DURING A TIME like this, they kid a lot among the doctors and nurses on the obstetrical floor because of the rushing business in new babies that’s pretty nearly always going on up there. It’s the Depression, they say, nobody has any money so they stay home nights. But one bad result of this is that in the children’s ward, another floor up, you see a lot of unwanted children.
The parents get them into the place under all sorts of pretexts. For instance, we have two premature brats, Navarro and Cryschka, one a boy and one a girl; the mother died when Cryschka was born, I think. We got them within a few days of each other, one weighing four pounds and one a few ounces more. They dropped down below four pounds before we got them going but there they are; we had a lot of fun betting on their daily gains in weight but we still have them. They’re in pretty good shape though now. Most of the kids that are left that way get along swell. The nurses grow attached to them and get a real thrill when they begin to pick up. It’s great to see. And the parents sometimes don’t even come to visit them, afraid we’ll grab them and make them take the kids out, I suppose.
A funny one is a little Hungarian Gypsy girl that’s been up there for the past month. She was about eight weeks old maybe when they brought her in with something on her lower lip that looked like a chancre. Everyone was interested but the Wassermann was negative. It turned out finally to be nothing but a peculiarly situated birthmark. But that kid is still there too. Nobody can find the parents. Maybe they’ll tum up some day.
Even when we do get rid-of them, they often come back in a week or so-sometimes in terrible condition, full of impetigo, down in weight-everything we’d done for them to do over again. I think it’s deliberate neglect in most cases. That’s what happened to this little Gypsy. The nurse was funny after the mother had left the second time. I couldn’t speak to her, she said. I just couldn’t say a word I was so mad. I wanted to slap her.
We had a couple of Irish girls a while back named Cowley. One was a red head with beautiful wavy hair and the other a straight haired blonde. They really were good looking and not infants at all. I should say they must have been two and three years old approximately. I can’t imagine how the parents could have abandoned them. But they did. I think they were habitual drunkards and may have had to beat it besides on short notice. No fault of theirs maybe.
But all these are, after all, not the kind of kids I have in mind. The ones I mean are those they bring in stinking dirty, and I mean stinking. The poor brats are almost dead sometimes, just living skeletons, almost, wrapped in rags, their heads caked with dirt, their eyes stuck together with pus and their legs all excoriated from the dirty diapers no one has had the interest to take off them regularly. One poor little pot we have now with a thin purplish skin and big veins standing out all over its head had a big sore place in the fold of its neck under the chin. The nurse told me that when she started to undress it it had on a shirt with a neckband that rubbed right into that place. Just dirt. The mother gave a story of having had it in some sort of home in Paterson. We couldn’t get it straight. We never try. What• the hell? We take ’em and try to make something out of them.
Sometimes, you’d be surprised, some doctor has given the parents a ride before they bring the child to the clinic. You wouldn’t believe it. They clean ’em out, maybe for twenty-five dollars—they maybe had to borrow—and then tell ’em to move on. It happens. Men we all know too. Pretty bad. But what can you do?
And sometimes the kids are not only dirty and neglected but sick, ready to die. You ought to see those nurses work. You’d think it was the brat of their best friend. They handle those kids as if they were worth a million dollars. Not that some nurses aren’t better than others but in general they break their hearts over those kids, many times, when I, for one, wish they’d never get well.
I often kid the girls. Why not? I look at some miserable specimens they’ve dolled up for me when I make the rounds in the morning and I tell them: Give it an enema, maybe it will get well and grow up into a cheap prostitute or something. The country needs you, brat. I once proposed that we have a mock wedding between a born garbage hustler we’d saved and a little female with a fresh mug on her that would make anybody smile.
Poor kids! You really wonder sometimes if medicine isn’t all wrong to try to do anything for them at all. You actually want to see them pass out, especially when they’re deformed or—they’re awful sometimes. Every one has rickets in an advanced form, scurvy too, flat chests, spindly arms and legs. They come in with pneumonia, a temperature of a hundred and six, maybe, and before you can do a thing, they’re dead.
This little Jean Beckie was like that. She was about the worst you’d expect to find anywhere. Eleven months old. Lying on the examining table with a blanket half way up her body, stripped, lying there, you’d think it a five months baby, just about that long. But when the nurse took the blanket away, her legs kept on going for a good eight inches longer. I couldn’t get used to it. I covered her up and asked two of the men to guess how long she was. Both guessed at least half a foot too short. One thing that helped the illusion besides her small face was her arms. They came about to her hips. I don’t know what made that. They should come down to her thighs, you know.
