The mourning after

IT starts innocently enough; a runny nose, lethargy. The first symptoms become obvious midweek, but Maddie Tippett appears to improve. It is February 2014, just over a month since her third birthday. Her dad, Mick, photographs her in the backyard of the family’s modest Mayfield home happily showing off her favourite present, a Snow White costume.

Like most three-year-old girls, Maddie is a delight. Amid her singing and endless chatter, she imagines entire worlds and has no trouble convincing Mick to play a cast of characters. But on Monday, February 17, she can not rummage the energy to leave the lounge.

‘‘We kept her home from preschool,’’ remembers her mum, Kerryn.

‘‘She spent the whole day lying on my chest and we watched Beauty and the Beast about 15 times,’’ adds Mick.

That afternoon, a concerned Kerryn takes Maddie to the GP. It is a virus and there isn’t much that can be done apart from Panadol, fluids, and rest.

Since the arrival of the couple’s son Clark six months earlier, Kerryn has been on maternity leave from her marketing role with Event Cinemas and also hasn’t yet returned to her other job as a wedding celebrant. Mick, a sound recordist, works from home – has done since Maddie’s trouble-free birth. He hadn’t wanted to be away from ‘‘this tiny, defenceless being’’ and put in long hours in a studio like his father. The decision allows Mick to support Kerryn throughout the day and well into the long, sleepless night that follows.

It is late and Maddie isn’t settling. Mick climbs into her bed and comforts her. She is ‘‘fitful’’ and her breathing is laboured. She says her chest hurts. Kerryn, now very worried, decides they need to drive her the eight kilometres to John Hunter Hospital.

It is not much past 3am on Tuesday when Maddie, accompanied by her parents and baby brother, walks through the hospital’s glass sliding doors.

Fourteen hours later, in spite of the desperate effort of a room full of tearful doctors and nurses, her heart givesout.

 THERE is before: play dates, giggles, first day of preschool, scattered toys, games in the cubby house, silly songs, mornings at Gregson Park, swimming lessons, contentment. And then there is after. Brutal. Soul destroying. The end of certainty and the destruction of the very ordinary, universal expectation of two parents who took for granted that they would see their only daughter navigate childhood and become a woman.

 Nothing could have prepared Kerryn and Mick for what happened.

‘‘I’d taken a photo with my phone of her hooked up to the monitor and drip to show her when she woke up,’’ remembers Kerryn, 35. ‘‘We knew it was serious, but we expected to take her home a few days later.’’

After arriving at the hospital, the triage nurse noticed Maddie’s nostrils were flared – a sign that she was having trouble breathing – and monitoring showed decreased oxygen saturation. The family was promptly escorted to a bed in the emergency department.

‘‘The doctors did some tests and because she was cold, they suggested I lie in bed with her,’’ says Mick. ‘‘She was facing away from me and suddenly everyone started panicking.’’

Adds Kerryn: ‘‘I could see her and she vagued out. I was saying ‘Maddie, Maddie’, and all of a sudden there was a room full of people.’’

She stopped breathing and was resuscitated before being transferred to intensive care. Though in a serious condition, by mid-morning Maddie showed signs of improvement. Mick’s parents visited and took Clark with them back to Mayfield. Because she was breastfeeding, Kerryn returned home to feed him a bit later. She repeated the trip again in the afternoon.

Test results showed that Maddie had respiratory syncytial virus (RCV) and adenovirus (see information box). Everyone was in ‘‘wait and see’’ mode, and the panic that engulfed the couple in emergency that morning diminished.

‘‘I had complete confidence in the care she was getting,’’ says Kerryn. ‘‘I was like, right, this is what we’ve got to do to reorganise the schedule. I sent emails that day saying Maddie wouldn’t be at music or preschool this week. I cancelled play dates and texted parents from preschool I knew and told them that Maddie had a virus and to keep an eye on their kids, but as far as we knew it wasn’t contagious.

‘‘Throughout that whole time it never entered our heads at all, even when they said she was very sick, that we wouldn’t be bringing her home.’’

‘‘I thought it would be something we talked about the rest of our lives,’’ says Mick, quietly. ‘‘The time Maddie was in hospital.’’

