And what's been going on the last few days....

They gave me strange duties on Friday, which leads me to my first case - H, who is seven months old. He was brought into the emergency room by his mother, whose story is that she found him in his crib, having caught his hand in the bars and rolled over it, twisting his arm. That's the story. On examination, the baby was found to have a spiral fracture of the humerus. This, O Best Beloved, is a fracture caused indeed by a twisting injury - but normally requires significant force. It's enough to warrant a skeletal survey, where one pins the baby down and takes X-rays of absolutely everything. What those X-rays revealed was frightening. The baby has old healed rib fractures and a thickening of the bone cortex in his tibia suggestive of an old healed fracture. A broken leg in a baby who's not old enough even to crawl... They filed a 310 with CPS, a report that basically indicates that we fear a child is in jeopardy. They sent him to get a head CT to look for damage to the brain. That came back looking good, preliminarily. And so the baby was admitted to our ward, and the mother was told that we were going to have to check him out head to toe because of some old fractures we'd seen. I spent Friday afternoon with mom and baby at the opthalmology clinic, waiting for a chance to look for retinal haemorrhages (another sign of shaken baby syndrome). And she was talking, and I conversed with her, knowing all the time that she didn't yet know why we were looking this baby over. It was hard, O Best Beloved, trying not to let her know anything she didn't already know. And when we got back, she talked to Child Welfare and JK and Social Work, and when they told her what was going on you could hear her scream and cry down the hall. Our guess...our impression, at least, was that she didn't do it...but she knew what was going on. And that's the part that really got me. It's one thing to abuse a child - for there to be something going on in your mind that causes you to hurt them...it's another to stand by and know that something's going on, and to let your baby be hurt. That was one. I'm not involved with his case; for legal reasons, they don't want my name on the paperwork - they don't want me to have to go to court if it comes to that - but I did act as a nurse and take him to the opthalmology clinic. And second is C, who's thirteen. She came in on Thursday afternoon with a toxic acetaminophen level. Apparently, she had a fight with her best friend, and also found out that the guy she's been seeing for two weeks - the one who told her he was 16 - is 21. And her mother said if he came around again she'd call the police. So she decided she'd kill herself. And when she woke up in the morning, she still was determined. So she stole some money out of her mom's purse, walked down to the corner store, bought a bottle of Tylenol and took 24 extra-strength tablets. And went to school. It wasn't until she started getting sick and was taken to the nurse that she finally admitted she'd taken them. After a brief evaluation by the psych unit, it was determined that she wasn't an immediate suicide risk - that she was safe to come up to our floor. And so there we have her, a 13-year-old girl on a 44 hour N-acetylcysteine drip to keep her from developing acute liver failure in the next few days, who was just here in February for the same thing. And this is when you wonder why. Because she's tried it twice, and she uses steak knives to gash at her wrists, and she made a plan, she didn't just do it on impulse. So when RR sent her mom out of the room and went through all the questions you ask anyone over the age of 10 during a history, it was heartrending and yet not surprising to hear her tell him that her uncle and her grandfather had touched her in some unwelcome way when she was six and eleven... She stays with us until her liver is out of danger. Then she goes to psychiatry...and I hope and pray that someone there will help her turn things around. I had a few other patients - asthma, croup, overnight observation and home in the morning - but those two left the impression on me. And such an impression. So much hurt, O Best Beloved, so much pain and cruelty and aberrance in this world. And all I can do is move one step at a time, one patient at a time, what little healing I can do. And then, O Best Beloved, the good. I hand out little surveys to the parents of my patients, because I'm a student. They fill them out, put them in sealed envelopes, and return them to the Paediatrics department. Only Mrs. M didn't. She gave it to the nurse to give to me. And it was all full of "strongly agree" and "agree", and at the bottom where you're supposed to write comments was the following [sic]:

She very nice. You couldn't even tell she was a student she sounded like she knew what she was talkin about like she has been on the job for years.

That, if nothing else, raised my spirits. And the other good thing was a stupid little thing - I got paged out of noon conference to take H over to the opthalmologist's. Paged out. I was vital to the functioning of the ward, even if it was a stupid little thing. Those are the brow-raisers, ...