She was just skin and bones but her eyes were good and she looked straight at you. Only if you touched her anywhere, she started to whine and then cry with a shrieking, distressing sort of cry that no one wanted to hear. We handled her as gently as we knew how but she had to cry just the same.
She was one of the damnedest looking kids I’ve ever seen. Her head was all up in front and flat behind, I suppose from lying on the back of her head so long the weight of it and the softness of the bones from the rickets had just flattened it out and pushed it up forward. And her legs and arms seemed loose on her like the arms and legs of some cheap dolls. You could bend her feet up on her shins absolutely flat-but there was no real deformity, just all loosened up. Nobody was with her when I saw her though her mother had brought her in.
It was about ten in the evening, the interne had asked me to see her because she had a stiff neck, and how! and there was some thought of meningitis—perhaps infantile paralysis. Anyhow, they didn’t want her to go through the night without at least a lumbar puncture if she needed it. She had a fierce cough and a fairly high fever. I made it out to be a case of broncho-pneumonia with meningismus but no true involvement of the central nervous system. Besides she had inflamed ear drums.
I wanted to incise the drums, especially the left, and would have done it only the night superintendent came along just then and made me call the ear man on service. You know. She also looked to see if we had an operative release from the parents. There was. So I went home, the ear man came in a while later and opened the ears—a little bloody serum from both sides and that was that.
Next day we did a lumbar puncture, tapped the spine that is, and found clear fluid with a few lymphocytes in it, nothing diagnostic. The X-ray of the chest clinched the diagnosis of broncho-pneumonia, there was an extensive involvement. She was pretty sick. We all expected her to die from exhaustion before she’d gone very far.
I had to laugh every time I looked at the brat after that, she was such a funny looking one but one thing that kept her from being a total loss was that she did eat. Boy! how that kid could eat! As sick as she was she took her grub right on time every three hours, a big eight ounce bottle of whole milk and digested it perfectly. In this depression you got to be such a hungry baby, I heard the nurse say to her once. It’s a sign of intelligence, I told her. But anyway, we all got to be crazy about Jean. She’d just lie there and eat and sleep. Or she’d lie and look straight in front of her by the hour. Her eyes were blue, a pale sort of blue. But if you went to touch her, she’d begin to scream. We just didn’t, that’s all, unless we absolutely had to. And she began to gain in weight. Can you imagine that? I suppose she had been so terribly run down that food, real food, was an entirely new experience to her. Anyway she took her food and gained on it though her temperature continued to run steadily around between a hundred and three and a hundred and four for the first eight or ten days. We were surprised.
When we were expecting her to begin to show improvement, however, she didn’t. We did another lumbar puncture and found fewer cells. That was fine and the second X-ray of the chest showed it somewhat improved also. That wasn’t so good though, because the temperature still kept up and we had no way to account for it. I looked at the ears again and thought they ought to be opened once more. The ear man disagreed but I kept after him and next day he did it to please me. He didn’t get anything but a drop of serum on either side.
Well, Jean didn’t get well. We did everything we knew how to do except the right thing. She carried on for another two—no I think it was three—weeks longer. A couple of times her temperature shot up to a hundred and eight. Of course we knew then it was the end. We went over her six or eight times, three or four of us, one after the other, and nobody thought to take an X-ray of the mastoid regions. It was dumb, if you want to say it, but there wasn’t a sign of anything but the history of the case to point to it. The ears had been opened early, they had been watched carefully, there was no discharge to speak of at any time and from the external examination, the mastoid processes showed no change from the normal. But that’s what she died of, acute purulent mastoiditis of the left side, going on to involvement of the left lateral sinus and finally the meninges. We might, however, have taken a culture of the pus when the ear was first opened and I shall always, after this, in suspicious cases. I have been told since that if you get a virulent bug like the streptococcus mucosus capsulatus it’s wise at least to go in behind the ear for drainage if the temperature keeps up. Anyhow she died.
