How could a parent forget a child in a sweltering car? It’s unthinkable, right?

For Nicole Engler, a nurse practitioner in Roseburg, Oregon, the unthinkable happened…and she’s now on suicide watch after the death of her 21 month-old daughter, Remington. Nicole’s husband, Peter, an emergency room tech, had just finished a night shift, and Nicole offered to take Remi to daycare on the way to the clinic so Pete could sleep. After completing her day hard at work treating patients, she walked to her car in the parking lot and found Remington blue and unconscious in the car. The little girl was rushed to the hospital (where Pete was on staff) and the ER team tried unsuccessfully to resuscitate her. It’s a nightmare made horrifyingly real. How could Nicole have let this happen to her little girl?

Image result for nicole engler roseburg

Nicole’s clinic, Evergreen Family Medicine, and most of the community of Roseburg have reached out and supported the Engler family during this ordeal. The president of the clinic wrote a message on Facebook praising Nicole as a mother and warning that this nightmare could happen to anyone if we remain even unaware of the possibility. Ribbons were hung around town.

At the same time, a good part of the community rose up in anger, calling for Nicole to be prosecuted (and even hanged). Someone pulled the ribbons down…

How could this happen?

Those who were furious might wonder how a successful, intelligent clinician and mom could do this to her baby girl? In this video I try my best to unpack the science a little, and discuss how our archaic reptile brain wiring (often compounded in Type A folks like those of us in healthcare), can lead us into fatal distraction.

Nicole Engler, 38, has been charged with second-degree manslaughter.
Nicole Engler’s police photo says it all…

Memory is a machine, and it is not flawless. Our conscious mind prioritizes things by importance, but on a cellular level, our memory does not. If you’re capable of forgetting your cellphone, you are potentially capable of forgetting your child.”

Is there room for forgiveness?

Compassion is love in the face of suffering. Watch the video to see my take on forgiveness in the face of unspeakable suffering. Here’s an editorial in a Roseburg newspaper. What do you feel and think?

Where do we go from here?

Every nine days, a young child dies after being left in a hot car in the U.S.

We can prevent these tragedies in the future. We MUST.

If you want to help, watch the original video on Facebook and share with those you care about, with new parents, with old parents. Lobby for change and let us know where you stand on this.

And always check the back of your car before you close the door, because if you think it can’t happen to you…

