In case you missed Sunday's article in the San Antonio Expess-News, this discussion of University Hospital's commitment to abused children is well worth the read. Although its focus is the Child Life program, the compassionate teamwork of nurses, social workers, physicians and Child Protective Services is also showcased,
By Cathy Frye
Express-News Staff Writer
A few hours before the baby was disconnected from life-support machines, McCall Taylor entered the hospital room clutching a purple clipboard and an inkpad.
Tenderly, she picked up one of the infant's tiny, limp hands and pressed it into the ink. Then she pressed the hand onto a sheet of blue paper.
Some child-life specialists wear latex gloves while inking the hands and feet of infants, but Taylor works bare-knuckled. "I'm not going to glove up to touch a baby."
This time, the baby was a girl with dark hair. Her mother and grandmother joined Taylor at the bedside to help print the girl's other hand, then her feet.
All this Taylor did with a horrible knowledge: Police had questioned the mother and her boyfriend about the baby girl's devastating head injuries and no doubt would question them again.
Taylor, a child-life specialist at University Hospital, wasn't here to judge. Her role in the tragedy was to offer comfort to the baby and give keepsake hand- and footprints to the family.
She would remember this child clearly, though — just like all the others who die at the hands of those who were supposed to nurture and protect them.
As a wave of child deaths prompted lawmakers to consider sweeping reforms in the state's Child Protective Services, the staff at University Hospital has watched tragedy after tragedy play out up close and personal.
Emergency measure
An emergency bill to overhaul the state's child and adult protection agencies cleared its first big hurdle last week with approval by the Senate Human Services Committee. The bill, authored by Sen. Jane Nelson, R-Lewisville, would restore funding for child abuse prevention services slashed by lawmakers in 2003 and calls for everything from improved training and incentive pay for caseworkers to stiffer penalties for those who refuse to cooperate with investigators. It seeks to address the stunning failures that have plagued both child and adult protective agencies in the past 21/2 years, as officials answered for the deaths of 140 children on the state's watch.
Medical workers at University Hospital see the small bodies devastated by third-degree burns, shattered skulls and punctured intestines. Their story is the sad and anticlimactic flipside of child abuse, the waiting that follows the flashpoint, the regret begotten by rage.
Many of the babies rushed into the hospital never will leave. Others will be forever disabled. Those who work in the Pediatric Intensive Care Unit assume various roles, from savior to comforter. They've hurried onstage during the last terrible act, when it's too late to rewrite the ending but too early for that merciful final curtain.
"The legislators, with all their cuts, have shown us where their interests are. And I don't think it's with the children," hospital social worker Cheryl Johnson says. Two years ago, lawmakers killed funding for eight child-abuse and prevention programs and cut funding for five others in an effort to close a $10 billion shortfall.
While hospital employees hope Child Protective Services will be expanded, they worry that preventive programs will remain ignored and unfunded.
Beefing up the state agency isn't enough, they say. The protective-services agency often is unaware of problems until the hospital calls. By then, it's often too late.
"This is not just about Child Protective Services," administrative nursing director Mickey Ryerson says. "It's about how to protect children from family violence."
Children such as:
An 18-month-old baby who was burned from mid-stomach to mid-thigh when someone held him by his arms and legs and dipped him into scalding water.
A 1-year-old boy who died of severe head injuries.
A toddler whose body was battered from the top of his head to the bottoms of his feet.
A 2-year-old whose intestines were cut in half after someone stomped on his abdomen.
In 2004, three abused children died at University Hospital. 2005 opened with another death, that of 1-year-old Clarissa Ramos. When Clarissa arrived at the trauma center, her brain was swollen and she was bleeding behind the eyes.
She died the day after the Legislature opened its 2005 regular session.
The intermediaries
Child-life specialists are the liaisons between medical staff and the families of children in University Hospital's pediatric unit. They hold the hands of trembling toddlers and worried parents. They serve as interpreters for family members, such as the 4-year-old who thought a CAT scan involved a feline.
And, when a child is near death, they tend to last wishes — for the patient as well as the parents.
Taylor and Rebecca Charlton do all this no matter who has been accused of what, no matter how many police officers are questioning a child's relatives.
"I find it hard not to be judgmental," Charlton says.
Taylor tries to understand. "I look at the parents and I wonder, 'Who treated this parent like that?'"
Taylor, 25, always wanted to be an advocate for children. She earned a degree in political science, thinking it would facilitate her dream. But she quickly learned there would be no interaction with children, so she returned to school and became a child-life specialist.
This is Taylor's first job.
Charlton, 43, worked for 16 years in St. Louis before joining University Hospital.
Long ago, she considered becoming a pediatric nurse. But, like Taylor, she wanted to connect with children and their families. That's not easy when you're part of the medical team. Doctors and nurses tend to put up barriers; they have to so they can do their jobs well.
Child-life specialists develop relationships with families. During a child's final hours they clip locks of hair or wrap tiny bodies in fresh blankets. But the hand- and footprints strike the most resonant chord. For grieving parents they evoke poignant memories: a baby's birth, a young child's first art project.
Taylor explains: "There's something about knowing that this is the last handprint they're going to see — that it's not ever going to get bigger."
For Taylor, her ink-stained hands are therapeutic somehow.
When she goes home with it on her hands, her roommate knows what happened that day.
The worst cases
University Hospital houses the only non-military Level 1 Trauma Center in a 22-county region. The worst-of-the-worst cases come here. Car accidents. Falls. Shootings.
Child abuse.
