What to do with this child?
Its about 10:00 p.m., I am about to wash up and go to bed. The phone rings. This is very unusual, as I don’t really have any close-buddy friends and can’t think of anyone else who would call. Its Roberta, the nurse on duty in the ER at the Soldier’s Memorial Hospital, in Campbelton N.B., a town population about 1500. I am one of the doctors in town. Sarah and I have been living there over a year with our 4 month old baby boy. (How we got there will be told in a future posting).
A young mother has traveled a great distance to bring her baby to the hospital. She told the nurse the baby is very sick and she must see a doctor. Roberta is the nurse in the urgent care called me. She said my name is the “on call roster” so would I come in and see the baby.
The hospital is about a kilometer from my apartment. I walk over. Outside the ER, on the side of the driveway is an old Chevrolet. It once had a vinyl roof, which had now all but peeled away. It was some sort of light color—maybe light blue or green--that was now dull and faded; the body was dented here and there, and behind the wheels the sides of the car were splattered with mud. And, oh yes, the car sat on the chassis without the benefit of being sprung.
When I enter the ER, it is eerily quiet and deserted. Not all the lights that are turned on in the daytime are on now. The place is empty except for a young couple sitting on chairs in the hallway. The man is very fair, short cropped reddish blond hair, bright blue eyes, looks very young. The woman is darker, has long black hair hanging to her shoulders. Her eyes are close set and looking in slightly different directions. He upper teeth are protruding from her upper lip and crowded together—sort of overlapped; her chin is receding. Both are dressed in jeans and button shirts. The lady is holding a swaddled baby. The baby is crying and whimpering. The lady makes no effort to comfort or quiet the baby. I approach them, introduce myself and ask “what is the problem with the baby?”
“He is sick, eh?”
“In what way is he sick?”
“I dunno.”
“I mean what symptoms does he have…”
“I dunno.”
“When did he become sick?”
“My mom told me.”
“Told you what?”
“He is sick.”
“Has he been sick before?”
“No.”
Clearly this is futile. Roberta takes the baby and brings him into the examination room. She begins to undress him. He is swaddled in some bed sheets with the edges torn. There is a rag around his groin and pelvis. He looks like a newborn, lying on his back with his head to the side. He is small, thin, emaciated, unaware of the surroundings, his cry is high pitched and strange. His hands are up around his head, his fists are tightly closed and his legs are bowed in frog position. He doesn’t respond to the examination. I try to pry his eyelids open. I look into his ears with my otoscope. I feel for lymph nodes in his neck, listen to his chest and heart, feel his abdomen and assess his liver. I look into his mouth. His heart sounds are normal, his lungs are clear, his ears look OK, his abdomen and liver are soft. His mouth is dry and skin loose. He is a bit dehydrated. We prick his heel and take a blood sample to measure his hemoglobin. So far, no abnormalities.
So…no history, nothing to find on examination. Roberta tells me the baby is about a year old. I am astounded. My baby is about 4 months old and is considerably bigger and heavier, more alert and interactive than this child. Roberta sees I am clued out so she fills me in.
There are a number of such families in the woods. She tells me their history goes back 300 years to when a group arrived from Hanover Germany and settled in the woods. They have remained separate from people “in town” and keep to themselves living, and making a living, in the woods. Efforts to provide education, sanitation, social services have not succeeded. They are by and large illiterate and isolated with the bare rudiments of the general culture: they speak English but retain a Germanic lilt in their speech. They wear contemporary clothing, have guns, hunt and trap. They get some sort of welfare and come to town to acquire some basic services like medical care and equipment including guns, and cars. I had seen 2-3 of these hill people from time to time as walk-ins in my office. Most were females, who requested contraceptive pills. I would give them my samples. The sum of my instructions were “take one pill every day”. One patient came back, threw the pill container on my desk and said “they don’t do me no good”. I could not get any more details from her. However, when I looked at the pill dispenser I had given her, I saw about 5 pills missing from random locations in the pack. I surmised that she was taking them when she had sex and was having breakthrough bleeding. I gave her a new pack and said “Take one pill EVERY day. Take the pill side by each. Start here after your next period.” I point to the beginning of the series. Hard to tell what got through.