– Let me tell you a story. A mother who happens to be a nurse practitioner, Roseburg, Oregon, decides because her husband Pete is working nights as an ED tech and doesn’t get off until four in the morning, she decides to take her child Remington, Remy for short, to daycare that day and it’s not their typical routine but she really wanted to let Pete sleep in. So she puts Remy in the car, Nicole is her name, the mother, the nurse practitioner, and drives to work where she starts a day as a nurse practitioner doing all the very harried and important work that we do in medicine. She goes to her car at 4:00 p.m. after finishing the day, walks to her car, and finds Remy in the backseat and she’s unconscious and blue. And apparently went back in and screamed to the rest of the staff and we who work in medicine can imagine what this is like, and she, Remy, was taken to the hospital where the staff know who she is because Pete is an ED tech and they try to resuscitate Remy and she dies. And when she was arrested, Nicole told the police that she thought that she had dropped Remy off at school, but she hadn’t and when she saw her mistake, when she went to the car, that’s when that thin wall that separates all of us from hell itself fell down. And your reaction to this horrible tragedy, look, I am a father, I have two little girls. Tom and Logan are both parents or parents-to-be on my team and we talked about this yesterday and our reactions were so different that it said something very important that I wanted to talk about today. I felt like this could have happened to me. I am so distracted a lot of the time and I’m so type A that I run on my prefrontal cortex. I’m always planning and strategizing and thinking where I’m going. And our underlying reptilian brain, that basal ganglia underneath it that’s wired to do things unconsciously like drive, go through routines, go through patterns, often will run on autopilot unless it’s overridden. Tom and Logan immediately felt the outrage that many feel, like this mother killed her child through neglect. And I felt this could have happened to anyone, it’s a mistake in how we’re wired and now this is the worst possible thing that could happen to a family. And how we see this case says a lot about how we’re wired. So Nicole’s clinic, Evergreen Family Medicine, supported her wholeheartedly. Most of her community supported her wholeheartedly, the president of the clinic wrote a beautiful thing on Facebook talking about this case and ribbons were put up around town. At the same time, people in the community called for her head, they wanted to see her hanged, they wanted to see her rot in prison. They went around and pulled the ribbons down. Who’s right? Let me back up for a second because what you think about this says a lot about who we are as human beings. This has actually been studied, this distraction where children are forgotten in cars. As a parent, it seems inconceivable. All our evolutionary drives are programmed to prevent us from letting our children come to harm, and yet this happens to 30 to 40 children a year. And it’s been looked at, who does it happen to, is it the drug addicted mother who’s abusive, is it the abusive father who’s an alcoholic? It’s professionals, it’s dentists, it’s pediatricians, it’s rocket scientists, it’s blue collar truck drivers, it’s men, it’s women, it happens to all of us. How, what is going on? Well, it turns out this was entirely rare, almost unheard of, decades ago and then something changed. We required that children sit, instead of in the front seat next to their parents, in the back in a car seat, and not only that but we said infants of a certain age, toddlers, that car seat should face backwards, away from the parents for maximal safety in the event of a collision. This was a compassionate decision based on science to protect the most children. But what it did was it allowed the way we are wired as humans to fall into a problem where a flaw in that wiring can be exploited if all the mistakes line up at once like pieces of Swiss cheese where all the holes line up. And let’s talk about Nicole. How did those holes line up? Nicole is a nurse practitioner. She’s by all accounts a wonderful clinician and a wonderful mother and if you look at how she works, like many of us in healthcare, she’s probably a type A who’s very planned out, whose prefrontal cortex that does our strategizing and our planning and our conscious awareness tends to really be in control. What happened this day? She was tired. There was a change in routine, normally Pete maybe takes her to the daycare, takes Remy to the daycare. On top of that, she probably had a very busy day scheduled and was running through in her prefrontal cortex all the things that could have happened that day that she needs to plan for as a nurse practitioner. Remy probably fell asleep and wasn’t making noise in the car, there wasn’t crying, there wasn’t laughing, there was just silence in a back-facing car seat. Well, what happens? The reptilian basal ganglia that evolved hundreds of millions of years ago, we share with lizards, took over because her frontal cortex was busy and fatigued. And automatically drove her to the clinic on autopilot. We’ve all been there. If you tell me you’ve never driven on autopilot, you are lying to me. So she ends up at the clinic. All the Swiss cheese holes line up. Remy doesn’t make a peep. She’s never reminded there’s a child in the car. Consciousness never overrides the patterned behavior. She goes in, does her job, comes back to find the unthinkable. Now when you look at the actual people who’ve had this happen, these stories tend to align. These are not people who are intentionally neglecting their children, they are not bad parents, they are not stupid. They are wired in a certain way and when all the factors align to take advantage of the flaw in that wiring, tragedy can happen. Now is it normal for us to feel outrage, yes. Is it compassionate of us to feel outrage? I’ve talked a lot on this show about empathy versus compassion. Empathy is feeling someone else’s pain. If I feel Nicole’s pain as a mother finding her child dead, I’m gonna act a certain way but I can only feel one person’s pain at a time and not only that but I’ll tell you I wanted to do this show yesterday from my phone at home and I couldn’t do it because I was too emotional about the topic, and why was I so emotional? Because I felt Nicole’s pain. But then I read an article on which you must read and I will link to, called Fatal Distraction. And it talked about the science behind what was going on, and it also talked about the experience of finding the children in their cars. There was a little girl who they found who had pulled all her hair out before she died. And when you think about that, when you feel that,that’s empathy. And look, I can’t even hold it together and I’m trying to teach. How are we gonna make rational decisions when we’re that emotional? What is compassion? Compassion is understanding the pain of the child and of the mother and feeling love and concern and the desire to alleviate the suffering. So what’s the compassionate answer to the fatal distraction that comes from us being wired the way we are? First of all, it’s to support Nicole and that’s what I wanna do here. I wanna support everyone who’s lost a child in this way. It is a personal hell that you will never recover from and that is a horrible punishment. Putting you in jail is not going to make it better. I think we can show compassion by saying this is how we’re wired, why can’t we have sensors in the back of the car that go off when that child is left in the seat and you close and lock the doors? They tried to make them mandatory with a law and the auto industry lobbied against it because it would add cost and complexity. Maybe we need to have a teaching for new parents where we say, you know what, this can happen to you because it can, especially if you’re type A and you rely on this frontal cortex to run your life. Well, when that fatigues you’re going on autopilot. Maybe we need to check every time in the back before we close the door. Maybe we need to leave something we need next to a child in the back so that to open the door and get out, we have to go next to the child and see them there. Maybe we need a mirror on that back headrest so that we always see in the rear view what’s going on in the back of our cars. These are the compassionate answers to this problem, not trying to villainize this poor mother who made a mistake that I am telling you any of us could have made, that I could have made. So please, if you want to help, share this video with people you care about, with new parents, with old parents. Lobby for change, maybe we need sensors, maybe we need systems that are better. Support people like Nicole who’ve lost something so important. And always check the back of your car before you close the door because if you think it can’t happen to you, you’re wrong.