I’d Do Anything If Only

Atina!  Stop shredding your bed!  Atina!  You can’t have chocolate!  You’re a dog!  Chocolate is NOT good for doggies!  Atina!  Get that goddam wet ball out of my face!  Atina!  SHUT THE FUCK UP!!!

Sigh.

Last night was a total wreck.  For some reason Atina spent her night growling, woofing, and outright barking, at something that I could not see. 

We are in a well-lit campground, so if there was, like, a bear strolling around, or a bull moose, or a hedgehog, I’m certain I would see it. 

Maybe it was some perv hiding behind a tree, whacking off.  All night.  Sheesh.

On this premise, I chalked Half #1 of the night up to Virtuous Vigilance on the part of the Pup.  But when Night Half #2 rolled wearily around, I got cranky.  I shushed.  I gave orders.  I YELLED.  I cursed. 

As grey dawn faded into a grey rainy morning, I felt worse and worse.  If there’s one thing that kicks me right out of orbit, mentally and physically, it’s sleep deprivation.

And of course my baby still needed her walkies, and breakfast, and more walkies, and playtime…And I needed large quantities of thick coffee, and something to force into my queasy stomach so I could take my pills, and I needed to use the bathroom, and brush my teeth, and put on clothes…And Atina, none the worse for her own sleepless night (who knows, maybe 🐶 s only take 😸 naps anyway…), was red hot and rarin’ to go, while I was dragging serious ass.

I got to feeling cross and cheated and just plain ill-tempered, and then I thought about something that happened, and my mind changed.

Here is what happened.

1989. I was pulling a two-week stint in the Pediatric Intensive Care Unit–the PICU. 

My residency program was working us like slaves because we were down four warm bodies.  One, my sweet ward partner, died in a car crash.  One got meningitis from a kid she was treating.  One got hepatitis from her dear boyfriend when he got back from India.  And one was on a sort of permanent leave, because he had miscalculated a chemotherapy dose and the child died.

So the house staff were stretched much thinner than usual.  Instead of every third or fourth night call, we were on every-other or every-every night.

In the PICU we usually did every-other-night, actually 24 hours on, 24 off.  But since we were so badly strapped for staff, the PICU director came up with a brilliant plan:  he would live in the PICU for two weeks, and I would live in the PICU for the next two weeks, and then we’d switch off again for another month.  That way we’d both get to see our families, for the two weeks we’d be off.  And of course if things were slow, our families could come and visit us in the call room, which was an 8 x10 ft luxurious affair made of beige-painted cinderblock, with a tiny bedside table to hold up the phone, and a worn metal chair.  

When you switched off the overhead fluorescent lights, you were instantly plunged into darkness.  Fortunately, every doctor carries a penlight, so at least you could find the bed, if you ever got a chance to actually lie down.

Hypervigilance is a common symptom of PTSD.  Therefore, since half of my consciousness was always scanning the PICU for problems, I never really got to sleep. 

One night when we had a truly puzzling and terribly critical case on the unit, I lay staring into the velvety black of the call room.  Everything had been taken care of, rounds, orders, and the nurses were wonderful and right on top of things; so there was no reason not to catch a few winks.

But I was in the grip of free-floating anxiety, so I felt my way along the wall until I found the light switch, and lacing up my Rockports, I sidled out into the unit.

We’d received a case that day that came in via the ER.  It was a little three year old boy, who presented with a high fever and blueberry muffin looking rash.  I mean really, he looked like a blueberry muffin.  But unlike muffins, which are good, he was not good.  He was in very bad shape.  Septic shock of some kind.  Our usual tests could not detect the pathogen, or anything that could have caused his condition.  This was 1989, remember.  We’ve learned a lot since then.

We ran through every possible infectious disease that we knew about, and every form of toxic ingestion or exposure, and every possible cause of bleeding and organ failure, but nothing came out positive.

So we did the only thing we could do: we put the little guy on life support, gave him fluids and antibiotics and steroids, and prayed that with supportive care, his body would come through whatever it was, and heal itself.

This was not to be.

Even with maximal supportive care, his body deteriorated.  He had been unconscious when he came in, and never opened his eyes or gave any indication of awareness.  His kidneys stopped working, and fluid was backing up into his organs and tissues.  We tried our hardest to keep up with that too, but soon it was clear that this little boy was not going to make it.

I can’t remember who we were waiting for.  His mother had died, I remember that.  It was just his father alone who took care of him.  We must have been waiting for someone else…to be there…when we took him off the vent.

