When the phone rings in Denise Bertone’s office, it’s usually tragic news: A child has died somewhere in Los Angeles County.
Bertone, 50, has been the chief – and only – infant and child death investigator at the county coroner’s office for the past 11 years. This year, she's averaging about 20 new cases every month.
Day after day, she looks at lifeless children, photographs ghastly and disfiguring wounds. She also consoles grieving parents and coaxes them to provide details of the death. Her job is to figure out what happened. Sometimes investigations take weeks.
On a sweltering July morning, Bertone was loading photos from a recent autopsy into her computer, adding them to the child’s file, when she learned of a new case.
“A 4-month-old little girl died in the hospital in the intensive care unit at Children's Hospital,” she said. “It was reported that she was found unresponsive while sleeping.”
Bertone immediately called the detectives who had been assigned to investigate the family's 911 call. The baby was discovered in bed, not breathing.
Oftentimes when a baby is found unresponsive, she said, distraught parents can become hysterical and details sometimes get confused.
The detective tells Bertone he heard varying accounts of what happened: Whether the baby choked or turned over and then couldn't breathe. Bertone thinks she can clarify things with a doll reenactment.
Bertone takes a baby doll with her when she investigates sleep deaths and asks parents to demonstrate how the baby was put to sleep and how the baby was found. It’s become her signature tool, unlocking many complicated or confusing cases.
In her years on the job, Bertone has seen many families in pain and shock. The family of the 4-month old is no different.
Bertone drove to the nondescript cement house in La Puente and spent more than an hour with the family. She took notes on almost everything they said, gently asked clarifying questions and probed for details that cause the parents to stop and think.
“I held her when she was born, and I got to hold her again for the last time when she passed,” the grieving mom, Debbie Avila, tells Bertone between deep sobs.
Denise Bertone does her job with grace: equal amounts of empathy, serious questioning and shared silence.
On leaving the home, Bertone took a deep breath. She absorbed the neighborhood sounds and roosters crowing, gazed up to the sky, and breathed deeply again.
“To sit and talk to me for an hour when it is so painful," she said. "I can’t imagine what it must be like ... .”
No one knows how the baby might have wound up face-down on the bed. Bertone wrote the death up as accidental.
In a county of 10 million, thousands die each year. Not all adult deaths are investigated. But Bertone looks into every child death.
“I keep a written log,” she said, flipping through a large, lined book. Each child death is entered on its own line in Bertone’s neat cursive script. There are 30 entries per page. Each tells a story of tragedy.
One child choked on a hotdog. Another fell from a height. Yet another drowned in a backyard pool. A fourth child was crushed by a car.
Then there are the infants and children who die from abuse or illness. This year Bertone has seen an unusually high number of stillborn infants born to drug-addicted mothers.
"Unsafe sleep environments"
The kind of death that bothers Bertone the most is accidental suffocation during sleep, often while sharing a bed with parents. The official finding is death due to “unsafe sleep environments.”
These scenarios involve babies unable to breathe when a sleeping parent’s blanket is accidentally tossed over their face, or when babies roll onto soft bedding or into stuffed toys and can’t lift their heads to breathe.
These preventable deaths bother Bertone so much that she became an advocate. She helped the county design and execute a public service campaign launched this past Spring to warn parents not to co-sleep or put toys or blankets in their baby’s crib.
The campaign was controversial because some parents believe sharing beds with their babies forms strong bonds. The practice has been widely advocated by some attachment parenting and breastfeeding groups, who say they've done it with multiple children, to wonderful results.
A month after the campaign launched, Bertone said she thinks it is working. She said fewer babies died during unsafe sleep in July than in prior months.
But it still happens.
Bertone has two adult children. Before she worked at the coroner's office, she was a nurse. Over the years, Bertone says she has learned not to take her work home with her.
She starts her day at 5:30 a.m. so she can finish up early enough to play with her dogs in the park and tend to her rose garden.
But still, even in her downtime, she sometimes can't escape her profession.
"I was on vacation on a train once in a very remote area of Scotland," she said, and struck up a conversation with an elderly passenger. "I normally don't say what I do, and she asked me, and I told her.
"She had a child who died when he was 7 years old," she added. "And she told me it feels just like it was yesterday."