Somehow, the babies and I all made it through. I didn’t get any sleep. I spent the whole night running from room to room trying to figure out what was going on, but nobody died, nobody even crumped, and when the morning came, I was still standing on my feet. I think I did pretty well. Maybe I’ll go into neonatology.
By the way, after I finished yesterday morning, I went into the chiefs’ office and they thanked me for filling in. I very graciously told them that if they ever pulled anything like that on me again, I’d reach down their throats, yank their spleens out through their mouths, and refeed it to them. I was very polite about it. I think they got the point.
Bob
NOVEMBER 1985
When I was a house officer, we occasionally saw children who were beaten or molested by their parents or other adults, but these cases seemed to be few and far between. I vividly remember one of the first abuse cases in which I was involved. In clinic one day during a month of OPD at Jonas Bronck, I found that I had been assigned a new patient, a little eleven-year-old girl named Brenda. As soon as I called her into the examining room, her mother began to tell me that Brenda never seemed to have any energy; she was always tired, was complaining of too many bellyaches, and seemed to be gaining a great deal of weight. When I started to examine the girl, it took less than a minute to diagnose the problem: Brenda was about six months pregnant.
Realizing that I now was going to have the gargantuan job of informing this mother that her daughter, a child herself, was going to have a baby, I told Brenda to get dressed and sent her out to the waiting room. I started the conversation awkwardly, asking if Brenda had begun to get her period yet and whether she had a boyfriend. Finally, after beating around the bush long enough, I blurted out the news to the woman.
She wasn’t surprised. She told me she had seen her daughter’s clothes get tight and had noticed that her breasts had become swollen. Then she told me an amazing piece of news: She knew who the father of the baby was. He was Brenda’s fifteen-year-old brother, the person who was entrusted with caring for the girl after school when the mother was at work. The brother, apparently fed up with having been saddled with the responsibility of looking after his sister when he’d rather have been out with his friends, had taken his frustrations out on the girl.
I spent hours with that family. We talked about abortion, an option Brenda’s mother rejected for religious reasons. We talked about the effect the pregnancy would have on Brenda and on her brother. We talked about what measures should be taken to prevent anything like this from happening again. Brenda’s mother assured me that she would discipline the boy in her own way and begged me not to report the case to the Bureau of Child Welfare, the state-run agency charged with investigating possible cases of child abuse. After long discussions with the mother and the clinic attending, I decided to go along with her wishes. That might have been a mistake: I never saw Brenda or her mother again.
I think I made that mistake for the same reason I can remember Brenda so distinctly: Hers was one of the few cases of child abuse I was called on to manage during my residency. Now, several years later, an intern can’t even make it through a single week in the OPD without getting involved with the BCW. Child abuse and neglect have definitely increased over the past few years. Rarely a day goes by now without a family of two or three or four kids who have been abandoned or beaten or sexually molested being escorted into the emergency room. I was working in the ER last week and the cops brought in a family of seven children ranging in age from ten months to eight years. The parents were both crack dealers; the mother had been arrested the previous Thursday, and the father had been taken into custody the day after that. These children had been left to fend for themselves for three full days. They were starving; dirty; and very, very scared. Medical care in their cases included food, baths, and hugs. The police had been called by a neighbor who had complained that the baby was crying too loudly. They were temporarily placed in a shelter.
Although child abuse is clearly on the rise in New York, there’s another reason that so many more abuse patients are being identified. The house officers are far more sensitized to the signs and symptoms of child abuse than my fellow residents and I were in the early 1980s. Interns are asking questions I never would have even thought of asking, such as: Where does the child sleep? How many people sleep in the same room? Who watches the child during the day? And they’re performing more pelvic and rectal exams in younger kids than we performed. Through these means, they’re finding evidence that we simply would have missed.