I'd always been a man of faith—a born-again, Sunday school-teaching Christian who believed that his religious grounding made him a better doctor. But a dead baby can change everything.

Returning home after a long day at the office, I called the hospital switchboard to sign off from call duty. Still, minutes later, the phone rang.

"We need you here now!" Rick, the charge nurse quavered. "We have a dying baby."

I'd witnessed my fair share of pediatric tragedies, although mostly from a distance. As a third-year medical student, for instance, I'd stood on a step stool to get a better view of the residents and attending physicians as they struggled unsuccessfully to save a toddler who'd been struck by a car. Three years later, I was moonlighting in a rural ED when we had a dual trauma code—two young children murdered by their psychotic father.

How did my faith fare during tragedies like these? Back then, I managed to redirect my anger to an inattentive driver or a mentally ill father, or to some other responsible human agent.

As long as I could find "meanings" for deaths, I was able to put a cushion around my God's role. I ignored whisperings in my mind that suggested that God was either responsible or He was irresponsible.

The second I set foot in the code room I knew that I was in way over my head.

On the stretcher lay a neonate, her eyes closed, two IVs in place. The nurse anesthetist had intubated her and someone had administered atropine. The monitor showed sinus rhythm at a rate of 50. I confirmed the bradycardia and ordered chest compressions.

"We've called the chopper," the ED doctor said. "They're putting a crew together, and will call us back." The 90-minute ambulance ride to the university would be a 15 minute trip by helicopter.

"Do we have a history?" I asked, examining the baby.

"Two-week old, discharged from another hospital this afternoon," the doctor replied. "Spent the last week there with fevers of unknown origin, but septic workup and cultures were negative. Her pediatrician discontinued antibiotics this morning, and she became afebrile. She was discharged home, with a presumptive diagnosis of viral syndrome and drug fever."

As he spoke, I checked the baby over, looking first for signs of abuse. No bruising, bony deformities, bulging fontanel, or retinal hemorrhages. I turned to other matters. Femoral pulses were good with chest compressions, absent without. Abdomen and thorax were grossly normal. There was no withdrawal reflex when I pinched her tiny feet, but her pupils were responsive. Her skin was cold and mottled, but with no obvious rash.

"Mom and dad had only been home from the hospital a couple of hours when mom noticed that the baby felt cold," the ED doctor continued. "She attempted to get a rectal temp, but the thermometer didn't register. That's when she called the other hospital's ED, and they told her to bring the baby right in. En route, dad noticed the child wasn't breathing, so he started CPR. Since we're closer than the other hospital, mom came here. Total down time was about 10 minutes before we got her tubed and the atropine on board."

"Let's get a blood gas," I said, stepping out of the room.