When Ryder Morrison was rushed to the hospital, paramedics and medical staff were told the 1-year-old boy had fallen about six inches while pushing or climbing on a toy.
The toddler's live-in nanny Kelli A. Jacobsen said she'd been preparing a snack in the kitchen when she heard a thud and rushed to the living room to find Ryder on the floor.
So as doctors at Kadlec Regional Medical Center in Richland were trying to determine the extent of the boy's injuries based on that description, one emergency room nurse said it confused her to then overhear the caregiver say it might not have been accidental.
Shelley Goldstein -- the lead nurse on Ryder's case when he came into the hospital on June 22, 2011 -- was one of seven emergency providers who took the stand Thursday in the first day of testimony in Jacobsen's trial.
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Jacobsen, 28, is charged in Benton County Superior Court with first-degree manslaughter. That includes aggravating circumstances that the victim was vulnerable given his young age and that his death had a destructive and foreseeable impact on others.
Goldstein said she was standing just inside the door of the pediatric trauma room, typing the information they'd received into a computer, when she heard Jacobsen apparently talking to herself.
"I heard her say 'I cannot believe I did this,' " Goldstein told jurors. "I looked out. I just thought it was a weird statement (after) hearing the story given to us by (Emergency Medical Services) that he'd fallen from six inches."
Goldstein said it "seemed a little strange," but admitted to the defense that she didn't mention the comment in her notes because her focus at the time was on trying to save Ryder's life. She also said she did not mention it to prosecutors or police until months later during a follow-up interview.
Doctors and nurses have said they already had determined that afternoon that the nanny's story didn't make sense.
Ryder didn't have any bruises, scrapes or marks on his body, Dr. Peter Later testified. But a scan showed the boy was bleeding inside his skull and his brain was swelling, and Later -- who has seen hundreds of children after minor falls and has six kids of his own -- recognized that something more had happened.
"I knew he had a brain hemorrhage, and he was probably going to die. You're just grasping at straws, trying to find what can I do to help this kid," Later testified. "What more can I do to correct the situation? What's going on?"
Later said he and his colleagues in the hospital knew there was no time to fly Ryder to Spokane. He said he told an emotional Tawney Johnson that they were going to try surgery, but let her know that her son was in poor condition and it didn't look too promising.
Then, as they were trying to get the boy up to the operating room, Later said he briefly stopped to tell Jacobsen she might be investigated by Child Protective Services or authorities. His intent wasn't to be accusatory, he testified, but he wanted to see if he could get any more information and to warn Jacobsen so she wouldn't be surprised.
Jacobsen was sullen with a "look of obvious worry" because something was wrong with the boy she said she loved almost as if he were her own child, Later said.
Jacobsen reportedly had helped to care for him since he was several weeks old. Ryder celebrated his first birthday the day before he died in surgery.
Prosecutor Andy Miller told jurors that during the three-week trial they will hear evidence that Ryder's injuries weren't caused by hitting his head in a fall, but by his nanny.
Ryder's cause of death was "abusive head trauma." Experts will testify that the autopsy showed numerous bruises, but two in particular occurred within minutes to hours of Ryder's death, Miller said.
However, defense lawyer Scott Johnson said there are three theories in the case: Tawney Johnson is to blame for her son's death; his client Jacobsen is responsible; or it was an unknown or accidental cause.
Johnson explained that in his third theory, "something happened and we don't know what that something is, but it wasn't at anyone's hands."
Jacobsen has been consistent in stating the basics of what happened that day, Johnson said. He argued that some doctors will say Ryder's injuries could have been up to 24 hours old, which would cover the time when the toddler might have fallen off the kitchen counter.
In the end, evidence will show there are two truths -- the heartbreaking fact that Ryder is gone and that we'll never know why, Johnson said. And that will lead to one outcome, that Jacobsen isn't guilty as charged, he said.
The trial continues Friday at the Benton County Justice Center in Kennewick.