I went in when she was just lying there gasping. Somehow or other, I hated to see that kid go. Everybody felt rotten. She was such a scrawny, misshapen, worthless piece of humanity that I had said many times that somebody ought to chuck her in the garbage chute—but after a month watching her suck up her milk and thrive on it—and to see those alert blue eyes in that face—well, it wasn’t pleasant. Her mother was sitting by the bed crying quietly when I came in, the morning of the last day. She was a young woman, didn’t look more than a girl, she just sat there looking at the child and crying without a sound.
I expected her to begin to ask me questions with that look on her face all doctors hate—but she didn’t. I put my hand on her shoulder and told her we had done everything we knew how to do for Jean but that we really didn’t know what, finally, was killing her. The woman didn’t make any sign of hearing me. Just sat there looking in between the bars of the crib. So after a moment watching the poor kid beside her, I turned to the infant in the next crib to go on with my rounds. There was an older woman there looking in at that baby also—no better off than Jean, surely. I spoke to her, thinking she was the mother of this one, but she wasn’t.
Before I could say anything, she told me she was the older sister of Jean’s mother and that she knew that Jean was dying and that it was a good thing. That gave me an idea—I hated to talk to Jean’s mother herself—so I beckoned the woman to come out into the hall with me.
I’m glad she’s going to die, she said. She’s got two others home, older, and her husband has run off with another woman. It’s better off dead—never was any good anyway. You know her husband came down from Canada about a year and a half ago. She seen him and asked him to come back and live with her and the children. He come back just long enough to get her pregnant with this one then he left her again and went back to the other woman. And I suppose knowing she was pregnant, and suffering, and having no money and nowhere to get it, she was worrying and this one never was formed right. I seen it as soon as it was born. I guess the condition she was in was the cause. She’s got enough to worry about now without this one. The husband’s gone to Canada again and we can’t get a thing out of him. I been keeping them, but we can’t do much more. She’d work if she could find anything but what can you do with three kids in times like this? She’s got a boy nine years old but her mother-in-law sneaked it away from her and now he’s with his father in Canada. She worries about him too, but that don’t do no good.
Listen, I said, I want to ask you something. Do you think she’d let us do an autopsy on Jean if she dies? I hate to speak to her of such a thing now but to tell you the truth, we’ve worked hard on that poor child and we don’t exactly know what is the trouble. We know that she’s had pneumonia but that’s been getting well. Would you take it up with her for me, if—of course—she dies.
Oh, she’s gonna die all right, said the woman. Sure, I will. If you can learn anything, it’s only right. I’ll see that you get the chance. She won’t make any kick, I’ll tell her.
Thanks, I said.
The infant died about five in the afternoon. The pathologist was dog-tired from a lot of extra work he’d had to do due to the absence of his assistant on her vacation so he put off the autopsy till next morning. They packed the body in ice in one of the service hoppers. It worked perfectly.
Next morning they did the postmortem. I couldn’t get the nurse to go down to it. I may be a sap, she said, but I can’t do it, that’s all. I can’t. Not when I’ve taken care of them. I feel as if they’re my own.
I was amazed to see how completely the lungs had cleared up. They were almost normal except for a very small patch of residual pneumonia here and there which really amounted to nothing. Chest and abdomen were in excellent shape, otherwise, throughout—not a thing aside from the negligible pneumonia. Then he opened the head.
It seemed to me the poor kid’s convolutions were unusually well developed. I kept thinking it’s incredible that that complicated mechanism of the brain has come into being just for this. I never can quite get used to an autopsy.
The first evidence of the real trouble—for there had been no gross evidence of meningitis—was when the pathologist took the brain in his hand and made the long steady cut which opened up the left lateral ventricle. There was just a faint color of pus on the bulb of the choroid plexus there. Then the diagnosis all cleared up quickly. The left lateral sinus was completely thrombosed and on going into the left temporal bone from the inside the mastoid process was all broken down.
I called up the ear man and he came down at once. A miss, he said. I think if we’d gone in there earlier, we’d have saved her.
For what? said I. Vote the straight Communist ticket.
Would it make us any dumber? said the ear man.
1. What do you think would happen to Jean Beckie if they saved her? How do you think that would have affected the narrator, the nurses, and the ear man?
2. Can hospitals and clinicians strictly treat just the medical ills of the patients? Does treating the medical ills necessarily entail treating the social ills? Does one need to draw a line at some point? When?