We are seated at the family’s dark timber dining table. The house is quiet because Clark, a blond ‘‘pocket rocket’’ as Kerryn describes him, is with his grandparents. A very pregnant Kerryn is opposite me, sipping a mug of tea. A canvas photo on the wall behind her shows a giggling Maddie as a toddler lying beside her newborn baby brother. The couple’s third child is due in early April.

Kerryn and Mick are welcoming and friendly, but my stomach is knotted. Throughout our three-hour conversation, Kerryn frequently sheds tears. ‘‘I’m a cryer,’’ she says at one point, smiling and sniffling. Mick is a calm, warm-hearted presence seated to my left in a flat cap, its quirkiness contrasted by a piercing on his left eyebrow.

Since their first night out together in 2007 at the Hotel Delany, the couple has been inseparable. ‘‘Kez’’ had resigned from her job in radio and was returning to Brisbane when they met for a few drinks that night in Cooks Hill. Mick, then a sound engineer at NBN, asked her to undo her plans, and she stayed. They married in late 2009 and renewed their vows last July in a kitsch Las Vegas wedding chapel. Madeleine was born in January, 2011, but very quickly became known as ‘‘Maddie’’.

‘‘The first month to six weeks, I was in awe of her and terrified of her,’’ recalls Kerryn. ‘‘I’ve run businesses and had a career in radio, but this baby was completely foreign and so dependent. After a while you get into the swing of it and Mick was there to help.’’

‘‘I’m a night owl and Maddie was too,’’ adds Mick, 41. ‘‘I’d stay up so Kez could sleep and I’d take her into her when she needed a feed. It was always a conscious decision to start working from home and looking back, every single available moment I could spend with Maddie, I did.

‘‘I didn’t miss out.’’

Kerryn returned to work at Event Cinemas around the time of Maddie’s first birthday. She found it hard to be separated from her daughter so Mick decided to make a video clip pick-me-up that she could watch in the office. They could also send it to Kerryn’s parents in Perth.

Maddie's original video

The hilarious result shows a big-eyed, short-haired Maddie with her first few teeth poking up. She is sitting in her highchair and enjoying a battle of wills with her father about which of her parents is her favourite. ‘‘Mum,’’ she announces, before the banter – some of it in witty subtitles – continues. Mick uploaded the clip, Who’s Your Favourite?, to YouTube and shared it on Facebook. It quickly spread and Maddie became a sensation. American actor/director Zach Braff was involved in a very funny follow-up video.

Who’s Your Favourite? has now been viewed more than 12 million times, but neither Kerryn or Mick are surprised that their daughter’s charm won over so many people. ‘‘There was a quality about her,’’ says Kerryn. ‘‘Everyone who met her fell in love with her.’

 LATE afternoon. Mick has just had a much-needed shower and is sitting beside Maddie’s bed in the intensive care unit. Since the fright they experienced in emergency that morning, she has been stable and even showing subtle signs of improvement. Kerryn is temporarily at home in Mayfield bathing and feeding Clark.

 Suddenly, a monitor begins beeping. Even without any medical training, Mick can see that Maddie’s heart rate is erratic. A nurse rushes in. And then another. ‘‘Before I knew it, it was a whirlwind of doctors,’’ says Mick. Someone tells him to phone Kerryn. ‘‘It was the worst phone call I’ve ever had to make in my life.’’

‘‘He said she was in cardiac arrest,’’ says Kerryn, crying, her voice strained. ‘‘I had to drive back to the hospital and I rang my parents and they stayed on the phone with me the whole time. I parked in the emergency section out the front and ran. I’m not sure if I even shut the car door.’’

Staff are waiting for her.

‘‘They worked on her for 55 minutes.’’ Kerryn wipes away the rush of tears. ‘‘I think they did it because they don’t ever want to give up on a child. Ever.’’

Mick is quiet. ‘‘The doctor who was pumping her chest just kept looking over at me,’’ he says, lowering his eyes. ‘‘I thought, f –  – k, mate, I know you’re trying.’’

A doctor tells them, ‘‘We are going to stop’’.

The couple is crippled with shock.

