker.
In fact, he was now developing something called Hypotonia, or severe muscle weakness.
Something was clearly slowly paralyzing Tommy.
But when Dr. Reynolds reviewed Tommy's brain scan, it showed nothing abnormal, which meant
that whatever was weakening his muscles probably wasn't affecting his brain or spinal cord.
Now, Dr. Reynolds knew he could diagnose Tommy with something called spinal muscular atrophy,
a degenerative motor neuron disease that weakens the muscles closest to the center of the body.
That would explain Tommy's overall weakness, his drooping eyelids, and his inability to
latch when his mother tried to breastfeed him.
It was also one of the more common genetic disorders in young kids. But deep down, Dr. Reynolds knew that diagnosis did not explain all of Tommy's symptoms,
including the high protein levels in Tommy's spinal cord fluid.
Then he thought Tommy's high protein levels and growing muscle weakness could be a sign
of Guillain-Barre syndrome, a condition caused when the immune system attacks the nervous
system and weakens the muscles.
But Dr. Reynolds knew that that syndrome was very rare in babies.
Dr. Reynolds paced the hallway outside of Tommy's room trying to think if there was
anything he hadn't thought of or some question he hadn't asked.
And then he realized there actually was one question he had not personally asked the parents
yet.
And so he dashed back down the hallway to Tommy's room, he went inside, and he asked
Emily and Dave, who were at their son's bedside, what had they fed their son in the past few
weeks.
Now, keep in mind, Tommy was breastfed, and so the assumption was he only got milk.
But Dr. Reynolds was wondering if maybe this child had eaten something other than milk.
But Emily looked up at Dr. Reynolds and just told the doctor that yeah, Tommy is breastfed
and he's only had her milk.
Dr. Reynolds felt defeated.
For a second he felt like maybe he had just solved what Tommy's issues were.
Maybe it was coming from eating something that was not his mother's milk.
However, just then Tommy's father, Dave, added that on occasion when Tommy would not take
his pacifier, they would sweeten it with a drop of honey.
Suddenly it all made sense and Dr. Reynolds knew what was wrong with Tommy.
But it was a terrible diagnosis and there was no time to waste. Tommy needed emergency treatment right away,
even before the diagnosis was confirmed.
The second Dave had said they fed their baby honey on occasion, Dr. Reynolds realized that Tommy had
something called Botulism. Botulism is a rare but serious illness caused by a bacterial toxin that attacks the nervous
system.
As the disease progresses, it causes difficulty breathing, muscle paralysis, and sometimes
even death.
Adults can typically fight off botulism, but babies like Tommy are not capable of overcoming
the bacteria that spreads it.
About 90% of untreated infant botulism cases are fatal.
While botulism is rare, the bacteria that causes it is not.
In fact, it's found in many kitchens, often hiding in an unlikely place, honey.
Honey is a natural sweetener, but it should never be given to babies under the age of
one for this reason. Unfortunately Dave and
Emily didn't know this and when they dipped Tommy's pacifier in honey to sweeten it they had
unknowingly made their baby very sick. Dr. Reynolds sent Tommy's stool sample out for testing knowing
that it would take six days for the results to come back. But he was so sure about the botulism diagnosis that he just started Tommy on a special antitoxin
treatment right away.
Over the next ten days, Tommy slowly regained movement in his arms and legs, and his botulism
diagnosis was confirmed.
It would still take another 20 days or so before he was well enough to be discharged
from the hospital, and then once he was discharged, he had to spend eight more days at a rehab facility. However, at the end of it all he would
make a full recovery and he is doing well today. you can listen to new episodes of Mr. Ballen's Medical Mysteries early and ad-free on Amazon Music.
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From Ballen Studios and Wondry, this is Mr. Ballen's Medical Mysteries, hosted by me,
Mr. Ballen.
A quick note about our stories.
They are all inspired by true events, but we do sometimes use pseudonyms to protect
the people involved, and also some details are fictionalized for dramatic purposes.
And a reminder, the content in this episode is not intended to be a substitute for professional
medical advice, diagnosis, or treatment.
This episode was written by Aaron Lann.
Our editor is Heather Dundas.
Sound design is by Matthew Cilelli.
Our senior managing producer is Nick Ryan.
And our coordinating producer is Taylor Sniffin.
Our senior producer is Alex Benedon.
Our associate producers and Researchers are
Sarah Bytak and Tasia Peliconda. Fact Checking was done by Sheila Patterson.
For Ballen Studios, our Head of Production is Zach Levitt, Script Editing by Scott Allen
and Evan Allen, our Coordinating Producer is Samantha Collins, Production Support by
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