Less than three hours after she was sitting up on her dad’s knee, happily eating an ice cream, Tauranga toddler Ruby Smart was dead. The cute 22-month-old had been unwell with a virus for three days, but that evening she climbed up onto the sofa where Dion (39) was sitting and cheekily took the ice cream from his hand. After eating it, Ruby fell asleep on the sofa beside her mum Katherine.
Even Katherine (38), a paediatric nurse, didn’t realise that Ruby had meningococcal disease and was dangerously close to death. Because Ruby was going through surgery for a cleft palate and also had some hearing loss, her parents were always extra-cautious about her health.
When she got a fever at daycare, Dion took her to their GP, who diagnosed a viral infection. Ruby vomited a few times but two days later she seemed to be on the mend, happily playing with her big sister Jorja (4). “She was a lot brighter and had started eating a little bit,” says Katherine. “She hadn’t vomited since the morning and was feeling a bit hot but we just thought it was a virus.”
That night, Ruby wouldn’t settle and had a fever again. “I thought that something else was going on so I decided to take her to the GP the next morning,” remembers Katherine. Ruby then ate the ice cream and fellasleep. But an hour later, she suddenly leapt up and fell off the couch. She became agitated and when Katherine managed to calm her down, she says Ruby “looked right through” her.
They called an ambulance and Ruby’s breathing became laboured. on the way to the hospital, a rash beganto appear on Ruby’s lower legs – a dreaded sign of meningococcal disease. Until then, Katherine had not suspected meningitis. “She had been happily eating ice cream so meningococcal was the farthest thing from my mind,” she says.
Although Katherine had spent her career working with sick children, she had not nursed anyone with meningitis before. “I thought she had a convulsion from her fever, but the ambulance driver didn’t think so. She was in and out of consciousness,” she says. “I was in shock so I wasn’t thinking like a nurse – I had my mother hat on.”
At hospital, Ruby’s system began to shut down. Suddenly, she called out three of the few words she had learned in her short life – “oummy”, “Naddy”, which was how she said Daddy, and “Unny”, her word for her favourite toy, Bunny. Then she let out a heart-wrenching cry. “I knew in my heart it was a bad sign,” recalls Katherine. “And then she took her last breath. It was surreal – I could see them pounding on her chest and I thought, ‘That can’t be my little girl.’ I knew she was already gone and after 25 minutes, I told them to stop working on her.”
At her funeral, Ruby’s favourite songs from the musical oamma oia! and The Muppets were played, along with Ruby Tuesday by the Rolling Stones. Since losing Ruby in April, her friends and family have joined together to help create a garden around a playhouse that Ruby loved, as a memorial to the little girl they all cherished.
It’s not known what strain of the disease Ruby was infected with. She was born in 2008, after the meningococcal B vaccine was removed from the immunisation programme due to a dramatic drop inthe number of cases. oeningococcal C can also not be ruled out as a cause and there continue to be a number of cases of meningococcal disease every year. The couple hope Ruby’s tragic death will remind New Zealanders that the disease is still an issue and want to
keep parents and caregivers alert to the warning signs.
“Tauranga is an area where they used to see hundreds of cases but now they see hardly any, so we felt safe,” explains Katherine. “It’s just terrible luck that Ruby was struck down by it.” Looking back, Katherine wishes that the paramedics had been able to give Ruby antibiotics immediately and wonders whether she and Dion should have taken her to hospital sooner.
“If something happens at night, you may think it can wait until morning, but you should go to the hospital – no matter what time it is,” she says. “I could torture myself by playing out different scenarios in my head, but I just have to accept that I did all I could. I take some comfort that Ruby only suffered a little bit and not for a long time.”
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