As I turned the corner from my call room to the unit, I saw the boy’s father sitting on a hard chair, his knees up against the bed, stroking his little boy’s swollen hand and weeping, his shoulders heaving.

I laid my hand gently on his shoulder and said nothing, waiting.

“Yesterday,” the father sobbed, “He was running around making so much noise, I told him to shut up…Oh, if he would only make that much noise again!”

National Child Abuse Awareness Month: Shaken Baby Syndrome

Prevent Child Abuse ribbonIn my lifetime, I’ve worn many hats, had many experiences, seen many things, both beautiful and ugly.

As a pediatrician, I’m grateful for the thousands of beautiful yummy babies who have passed through my hands: such a blessing, such a privilege.

As a parent, I’m grateful that I have a beautiful grownup son, who as a child provided me both with joy that surpasseth understanding and with countless sleepless nights.  This in turn provided me with the experience that I needed so that I could properly empathize with the parents of a subset of my patients: the ones that would not sleep.

My beautiful, wonderful son.  I have never loved him the less, even though he never slept through the night until he was five years old.  He had a traumatic birth; and literally from birth was afraid to close his eyes and sleep.  He cried all night, and I cried too, from a mixture of sadness for him and exhaustion for me.

Sometimes it would get too much for me, and I would feel the edges of anger creeping in: why don’t you just go to sleep, damn it?  And then I knew it was time to put him down safely in his crib, shut the door, put in earplugs or the Walkman, and go for a walk in the yard, or around the block, do jumping-jacks, dance and sing, whatever was needed to get back in equilibrium so that I would NOT SHAKE THE BABY.

Sometimes it hangs on such a fine thread.  I’ve seen parents, usually young and inexperienced, bring their pale, limp six week old in to the Emergency Department in the middle of the night.  We just found him like this, Doctor.  He was fine when we put him down.  No, he hasn’t been sick.

Physical exam: Pupils fixed and dilated.  Anterior fontanel bulging.  Otherwise negative, except that the patient is dead.

Postmortem findings consistent with Shaken Baby Syndrome.

Shaken Baby Syndrome doesn’t just only come from shaking.  It happens when the baby is shaken and then thrown down on a surface, usually a bed or crib.  What causes death is the combination of the shaking and the sudden deceleration that causes tearing of blood vessels in the tissues surrounding the brain, which usually results in death.

Why do people shake their baby?  I know exactly why.  That is why I used to put my baby somewhere safe and go outside and walk around the block, or whatever I needed to do to keep myself sane and the baby safe.  It is because the incessant crying of a hard-to-console baby can and will grate on anyone’s nerves.  Some babies have piercing, high-pitched cries that go off like sirens.  And if the caregiver lacks the emotional resources necessary to take a deep breath and step away, the thing can happen in the blink of an eye.

In the blink of an eye, things can go from having a healthy yet frustrating baby, to having a dead baby.  All in the blink of an eye.

Who does this happen to?  I saw a pattern.  The perpetrator was almost always male, usually under 30, high school graduate or less, often not the baby’s biological father.  The motivating factor was “wanting the baby to shut up and stop crying.”  The problem: lack of impulse control.  If only he had taken that deep breath, turned around and walked out that door….but he wanted the baby to stop crying.  Now the baby will never cry again.

And what about the mothers?  My heart broke for them.  Her boyfriend killed her baby.  How will she ever live with herself?  And so often I saw a dreadful conflict: the mothers would lie to the investigators, to try to protect the boyfriend.  Some even claimed to have done it themselves!  It was so sad, so tragic.

To be fair, I did see a few cases in new parents who were “white, educated, middle class”.  A very few.  The vast majority were from economically and educationally underprivileged families, across all ethnic groups.  It is a kind of death that discriminates against the uneducated, the young, the disenfranchised, the controlled.

How do we prevent Shaken Baby Syndrome?  Sure, we can put up “Don’t Shake The Baby” posters everywhere.  But that doesn’t do a thing to solve the social problems that underlie the issue.  We can’t solve the problem of young women getting into relationships with impulsive, controlling men–who by the way are quite as likely to shake and shove the mother around–although she, being full grown, is able to absorb more physical shock than a six week old.

To me, Shaken Baby Syndrome is emblematic of the price we are paying for allowing our girls to grow up in a system of intergenerational abuse that starts at home and continues into serial abusive relationships.  The solution is not a quick and easy one.  It really does take a village to save one child.