Sunday, 25 December 2011

Suffer the little children...

Christmas Eve...and on a combined with the usual end-of-month/payday/Friday-night-party "PFO injuries"...exacerbated by the post-'end-of-year-free-alcohol-staff-party' requests for Emergency Contraception and the removal of various foreign bodies from various body compartments...all topped off with the confused,dehydrated and lonely and afraid "lets-see-whats-happening-to-granny" patients.

Still and all,we were doing well...there was a two hour wait which didn't seem too excessive...after shopping was already done...

And so the day droned on with only the occasional mince pie to remind us that it was anything other than a typical Saturday.

Five o' hour from my evening meal break...the chili prawn linguine was already calling me...
...and the next patient to be seen was a baby with a sore arm...who was apparently only six months old.

"Baby Cabbage Patch?"

I didn't really need to ask who he was...there were two babies in the waiting room,but only one was screaming in pain.

A scared looking young woman stood up clutching the baby...a bag...a blanket...her handbag...and a cellphone.
A young man,long shaggy hair,long shaggy jeans shambled in behind her,looking upset.

"Please come through to my room..."

She followed me holding the baby out in front of her,arms rigidly straight,like he was a live grenade.

"Whats happening then?"

Well...what it was...we was at home...and he tried to stand up...and he fell and hurt his arm...and he hasn't stopped screaming...and he's not using his arm...

"Did he fall backwards...or forwards...or sideways?"

I don't remember...

"Okay...have you given him anything for the pain then?"

No...we just brought him straight here...

"Okay then...lets get him undressed...completely undressed down to his nappy so that we can see whats going on..."

She dropped him onto the examination bed , grabbed his possibly-injured right arm and started to tug his babygro off of his injured arm.

"Stop...stop...lets take his good arm out of the babygro first...then slip it over his head..and then take his bad arm out..."


"Are you his mum and dad then?"

No...I'm his aunt...this is my dad brought me here cos we was at their house...

"Okay...where is his mum or dad then?"

Ummhh...well...they've just been arrested by the police...

"Okaaaaaaaaaaaaaaaay...was he with them when they were arrested?"

No...I was babysitting for them cos they wanted to do some shopping...

"Do you know why they were arrested?" dad might know......he's sitting in his car with my daughter...

"Okay then..."

She was struggling to undress the boy who was still screaming.

"Look....just stop okay...let me undress him..."

I noticed the old dried faeces on the bottom of his vest...and made a mental note.
I examined him fully...and couldn't really find any indication of an injury,new or swelling or bruising or redness or deformity or wounds.
No burns

But every time I picked up-, or moved-, or tested his right arm,-from his fingers to his shoulder-,he screamed.

Is he going to be alright mate ? asked the uncle

"I think so...lets just get some x-rays done...I think we're going to x ray his entire right arm...will you sign the consent?"'d rather not...said the aunt

I'm only 17, said the uncle.

I signed the paperwork myself and,-having weighed him and given him "Gods-own" dose of paracetamol-,whisked him off to the radiology department where the ever efficient Anna very quickly did a series of films for me...all of which turned out to show absolutely no obvious bony injury of any sort.

But still the baby was screaming.

I had taken the opportunity to talk to the grandfather about what he thought had happened...I found him sitting in his car with his 4 year old granddaughter,engine running,music blaring,heater blasting.
I knocked on the car window and asked him to get out of the car.

He too seemed unsure of how the baby boy had fallen...and could not...or would not tell me why his daughter and "son in law" had been arrested.

I couldn't help noticing that he only had one arm.

I also took the opportunity to phone the duty social work team to see if the child was on the child protection register.
After the usual runaround of wanting to know exactly,precisely,definitively why I wanted to know,they deigned to inform me that the family where "known to the family support team"...

...and that there were "behavioural issues" with the parents in regard to their dealings with the Housing Department inasmuch as they were holding out for a 3-bedroomed house against the flat they had been offered...

...and...oh,by the way...the father had done prison time for domestic abuse...


...all things considered...the child was not deemed to be at risk and was therefore not on the register.


They came back from radiology,with the uncle looking shell shocked and the aunt looking scared.
I wrapped the little 'baba' in a blanket and held him tight and rocked him and sang a little lullaby as I considered my next move...
...which was to phone the on-call paediatrician and throw myself on her mercy and beg for clemency.

I explained the family and social and medical situation and raised my concerns...she very kindly agreed to admit him to the Children's Assessment Unit at the main hospital.

I decided to transfer him to the hospital in an emergency ambulance (a) because he was still screaming inconsolably (b) I was concerned the family would try and do a runner (c) I don't trust either the cops or the social workers to actually provide any meaningful help(d) but I do trust the paramedics.

The 'baba' was still crying...I was still holding him tight.

Listen mate...said the uncle...can I go to hospital with him?


Can you give me a note for the control room?Its just that I've got an ankle tag on and my curfew is at 7 o'clock...

(He was on probation and was fitted with an electronic ankle tag which sends an alarm to the probation team if he's not indoors from 7pm to 7am)

"Jah...sure....I'll write a note"

An ambulance finally pulled up 20 minutes later...
...but it was a delivery...
....of a chap who had been in a local chain restaurant toasting his daughter at her wedding reception...
...when he heard a noise above him and looked up at the ceiling... it gave way due to the pressure of a burst sewerage pipe...
...which decanted its load into his eyes...


Finally our ambulance arrived...about two minutes after the baby's mother...who refused to answer my questions...
...and the baby was whisked away to the loving care of the peads department.

That baby really could scream.

All I managed to eat was a yoghurt.

It was the sort of day that puts the "freak" back into Christmas.


  1. Weird huh? Did you ever find out what... ah hell, we never find out anything after they leave our ER. The main bummer of working in Emergency medicine is the lack of follow-up; hard on the curious.

  2. I'm sure you considered it but...... Pulled elbow?

  3. was the first thing I tried...I just condensed the story a little for clarity purposes

  4. Uh-huh, thought as much, it is too much of a no brainer not to test for it. Did you ever find out what the diagnosis was?

  5. No Grumpy...partly i try not to invest too much emotional energy...partly...well...once theyre gone,theyre gone