Kerryn struggles to speak. ‘‘A nurse whispered to me, ‘Go to her, hold your baby’.’’ They cradle Maddie for an hour, uncomprehending.

 NEWS of Maddie’s death made headlines around the world. In Mayfield, Kerryn and Mick were existing in their own orbit of grief. Maddie’s toys dotted the lawn, her crumpled sheets remained on her bed (they are yet to touch her belongings). Clark remained blissfully unaware that his doting big sister was gone.

‘We weren’t trying to be brave, but I think we felt we had to be strong for Clark,’’ says Kerryn, who continued to breastfeed. ‘‘He had no idea what was going on, but I was aware that even at that age, he would still be susceptible to our stress and emotions.’’

They admit they are hyper-vigilant with Clark. Any sign of a snotty nose sees him whisked off to see their empathic GP. A bout of gastro meant a visit to John Hunter Hospital. ‘‘I see myself doing things at times and I know it’s too much,’’ admits Mick. ‘‘He has to be able to graze his knee, to fall. I think as long as we’re aware of it, and can pull back, it’ll be OK.’’

Maddie’s absence has left a yawning gap in the couple’s lives.

‘‘In the beginning, you think that you might never be happy again,’’ says Kerryn. ‘‘You think about the act you’re putting on, at birthday parties and that kind of thing. The pain is there in your heart the entire time,’’ she continues, placing her closed right hand on her chest, ‘‘and it always will be. That’s one thing that’s hard to explain to other people; the pain doesn’t leave. Time doesn’t change anything, it just puts distance between you and the memories of that day.’’

Kerryn and Mick have endured the stuff of nightmares. Having to watch their precious child die entitles them to rewrite the rules, or to smash them to pieces. That protective force field we conjure to envelope our children has vanished for them. In its place is a blade-sharp awareness of their mortality, and a desire to savour every priceless moment.

‘‘Grief can be selfish,’’ says Mick, ‘‘and as Maddie’s parents you want to own it. I had a down point last year and I spoke to Kez about going to South America. I’d always wanted to climb Machu Picchu and she practically bought me the plane ticket on the spot. I went with Ben [Hayes, a mate] and there were a couple of points where I was really struggling, mainly because of the altitude. I remember projecting Maddie’s image and her saying, ‘Come on, Dad’.’’

‘‘She’s taught me to be fearless,’’ says Mick, who has started to explore writing, something he has wanted to do for a long time. ‘‘I’ve got nothing to lose. All these things she’ll never have the chance to do – climb a mountain, write a book – I almost feel a duty to do that for her. Maddie could have cured cancer, or just lived a life of pleasant mediocrity, but the fact is she didn’t get the chance to do anything.’’

When Mick reached Machu Picchu after the challenging trek, he made a video and announced to friends via social media that he and Kerryn were expecting another baby. They have chosen not to find out the sex of their unborn child. They are aware either outcome will be emotionally loaded and they aren’t prepared to absorb other people’s platitudes, however well-intentioned.

Ben Hayes and his wife Mel, longtime friends of the couple, have helped to support them in the past year. ‘‘To tell you the truth, they’re doing remarkably well,’’ says Mel, whose four-year-old daughter Charlotte was close to Maddie. ‘‘Their ability to pick themselves up and carry on is amazing. We still get together and we laugh.

‘‘I said to my husband early on, ‘I’m not going to be absent’. I think the mistake people make is that they don’t know what to do to help, so they don’t do anything.’’

Amid the devastating aftermath of Maddie’s death, Kerryn and Mel would go for long walks on the Warners Bay foreshore or Nobbys breakwall. ‘‘Kez would just talk the whole way.’’

I FEEL so sad for Kerryn and Mick. I know in my heart what it is like to have a spirited three-year-old filling the house with her boundless, joyous energy. Our daughters were born in water, three months apart. It is painfully easy to imagine their bone-deep sorrow.

‘‘Oh god, yeah, I miss her,’’ weeps Kerryn, pausing to compose herself. ‘‘Clark is different and this baby will be different. They are not Maddie. I miss her conversation ... [pause] ... I miss her imagination, her energy. She was a bright, happy little girl.’’