Victims arrive either by ambulance or AirLife helicopter. First stop is what staff call the "resus" room — short for resuscitation — where a patient is stabilized and assessed. From there, the wounded often are rolled directly into the operating room. Children cry for their mommies and daddies.
Hospital social worker LaTreece Brown usually is the first person to meet with injured children's families. Some parents are defensive. Some mothers leave after bringing in a hurt child.
Brown marvels at such behavior.
"If that were my child," she says, "I would be bawling, screaming and on the floor passed out."
As she asks family members of the child what happened, Brown sorts through their stories to see if they're consistent.
When their accounts don't mesh or support what doctors find she is blunt with parents.
"You know what, guys? Your story just doesn't match."
Consider, for example, the little boy who "drank some shampoo."
Actually, he'd been beaten beyond saving.
And the 1-year-old girl who "choked on a battery"?
Someone had shaken her violently.
Dallas Connor, a physician at the hospital, often finds himself baffled and repulsed by grim discoveries.
"It takes a tremendous blow to cut the intestines in two areas," says Connor, who helped treat the toddler whose stomach was stomped. "It popped them like a balloon."
Connor knew a fist to the abdomen wouldn't be powerful enough to cause such terrible injuries.
And yet parents often can't see or fathom the damage they've done.
"Why won't she wake up?" they ask. "When is she going to get better?"
Many of the babies he sees have suffered head trauma, which often isn't visible, Connor says. There are no bruises, no cuts. In fact, most violently shaken babies appear to be in a deep sleep.
A look inside the skull, however, reveals a brain that looks like it went through a mixer.
"Even if a kid fell off a 10-story building, you would not see these types of injuries," Connor says.
Pediatric nurse practitioner Chelsea Valle recalls a family member who didn't understand why putting an injured child in the shower and turning the water on didn't help this time.This time? Valle thought.
"It's hard for them to see that it got to that point, especially if the abuse has been going on for awhile," she says.
"Now it's like, 'Uh-oh. I went too far this time.'"
She remembers the 1-year-old who spent two days in intensive care before dying of head injuries. After the toddler slipped away, she stood over a hospital sink and sobbed. Then she wiped away the tears and went to check on her next patient.
Connor finds comfort in speaking up for these young victims. When judges ask for his opinion, the doctor takes great care in penning a letter that will help remove a child or his siblings from an abusive home life.
"In some cases, I may be the only voice for the child," he says.
If only there were resources to counter the problem on the front end, nurses say.
High-risk families are so easy to spot. Labor and delivery nurses see them go home with new babies every day. They're the impoverished, uneducated young mothers, ill equipped to deal with a new baby. They're the working, single moms who rely on new boyfriends or family members to watch the kids because they can't find affordable day care with flexible hours.
They're the young parents who leave the hospital with a premature or disabled child, still unaware of the enormous pressures they will face.
Most frustrating, the nurses agree, are the "boyfriend cases." They remember the young mother who, even as she learned her baby girl was dying, fretted over her boyfriend — the man who had been alone with the child when she was hurt.
The nurses hear the same refrains: "Oh, he didn't mean it." Or: "Oh, he could never do that."
Bring in the siblings
Taylor usually arrives to make prints as soon as she learns a child is going to die.
Sometimes, she gets there too late.
Either way, she urges parents to watch as she inks their babies' hands and feet. And she asks them to bring in the dying or dead child's siblings as well.
Taylor remembers a 1-year-old boy who already was brain-dead when his siblings entered the room. "Their grandmother said, 'He's very sick and he's going to die.'"
Taylor corrected the grandmother, telling the baby's siblings, "Your brother got very hurt, hurt so bad that he couldn't live."
"We know how he got hurt," the children said.
The police were called and the young witnesses described a home life in which small children were beaten up.
Taylor and Charlton are just as gut-wrenchingly honest with the women who insist on protecting suspected abusers. They tell these women that a child never will be able to chew or swallow food. That he'll never walk again.
Charlton adds: "We'll ask, 'Where were you when this happened?' And they'll say, 'At the mall, shopping with my girlfriends.'
"They're still kids, so young that they don't understand what's going on and that someone has hurt their child. They're more worried about being in trouble."
Sometimes Taylor and Charlton can't help but compare families.
In one room, desperate parents bargain endlessly with doctors and God to save a child with a terminal disease.
Next door, a mother makes excuses for a boyfriend, her once-healthy child on life support because someone smashed his fragile, undeveloped skull against a wall.
Odds against them
Taylor renews her faith by volunteering at the Children's Bereavement Center, where kids who have lost someone can find companionship, counseling and support. She can walk in with ink-stained hands and the other volunteers understand. Charlton finds peace working with the children of happy, normal families, usually at church.
Still, she frets over what can be done for the little ones born with staggering odds stacked against them.
"This is such an overworked system," she says, sighing. "A lot of these parents could have gotten help if only they had had access to it sooner."
The day Taylor inked the baby girl with dark hair there was a toddler, a little girl, in the next room.
The inquisitive toddler quizzed Taylor.
"What's wrong with the baby?"
"What happened to the baby?"
What could Taylor say? That some people hurt children? That some people, even mommies and daddies, can't be trusted?
By then the baby had been declared brain-dead. She would be taken off life-support machines later that day.
In the eyes of the medical profession, she already was gone.
But Taylor told the toddler none of this. Instead, the normally blunt woman fudged.
"She's really sick," Taylor told the toddler.
Later that day, the baby girl died with ink stains still on her hands and feet, despite Taylor's efforts to scrub them off.
For nearly a week afterward, a faint purple also lingered on Taylor's fingers — an indelible testament to a baby's suffering.
