Wednesday, September 28, 2022

Cry Baby

As a lingering link to my first career love for Paediatrics, I do a regular baby clinic as part of the national child health programme.  The mothers bring in their babies around 6 -8 weeks old for a general examination and developmental assessment, a check up for themselves and for baby vaccinations.

It is a sensitive time for most mothers, especially first time mothers who may be sleep-deprived, hormonal, and grappling with the realisation that this squirming, pooping, guzzling, yet fragile creature is now their full responsibility.

I have a lot of sympathy for the process.

My next patient spent the first few minutes explaining just how precious this baby was due to the difficult period around the delivery, unlike her previous experience. 

I was genuinely attentive to her detailed description of the colours and consistency of his nappy contents and all his feeding and burping routines. 

After the introductory chat, she placed her half asleep baby on the couch for examination.

I started by checking the baby's head control which is done by gently lifting the baby up by the arms.

As I started to lift the baby up, he startled awake and started crying- like a baby.

I tried to settle him by rubbing on his tummy for a few seconds, no luck. From the corner of my eyes I could see the mothers countenance changing. 

"Maybe you should give him a cuddle." I said calmly, gesturing for her to pick him up which she did, but the crying did not immediately cease. 

It was a normal baby cry, not a shrill where I would start to think that there was something irritating his brain but his mother had gradually started turning red and her eyes getting larger.

"What is wrong doctor? Why is he crying?"

I thought about the question for a second and stopped myself from saying "You tell me, you're the mum,".... for all the times people say to me "You tell me, you're the doctor."

The next thing I knew, the mother exclaimed "You have dislocated his shoulder!"

By now her eyes had widened and seemed to take over her forehead. She was starring straight into my face and huffing and puffing, as if trying to intimidate me.

Really?! I thought, puzzled, my mind quickly racing across all possible causes of hypermobility whilst trying to figure out how the mother arrived at this diagnosis. 

I have heard about mothers who have inflicted injury on their baby unintentionally, but for fear of being perceived as neglectful or having the social services invading their lives as safeguarding risks, concort a story to explain the injuries and absolve them of any guilt.

Was this woman possibly trying to blame me for something she had done to her child?! I wondered. 

By now her whole body was shaking and she was pacing back and forth which, in my opinion, was making the baby cry even more. 

"Look," I said " Why don't we just settle down and I can have a look at his arm and check him over? It is very unlikely that his shoulder would dislocate from such a simple manoeuvre." 

I sat at the edge of the couch in attempt to restore calm and control of the rapidly escalating situation.

"Call an ambulance!" She demanded "You should not be sitting, you should be getting an ambulance. You have dislocated my baby's shoulder!! See he's not moving it!"

She was holding him tightly across her chest, both of his arms enveloped within hers. I wondered how he was expected to move his arms.

"Can I examine him?" I asked. "If there's something wrong I can refer him to be checked by the paediatricians." 

She looked at me in shock/horror, as if I had said something like "Well, he's broken now, pass him over so I can throw him in the bin."

By now, the baby seemed to have tired of crying and just wanted to go back to sleep.

She clutched him tighter and burst out of the room shouting "Ambulance, get an ambulance "

She ran to the waiting room, banging on the reception screen screaming "Get me an ambulance, the doctor has dislocated my baby's shoulder!"

I made a quick call to the hospital paediatrician on call to refer him for further checks and then went out to meet her in the waiting room. 

By this time a few of the reception and other staff had gathered around her.

"I have asked the paediatricians to have a look at him, so you can take him to the emergency room to be seen." I said. 

"I have already called ambulance myself " She said with indignation, holding her mobile to her ears and saying (to baby's dad apparently) "Come quickly, the doctor has dislocated his shoulder we need to go to A&E!"

She looked at me and said "I cannot carry a baby with a broken arm to the hospital, I need an ambulance!"

(So apparently the arm was broken now. Things were getting worse 😕!)

The father appeared very quickly, making me more convinced that they were staging this whole performance to cover up something they already knew.

She repeated her recurrent claim to him and he charged at me saying "I cannot believe this. I cannot bloody believe this. We brought our baby to be looked after and now you have broken her arm. Useless! Bloody hell!"

"How could you? How many times have you dislocated babies' shoulder? Can you not do an Xray and fix it? Are you not a trained doctor? And so on...

Not sure which of them would be willing to rationalise at this point, I stated to both. "You would probably be waiting over an hour, likely longer for an ambulance. " (The sad reality of the overstretched NHS). "You are probably better taking him to the hospital yourselves. They will be expecting him."

They turned to each other and started arguing.  By this time the baby in question was sound asleep. 

I thought I saw a brief smile pass his lips, perhaps it was just wind.

They refused to re-enter my consulting room to remove their car seat and other belongings.

They sat arguing in the waiting room until they were the only ones left there, then they got in their car and took their baby to the hospital. 

The next day I received the hospital discharge letter saying that the baby was well on arrival and was discharged home without needing any tests. My suspicions were wrong, the poor woman.😏

In another place, another time and another culture, some people would have insinuated that this was an "ogbanje" baby. (A reincarnated baby with an evil agenda.)

Here and now, he was just another cute, cheeky little monkey. 👻👶


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