Anyway, Roberta knows this particular family and its circumstances. She tells me that once the baby is born it just lies in the crib. The visiting nurse visits every day and shows the mother how to feed, wash and care for the child. Between that no one goes to the child, no one picks it up, plays with it, comforts it, coos with it—nothing. It just lies there, all day, all night, day after day.
And here we are. A helpless child with the worst possible type of abuse: neglect. A child robbed of his humanity, bred to be retarded and institutionalized, or at best perpetuate the life in the woods and bring more children like him into the world.
Now, what to do?
I went to the coffee machine, put in a quarter and pressed “coffee, black”. I don’t drink coffee but I needed the warm cup to hold as I went up to the library to think this out. I opened the heavy oak door, turned on the lights, put down the coffee and sat down on one of the padded chairs at the side of a big oak table. Lets see…
Angel on the right shoulder:
Joe, listen to me: Admit the child to the hospital. Feed, dress, care for the child. Provide it with human companionship, physical contact, stimulation. Call in the social services and bring the resources to bear, maybe a foster home. Try to salvage this human being.
Angel on the left shoulder:
Not so fast cowboy! What makes you think you should impose your Big City Jewish and other cultural biases on these people. How arrogant. These people have lived like this for 300 years and its how they like it. You have no right to value your style of life above theirs, to cast their culture aside and impose yours on the child. You have the power to admit the child, it may make you feel better about yourself, but is it in the child’s best interest?
Angel on the right:
Of course it is in his best interest! How can you argue that lying in a dirty playpen, in pee and poo and abandoned all day with your intellect and humanity shriveling away is what the child would want. We are talking now about the child, not the parents, society or anyone else. The child has a right to optimize his human potential: to speak, to read, to gain knowledge, to see and understand aspects of the world, to love and be loved…
Angel on the left:
I can’t believe you learned nothing in the Sociology 101 in pre-Med. You are spouting pure ethnocentrism. Who says your life has greater value, and is more worth living than the life of his family and their ancestors. They have lived this life generation after generation—300 years. The parents grew up like this, this child will and so will his children. Some deaf people prefer the life and culture of deafness and would prefer it to recovery of hearing. He was born into this life and he has the right to live it without you coming out of your ivory tower and yanking him into a world that he doesn’t know and that doesn’t know him. That is setting him up for disaster. Yes I said “yanking”. He didn’t come and ask you to “rescue” him. It is not his fault he crossed your path. Without that the universe would unfold for him as it is destined to do.
And what are you going to do next? Go out there with the visiting nurse and yank all the other children? Joe. Really!
Angel on the right:
Yes, his path crossed yours. Yes, if it had not, his life would have evolved as it is destined to do. But sometimes one can’t save the whole world, or all the children in the Warsaw Ghetto or villages in the Congo. Maybe its enough that the chance encounter allows you to save one life. The Jews say “He who saves one life, is as if he had saved the whole world”. This child has chanced across you. It is an evil to see a desperate child and avert your eyes. This is a unique chance to save this one life. Your humanity insists you do it.
Angel on the left:
Save a life? You mean snatch a human from his family and his social milieu. Then what are you going to do? Take him home? Put him in an orphanage? And do so while he still has a mother and father? Who looks after their interests in this? What are you going to say to these parents? In which human society would you be allowed to do that?
No, after he is fed and cleaned, a judge will say “send him back to his parents”. Which is what you should say. By the way did you even ask Roberta what she thinks?
Angel on the right:
Not succeeding is one thing. Not trying is perhaps the bigger sin. How will you face the rest of your life if you turn your back on this child? Sure, you need to hear what Roberta thinks, but then again she has lived with this her whole life and accepts it as is. Sure you will hear her perspective but you have to live with your conscience, not hers.
I went over these arguments back and forth, this way and that. I rose, dropped the coffee into the garbage can, opened the library door and turned off the lights. I went down the stairs into the Emergency department. As I entered the hallway, Roberta and the parents stood up from their chairs and looked at me expectantly.