‘‘You’ve got two choices,’’ says Mick, placing his left hand on top of Kerryn’s. ‘‘You can let it destroy you or you can make the best out of a really shitty situation. Even though our hearts are broken and always will be, good has come from her passing – us realising what’s important, and me healing the relationship with my mum.’’

They are grateful Maddie received the best care possible.

‘‘Everything that happened, regardless of the outcome, was the ideal,’’ says Mick. ‘‘She had every possible person looking after her, every possible procedure that needed to be done, was done.

‘‘We can’t fault that, and that’s a blessing in itself. The anger that we have isn’t directed at anyone, it’s just directed at the situation.’’

Kerryn and Mick don’t often watch the video of Maddie that introduced her to the world, but neither do they regret its impact. ‘‘I got a personal message a couple of weeks ago from a man in Iran,’’ says Mick. ‘‘It was a four-page message and he said they had a daughter and named her after Maddie. It was an incredible moment. This guy, who lives on the other side of the world, was inspired by Maddie.’’

Maddie’s death has altered them in ways they couldn’t have predicted. ‘‘You try and keep your humanity,’’ says Mick with just a hint of frustration. 

‘‘When you see people on Facebook complaining because their car has broken down, or they’ve stubbed their toe, and whingeing about having a bad day. My definition of a bad day has been totally rewritten.’’

Adds Kerryn: ‘‘It’s a whole new exercise in tolerance and getting out of bed each day. Here we are 12 months later and some people have moved on, and some people haven’t and that’s normal, that’s fine. 

‘‘We’re trying to manage how we feel against everyone else and it’s hard because some people want to express their grief to you, and .... [Kerryn pauses, crying, and presses her right hand to her chest] .... but it’s hard because I might be having a good day.’’

The unpredictable moods of grief impact on Mick and Kerryn differently, too. On what would have been Maddie’s fourth birthday in January, Kerryn managed a bit better than Mick, but she took a dive on the recent anniversary of her death.

‘‘It’s hard,’’ reflects Kerryn. ‘‘I might be having a bad day and struggle to stop the tears, yet Mick can be going OK. Or it’s the other way around. 

‘‘You do snap at each other, but we also know what the other is feeling. We’re her parents.’’ 

We have talked far longer than planned and Kerryn needs to rush off to an appointment with a couple she will marry in a few weeks. She straightens her red and black floral dress, grabs a folder and walks outside with me after farewelling Mick with a sincere, ‘‘I love you’’.

She manoeuvres her large, beautiful belly into the driver’s seat of the family car and waves goodbye with a smile.

Life, though forever altered, goes on for Kerryn and Mick. And there is a new baby on the way.

Listen to your Uncle Zach

Maddie was infected by an uncommon combination of two viruses, respiratory syncytial virus (RSV) and adenovirus, which caused inflammation of her heart.

RSV is common in children, especially in the first year of life, and causes respiratory tract infections such as bronchiolitis. ‘‘RSV is something you and I get most winters,’’ says John Hunter Hospital intensive care specialist Martin Rowley. ‘‘When your child has it, they can develop a respiratory infection and you will probably only have the sniffles.

At JHH, staff see about 500 children a year with RSV. ‘‘About 25 end up in intensive care and of those, possibly five to 10 need major life support,’’ says Rowley.

Adenoviruses are a group of viruses that can infect the membranes of the respiratory tract, eyes, intestines, and urinary tract. They account for about 10 per cent of acute respiratory infections in children.

‘‘Adnovirus is not common,’’ says Rowley. ‘‘For the past two years, we’ve had the ability to do rapid tests to look for these viruses and we haven’t picked up more than half a dozen children with adnovirus in the period. I haven’t seen the combination of the two viruses at all in that time.’’

Maddie developed viral myocarditis and also cardiomyopathy, serious complications affecting the heart.

Rowley stresses that parents should not panic if their child has a cold. ‘‘Most children get a cold, but we are looking for something more than a cold,’’ he says. ‘‘We’re looking for a prostrate child, a child who is lethargic, who’s struggling to breathe, who won’t eat or drink. It’s a cold gone bad and there are so many ways a cold can go bad and myocarditis isn’t even on the page of complications it’s so rare.’’