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On his fourth birthday, Mikal Pickens slipped into semi-consciousness in a bed at St. Louis Children's Hospital. His sister Kheematah Pickens, a year older, lay in the bed beside his, alert but unwell. It was October 8, 2004. The siblings had been sick for more than a week.
Doctors were stumped as to the cause. Mikal (pronounced like "Michael") and Kheematah (pronounced kah-mah-tah), who had no history of health problems, had arrived at the hospital on October 4, exhausted and severely dehydrated. They exhibited similar symptoms: incessant vomiting and diarrhea. So constant were their expulsions that nurses were keeping the children diapered. Colorful buckets for vomit were swapped out regularly.
Judy Pickens, the children's mother, told doctors that the children had fallen ill a week earlier. A bug was going around, she said, and several of the children's classmates were sick. Suspecting stomach flu, doctors initially prescribed IV fluid replenishment and figured the children would soon recover.
But they didn't. Several days into the hospital stay, their mother mentioned a chicken sandwich she'd purchased for the kids from a north-county street vendor.
Aha, thought Dr. Jamie Sutherell, the hospital's then-chief medical resident: Perhaps they'd fallen prey to food poisoning.
The revelation sent Sutherell's staff down a new path of inquiry. Nurses began to poke and prod their little patients, extracting vials of blood, urine and stool to submit for a battery of tests. But nothing conclusive emerged. Mikal and Kheematah continued to vomit, and vomit, and vomit.
Sutherell consulted specialists, including pediatric infectious-disease experts, who asked numerous questions of Judy Pickens and her husband, Karl: Had the family taken any unusual trips recently? Where did the Pickenses store things such as household cleaners? Was there any rat poison within reach? Any strange insects in the house? Were the parents' medications stored up high in a medicine cabinet?
Nothing out of the ordinary.
The hospital alerted the city and state public-health departments, which dispatched their own sleuths to look for clues of a possible outbreak at the daycare center Mikal attended.
Meanwhile, nurses were having trouble keeping Mikal's IV lines in. Sutherell inserted a feeding tube into his stomach, but that didn't work, so a surgeon implanted a catheter into a vein in the boy's leg. For a day the source of nourishment seemed to quell the mysterious invader. But on his birthday, the new arrangement appeared to malfunction, and Mikal's condition took another turn for the worse. Only a firm turn of the fist into his breastbone — a maneuver doctors call a "sternal rub" — could induce the boy to open his eyes.
Something appeared to be blocking the IV lines into the catheter, so the medical staff inquired with the hospital pharmacy: Were there problems with the saline bags? Was any of the saline crystallizing in the tubing? A hospital pharmacist checked for product recalls and spent several hours experimenting with the bags. All kosher, he reported.
Mikal's condition seesawed all evening. Concerned that a blood clot might be interfering with the feeding apparatus, Sutherell prescribed an anticoagulant, and, for a time around midnight, his patient was stable.
Soon afterward, though, Mikal began to wheeze. Sutherell ordered a chest X-ray. It came back normal. By 4:30 a.m., when Sutherell was again summoned to Mikal's room, the boy was unable to breathe. "He was using all the muscles of his body, struggling to breathe," Sutherell would subsequently recall during court testimony. "He had a fearful look in his eyes. You could tell he was afraid."
Abruptly, Mikal lapsed into unconsciousness. Sutherell and several nurses performed CPR as a crisis-response team was summoned to rush the boy to intensive care.
"I stayed with the family, because at that point I wasn't their doctor anymore," Sutherell would later testify. "I wouldn't necessarily say [I was their] friend, but there was so much emotion in the rapidity — the suddenness — of how this evolved, that at that point I was right there in tears with them when the doctor came in with the bad news."
Mikal was dead.
Later that morning Mikal's sister Kheematah awoke and told family members, "I don't want to die," and, "I want my brother back."
A day afterward she fell unconscious, just as her brother had, and was rushed to the ICU. Complaining of dizziness and feeling faint, a stricken Judy Pickens was conveyed to the hospital's emergency room on a stretcher. She told doctors her heart was breaking.
Sixteen months later, after an extensive investigation, the St. Louis Medical Examiner's Office concluded that Mikal Pickens had been fatally poisoned. On February 8, 2006, a day after the medical examiner signed Mikal's death certificate, St. Louis police arrested Judy Pickens and charged her with six felonies, including child abuse and the murder of her son.
Why would a mother harm her own children?
In 1977 a British pediatrician thought he'd found an answer: She'd do it to look like a hero.
Roy Meadow had been studying the cases of two unrelated children. Six-year-old Kay suffered from an apparent urinary-tract infection; fourteen-month-old Charles experienced sudden spells of drowsiness and vomiting. In both cases doctors could find no cause for the children's mysteriously recurring illnesses.