The police had been called to the house by a neighbor who said she heard children crying and hadn’t seen the mother in two days. It was the middle of a night in July, and the children’s wails would have traveled through the project windows left open to catch cooling breezes.
Paramedics provided transport to the hospital, but the normally cynical and well-defended police were so outraged that they also came to the ER, where I was the resident on call.
The police came to find and punish those who had neglected this waif, but I also sensed that, despite their tough exteriors, they came also to vent their impotent rage and to seek reassurance that this tiny, dirty, appealing thing would live. Our hospital had no pediatric ER staff, and although I was only a second-year Family Medicine resident, I was the senior “pediatrician” in-house. And so I needed information. How was the baby found? What diseases had she been exposed to? Why was she so starved? I chose the greenest member of the team, knowing that he would be the most talkative. And, as a rookie myself, I sensed a kindred spirit.
The young cop was trembling as he described the conditions in the apartment. “Three kids in the kitchen, all under eight years. The place was a wreck. There was moldy mac and cheese in a pot on the stove, and the oldest said that’s what they’d been eating. We saw all these bottles with crusty milk lying around, but, like, no baby, you know? There was formula in open cans in the fridge, looked like a million years old. Roaches. I was in the bedroom, clothes everywhere, place stank, and I saw something moving under a pile of rags. Christ! I thought it was a rat.”
He expelled a breath loudly, shaking his head, and turned to look yet again at the Emaciated Infant under the warmer, exposed in the revealing glare of the fluorescent ER lights.
Somalia comes to Baltimore. Huge pink belly and wispy thin hair. Inflamed, itchy-looking diaper rash all the way up to her nipples. Wizened. She mewled faintly. I’d never before seen a child this starved. I called the head of Pediatrics at home and, bless him, he gave me good advice. I was afraid to feed her by mouth, but he said that in addition to IV fluids, antibiotics and warmth, a tiny bit of Pedialyte was allowable. The older children, less obviously damaged, had already been taken by Social Services and assigned to separate foster homes. I wondered if they’d ever see their sibs again.
Among the staff, there was an atmosphere of palpable rage, slightly softened by coos and aahs when the Emaciated Infant actually showed the will to suck.
What erases mother love? Cocaine. The cops had found razors on fragments of glass, and traces of white powder. They didn’t wait for the forensics report before making their own judgment; they’d seen these telltale signs many times before.
Mother couldn’t be located that night, and as for the father…who knew? The return address on an unopened Christmas card, discovered in the apartment by the rookie cop, led us to some relatives.
When the mother’s parents arrived at the ER, the nurses punished them with the hard, bright, professional treatment, and with looks that chastised more harshly than words. They were prepared to hate any adult who they thought had known, or should have known, of the infant’s plight yet had done nothing to save her.
The baby was named Victoria, her grandparents said. She was only four months old. Then, as these portly people in their sixties held each other and wept loudly by the warmer, oblivious to everyone but Victoria and each other, the staff visibly relented. The charge nurse brought them tissues and, with a snap of her wrist, drew the bed curtain around us. I encouraged Grandmom to touch Victoria’s matchstick arm, having noted with hope that the baby smiled and curled closer in response to touch.
Though the cops wanted justice (and vengeance), there was no one present to blame. Grandpop, limping with arthritis, blew his nose wetly and went outside to sit on the ER steps.
Victoria’s grandmother helped the nurses to tenderly wipe the baby’s damaged skin. I could hear murmured words: “Sweet honey, you’ll be okay, let us wash you up.” Through the glass ER doors, I caught sight of the shaken rookie police officer lighting his own cigarette, then the older man’s. I was, for once, happy to see people smoking, for the comfort it could give. They sat close together, speaking a little and quietly, out in the darkened ambulance bay.
Finally, the police radio gave us a glimpse of the rest of the picture. Dad was incarcerated, and Mom was working her trade, under brutal circumstances, in the street. How could I condemn them, when I knew only a fragment of this horror story? How could I fix or save anyone, when clearly even God could not or had not? I could only attempt to ease the survivors and the horrified witnesses in the best way I knew how, and despite my inexperience.
I tried my best. I spoke reassuringly and kindly to the baby, the grandparents, staff, cops and paramedics, despite my fears that the baby might not make it and my inner disquiet at providing what I knew was a novice’s care–earnest, but likely incomplete. I don’t know why, but as I was trying to calculate antibiotic doses and IV fluid strengths and flow rates, seemingly everyone wanted to talk to “the doc.” Their emotions were buffeting me, and my own heart was breaking, yet I had to maintain my composure and step up to the plate as the “doc in charge.”
After my thirty-six-hour call was over, I picked up my two young daughters from daycare. I marveled at their well-fed forms and unburdened expressions. I saw their precious lives with luminous clarity, having just been shown, firsthand, how bad things could get. Despite my soiled scrubs and fatigue, we drove to the park and played on the swings for a rare, stolen half-hour before having to be home to make dinner with Daddy. My girls laughed, and I cried tears that I tried to hide–all the while thanking the powers that be that my own family was whole.
Story Author: Paula Lyons, M.D.
Story Editor: Diane Guernsey
First published in Pulse – Voices from the Heart of Medicine – 11 September 2009