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Mar 9, 2016 · Battle's sign

Out of the 100+ patients I have seen and helped manage over the course of this month, the one I will remember most was not even a patient of mine. Nearing the end of the shift, I overheard rumblings about a patient coming in. The words “subdural hematoma”, “skull fracture”, “NAT”, and “CPS” were thrown around. Just as I was packing my things to leave, the resident said, “if you want to take a look at that 9 month-old in room 3, she has some interesting physical exam findings”. I took her up on the learning opportunity, realizing it was the same patient at the center of the non-accidental trauma (NAT) conversation – a particular group of children I hope to reach and serve in my career. Though I had spent hours studying NAT and imagining the emotional toll that work in this field this would take, nothing could have prepared me for what this simple yet phenomenal interaction would teach me.

Katie worked in pediatric emergency medicine at Riley Hospital for Children in Indianapolis

Katie worked at Riley Hospital for Children in Indianapolis during her pediatric emergency medicine rotation

I guess I thought victims of NAT would look different – that they would come in wearing signs reading “victim of child abuse”, would be surrounded by defensive, argumentative parents, and would not actually display the classic textbook signs of injury like posterior rib fractures, retinal hemorrhages, Battle’s sign, and raccoon eyes. None of these things were true. The room was quiet and dim. The only other person present was a nurse, who stood at the computer pulling up a lullaby video of a fish tank on the screen. The child sat supported in the bed, slightly reclined, calm, and looked at me with big, loving eyes. Despite the love in her eyes, though, there was fear. As I approached, her distress and distrust was evident by the furrow in her brow. She whimpered. I put my hands behind my back to make it evident I would not be touching her. To see a 9 month-old who had already developed such a fear and distrust of other human beings was heart-breaking. The Battle’s sign was also clear – bilateral bruising posterior to her ears – just like the textbooks…except not.

“It’s horrible, isn’t it?” said the nurse. “Just last week we had one, detached retinas, everything. CPS sent her home with the dad. He was on the news last night – she died.” Again, a reality check. I knew the statistics. I was not naïve to the magnitude of children that died every year at the hands of NAT. Yet, I had to keep reminding myself: These are real children. This really happens. It happens here. Somebody intentionally hurt this sweet baby girl. I had long known that if I chose to care for victims of child abuse, it would take an emotional toll and that my desire for logic and rationalization would not be satisfied. I am a person who always tries to understand all sides of the story, but trying to understand how a person could ever, ever intentionally hurt their own child is like trying to understand the logic of a mass shooter – there simply is none. It is senseless. That is hard to accept.

Meeting this 9 month-old victim of NAT was the beginning of what I hope will be a long career helping, serving, and keeping safe victims of child abuse. It was a primer not only to the physical exam findings I will see, but also the heartache and frustration I will surely re-experience each time I have an encounter like this one. Bigger than the heartache and frustration, though, is the purpose of this work. That is what I hope to keep in mind as I traverse a difficult but exceptionally meaningful career path in pediatrics.

Katie is a fourth year medical student originally from Renton, Washington. She is pursuing residency in pediatrics and aspires to focus on global health as well as vulnerable populations such as victims of child abuse, domestic violence, and sex trafficking.

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