The hardest conversation of my intern year
Most people think that working in pediatrics is like this:
And it's pretty true. But when it gets nasty, it gets really nasty.
I started my rotation in the ED last week, and my second patient was a 4 week old with a finger fracture.
FOUR weeks old. Meaning that he can't roll over, can't crawl, can only see about a foot in front of his face and can't lift his head. So that fact that he reportedly just "woke up like that” sketched us all out.
So we got a skeletal survey, which is a series of x-rays of every bone in the body that we get on babies when we're concerned that they're being abused. And the results made me literally gasp out loud and feel like I was going to vomit.
12 fractures. 9 posterior rib fractures, which happen when adult hands squeeze a baby so hard that it breaks them. Two leg fractures, which happen when an adult picks a baby up and swings them by their leg. And then the finger, which I don't even want to imagine.
It was then my job to go tell the parents what we had found and what was going to happen now. I took care of all of my other patients first and fiddled around on my computer for a few minutes. When I finally couldn't put it off anymore, I walked towards their room, shaking so badly I wasn't sure my voice would work. I was so afraid of what their reactions would be. Would they scream at me? Be physically violent? Take the baby and run (it happened to another resident earlier this month!)?
"The x-rays came back and we found multiple rib fractures and two leg fractures. They are already healed and are older than the finger injury. At this point, we are required to contact CPS and admit him to the hospital to make sure that he will be safe at home before he can leave."
The mom was shocked beyond words and wanted to know how this could have happened. I thought "You tell me and we'll both know," but said "I can't tell you how the fractures happened, I can just tell you that they're there." The dad had his face in his hands and… didn't seem too surprised. I’ll never know the whole story.
When we were in med school and all deciding which field to go into, people would often say, "I can't go into Peds because seeing kids get sick with cancer is too sad." I disagree. Our cancer patients are some of the strongest and pure-souled people on the planet. I am so honored to get to walk along side them on their journeys, and getting to know them is one of the best parts of my job.
But child abuse sucks. It keeps us up at night and makes us lock ourselves in the bathroom at the hospital to cry. It puts fire in the eyes of even the sweetest and gentlest pediatric nurses and doctors. It's what I hate the most about my job.
Child abuse is one of, if not THE, worst thing that could ever happen to a child, and is 100% preventable. There are no excuses for hurting a child and there are no excuses for turning a blind eye when you see it. Everyone who works with children has to be on high alert and always trust their instincts.
If you want to learn more, check out:
https://www.cdc.gov/features/healthychildren/ and https://www.childwelfare.gov/topics/preventing/preventionmonth/
