The Intern Blues(73)
The net effect of all of this is that the Bureau of Child Welfare has become completely overwhelmed. The BCW always has had its problems. Calling their twenty-four-hour hot-line number to report a family has always been an exercise in frustration. They’ve been slow-moving in completing investigations. But this has all become worse since the current “epidemic” of child abuse hit. And new methods of guaranteeing the safety of at-risk children have had to be invented.
The “joint response” for reporting serious abuse involving children was only recently developed. When the examining doctor believes that a child has been abused and that his or her life may be in danger, both the BCW and the New York City Police must be informed immediately. A member of the sex crimes unit of the police force is then immediately dispatched to investigate the situation. The child, who may have been beaten by the mother’s ex-boyfriend, may have been sexually molested by a relative who lives in the same apartment, or may have been removed from a home in which another child has been killed or seriously injured, cannot be released into the custody of the parents or other relatives until the results of the police investigation are known. Since most abused children appear in the emergency room during the evening or night, sleeping accommodations for the child must be arranged. This entails either admission to the hospital or, if possible, transfer to some shelter.
To the house officer, dealing with child abuse translates into pure aggravation. There’s endless scut that must be done. In cases in which sexual abuse is suspected, a “rape kit” must be completed and followed to the letter so that the collected specimens can be used later in court as evidence; reams of medical and legal forms must be completed according to strict guidelines; telephone calls to agents who are themselves overworked and who aren’t always the most caring or sympathetic individuals must be made; and careful explanations to hostile, suspicious, and often guilt-ridden parents must be given. All this must be carried out by doctors to whom child abuse is a particular anathema; these people, who become adjusted to death and disease, frequently become physically ill themselves while working with a child who has been abused.
The net effect of all this is that progress through the pile of ER charts is dramatically slowed. A house officer can be tied up for an entire night reporting a single child abuse case. In an emergency room in which three or four residents are seeing all patients, the loss of one or sometimes two doctors can add endless hours to the waiting time. Parents sitting with sick children become angry and hostile as the clock ticks on. Often the whole situation ends with hospital guards being called to protect everyone from injury.
Andy
DECEMBER 1985
Wednesday, November 27, 1985
So I survived my first night on call at Jonas Bronck. It was busy, another night of sleep deprivation. Harvey Abelson announced in front of about six people that I was going back to Boston. Not in a real obvious way; no, he was very subtle. He said something like, “So I hear you’re going to Boston next year!” He said it really loud, in kind of a nasty tone. So now I feel a little bit like a persona non grata around some people. What do people think when you leave a program? Do they think you’re turning your nose up at it and, in a sense, at them? Can’t they accept that you’re leaving because there’s something else, something more important than being in this program for you? Why can’t they just accept that?
Friday, November 29, 1985
I’m on a flight to Boston, to spent the weekend at home. This is the first year I was away from my family on Thanksgiving. It was a real bummer. I was on call yesterday, and there was nothing to eat. Stupidly, I forgot to bring anything to the hospital from home. I should have known that there would have been nothing available to eat at Jonas Bronck, but I just didn’t think about it. I mean, there was nothing. I starved during Thanksgiving. What an image! Well, it’ll make going home even better. I don’t know . . . I just hope I’m never on call for another Thanksgiving.
It’s been an amazing few days. I started working on 8 East this week. It took only a few days for word to get around that I’m leaving the program next year, and I’ve already noticed a big change in the way people are reacting to me. It’s a funny thing; some people want everybody to know that I’m leaving. For example, Alan Cozza, the director of the pediatric service at Jonas Bronck, has referred to my leaving in front of a lot of people on a couple of occasions over the past week. He’s not doing it with any kind of malice. I’m not really sure why he’s doing it, whether there’s a certain sense of pride he feels, like he’s proud of this program and thinks that when I go to Boston I should reflect how good it is, or if he really wants to mark me as different from everybody else. It’s a strange thing.