Today is my 5th wedding anniversary.  I began the day hopeful, wanting to get through my work as quickly and as smoothly as possible so that I could go home and enjoy a dinner out at my favorite local restaurant with my husband.  Just after I arrived, my nurse, Belinda, said to me, “A’s on the schedule today for a follow up.  I’d better call his mom to remind her to come in.”  A is a two month old baby boy who I’d followed closely in the weeks prior to Zambia for failure to thrive.  This baby wouldn’t gain weight for anything.  His mother always seemed a little distant, detached.  She never held him.  He was always on the exam table while she sat in a chair.  She never seemed to know the answers to my questions, “How many ounces of formula does he eat?”  “How often does he eat?”  “Does he spit up?” “How many wet diapers in a day?” “Any diarrhea?”  She never gave me or Belinda a consistent answer.  In the meantime, this baby wasted away before my eyes, wrinkled skin sagging on his arms and thighs.  Finally, I convinced the local hospitalist to take him as an impatient, because I couldn’t seem to help this child at home.  Ultimately, this child was diagnosed with a condition which generally causes profuse and forceful vomiting (though mom never reported any vomiting).  I was still very suspicious of her abilities as a caregiver in spite of this medical condition.  So, Belinda calls to remind mom of her follow up appointment.  She says that she’s forgotten, but she will come.  Mom arrives with A and with the baby’s aunt.  Belinda calls them back to a room, obtains vital signs, and undresses the baby to weigh him.  Then she comes to my office and says, “There are bruises all over him.”  I enter the room immediately and find 2 month old A with purple streaks on his arms, back, chest, and abdomen.  I asked mom what happened, and she tells me that A was wearing an outfit that was too big for him, and he slipped from her grasp.  When he slipped, she tightened her grip on him, pinching his skin between her fingers.  Right.  A’s aunt then pulls me aside to tell me that she’s seen drugs in the home.  She is trying desperately to preserve her relationship with A’s mother, to try to help her find rehabilitation.  At this point, I have to tell A’s mother that they will not be leaving the office until I have a safe place for A to stay because I’m quite convinced that someone has hurt him.  A’s mother tells me that’s fine, but she needs to leave for a little while to see her boyfriend.  She leaves, but not until after she’s had a cigarette in my bathroom across the hall from the exam room.  A waits with me in my office for 3 hours until child protective services arrives to take custody of the baby.  I don’t really have any words for this.  On one hand, this is a victory.  I’ve removed a child from a dangerous situation before he was seriously hurt.  On the other hand . . . A’s mother is a teen who was abused as a child.  She was shuffled around to different foster homes throughout her childhood until her early teens, when she met the foster family who claims her and loves her now.  She’s made terrible choices and became a mother at a very young age, but how could she possibly be equipped to make good decisions with the upbringing that she’s had?  Would any of this have happened had she had a loving family and the security of a stable home?  How does anyone fix this?


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