The final hours of Jeremiah Clark

Kathern Clark holds her 9-year-old son, Jeremiah, on the day he died, at Children's Memorial Hospital in Chicago on May 21, 2009. (Family photo)

An hour and 45 minutes later, Jeremiah continued to lie in the fetal position, records state. His skin was clammy, and he was making gagging sounds. Moffitt told investigators she didn't call 911 partly because Jeremiah didn't have a fever. But the school nurse called Alden again, this time complaining to the director of nursing.

Finally, at 12:45 p.m. — three hours after the school initially called — an Alden case manager showed up. Teachers lifted the boy from the mat and placed him in his wheelchair. The case manager then began pushing Jeremiah back to Alden.

When Jeremiah arrived at the facility, nurse Anna Jimenez reported he was moaning but not feverish, according to her nursing notes and statement to investigators. She decided to give the boy Tylenol.

Investigators would later ask why she didn't call a doctor. "I assumed he looked well," she responded. "And I was about to leave." Her shift was ending.

That night, Jeremiah's nurse was Morayo Oladeinde. When she came on duty at 11 p.m., Jeremiah was sleeping but "restless off and on all night," she reported. She gave him more Tylenol.

She told investigators that Jeremiah wasn't moaning, but Frimpong, the nursing assistant, reported that the boy — for the second night in a row — was "tossing and moaning all night." Jeremiah, he said, "looked really sick."

Oladeinde's night shift ended at 7 a.m. She was relieved by Digna Fatog — the only Alden nurse, records show, who reacted to Jeremiah's condition with urgency.

When Fatog began her shift, she found Jeremiah in his wheelchair, pale and lethargic. Alarmed, she asked the night nurse why she hadn't sent him to a hospital. Oladeinde did not answer, Fatog said. When investigators later asked Oladeinde why she did not call Jeremiah's doctor, she said, "No reason."

Fatog's nursing notes said Jeremiah's abdomen was distended "with board-like rigidity." Another nurse told investigators the boy was moaning, his heart rate was up, he was drooling excessively and he was sweating so much his clothes were wet.

Fatog noticed his oxygen saturation rate — the concentration of oxygen in the bloodstream — was low: 89 percent, compared with a normal range of 95 to 100 percent.

She immediately hooked up Jeremiah to an oxygen tank and called the boy's family and physician — the first time, records show, anyone had called his doctor in the 48 hours since he showed up at school with his abdomen leaking fluid.

The doctor gave orders to send Jeremiah to the emergency room. Ambulance paramedics found him breathing rapidly and his pulse racing at 160 beats per minute.

At Advocate Illinois Masonic Medical Center, emergency room doctor Max Koenigsberg saw that Jeremiah was pale, gray and in shock. Blood was in his G-tube, and he had bloody diarrhea and a massively distended abdomen. Jeremiah had stopped breathing on his own, so a tube was inserted into his windpipe, and he was connected to a ventilator, records state.

About 11:15 a.m. Jeremiah was transferred to Children's Memorial Hospital, where physicians found him to be in extremely critical condition, likely related to a "catastrophic" event involving his stomach and intestines, probably an obstruction of some kind, records state.

On the way to Children's Memorial with her sister, Jeremiah's mother didn't realize how sick he was and thought he would be fine. He had been in and out of hospitals many times before.

She said she was stunned when a doctor called her cell phone to say Jeremiah was in grave condition and "may not survive even if he could tolerate a surgical procedure."

Unwilling to subject her son to any more suffering, she decided to forgo surgery and let him go. Hospital staff took photographs of the two of them together as well as ink and plaster prints of one of his hands. Jeremiah then died at 9:25 p.m., in his mother's arms, surrounded by family.

When Jeremiah wasn't in class the next day, a Friday, Moffitt thought he was out sick. It wasn't until the following Tuesday that the teacher learned from a school attendance aide that Jeremiah had died.

"I don't think I've ever been shocked like that in my life," she said. "After that, shock had a new definition. Never ever, ever, did I ever think he was going to pass away — ever."

There was no public announcement of his death at the school. No e-mail was sent to parents. When Jeremiah's "book buddies" — the Gale students who read to him — asked where he was, Moffitt felt she had to tell them.