LONG BEACH - Trauma surgeon Dr. Mauricio Heilbron Jr. was halfway through a 24-hour shift when the frantic family of a 10-year-old girl rushed her into the emergency room at St. Mary Medical Center.
The girl wasn't breathing, and a CT scan would later show severe bleeding inside her skull.
A team of doctors and nurses immediately surrounded young Joanna Ramos and began the scramble to save her life.
As a general trauma and vascular surgeon on staff at St. Mary since 1998, Heilbron has seen many tragedies. But tragedies involving children, he said, are always the hardest.
"I just can't do kids," said Heilbron, a Long Beach resident and father of an 8-year-old son. "It's too hard."
In March 2008, Heilbron wrote an editorial for the Press-Telegram recounting his efforts to save 11-year-old Jose Bailey, who was shot through the heart in a gang-related shooting at the corner of 15th Street and Cherry Avenue. Police have yet to find Bailey's killer.
The letter, titled "A Heart That Can't Be Mended," received an outpouring of emotion and support from the community and earned Heilbron a state journalism award from the California Newspaper Publishers Association.
Heilbron said he isn't looking for recognition. The act of writing about his experiences, he said, helps him deal with the tragedy on a personal level.
And now with the death of Joanna Ramos, Heilbron has written about another nightmare.
In his latest submission to the Press-Telegram, he describes the St. Mary medical team's efforts to save Joanna, who he said was brought to the emergency room with the "lifeless eyes of a little child's doll."
Heilbron said the girl likely suffered head trauma during the fight with another student, and the trauma caused an epidural hemorrhage, which is a buildup of blood between the brain and the skull.
"Basically this is a nightmare situation where an apparently trivial injury caused a devastating outcome," he said.
People can suffer a brain hemorrhage for several hours before it is discovered, depending on the speed of the bleeding, he said.
Joanna had no visible signs of trauma and returned to an after-school program shortly after the altercation. But at some point thereafter, she vomited and went home, family said.
By the time she reached the emergency room, she was unconscious and not breathing, Heilbron said. The medical team worked on Joanna for three hours. Her heart stopped four times - they were able to revive it three times.
When doctors finally determined Joanna was gone, the mood in the operating room was grim, he said.
"One of the nurses sat down and her shoulders slumped," he said. "We looked at each other and our eyes were red and we just started crying. We had tried so hard to save her. We'd done everything twice."
In his letter, Heilbron describes the difficult task of telling Joanna's family.
"The crowd disperses. The nurses start cleaning up the area, as I do the single most painful, soul-crushing thing any person ever has to do," he writes. "I have to tell a mother that her child has died."
"I have to shuffle down the longest hallway on the planet to get the rest of the family and give them the news," he continues. "My tears tell them she's gone. The tears of every hospital employee they walk by tell them that they're not completely alone."