Overhead page at the office.

ER.

Infant from out of town presents with fussiness and perceived arm pain. X-Ray reveals mid-shaft spiral fracture of the humerus. Spiral fractures are caused by twisting of the limb with a fair amount of torsion. A very high percentage of these turn out to be abuse. There is a chance this could be innocent, but that chance is not real large.

They seem like nice people. They usually do. No "smoking gun" story of what happened. Now the job is to just wait until we can send the child home with someone we know is safe.

I try not to judge, since I don't know really what happened. Besides, I am just supposed to take care of the child. Leave judgment to judges. I do my best to be polite and helpful to the family, yet I measure all of my words and hold a little back in my usual friendliness.

Part of a pediatrician's job is to wait for the next disaster. It may be child abuse, it may be a birth defect. You wait with dread and as yourself questions. When will the next child abuse case come? Will I catch it or miss it? How many abused children have I missed?

I hope I can stay vigilant without getting cynical. It's hard sometimes. Bad things happen to people, even babies. Part of my job is protecting babies from people who would harm them.

I hate that part of my job.