As a child abuse pediatrician, I am often asked how can I do this work? My answer is, "How Can I Not?" I have never doubted that as I help to protect the health of my young patients, particularly those who have been abused or neglected, it will impact them across their entire lifespan.
This book chronicles the difficulties in dealing with child maltreatment in rural Pennsylvania as well as the local, state and federal problems that are inherent in the multifactorial, multigenerational, and multidisciplinary issue. Clinical cases are utilized to illustrate the complexities and cracks that exist when health care, law, social services, and cultural norms and practices converge.
In the book there is, at times, great suffering and even death. Sometimes there is reconciliation and rehabilitation. Through it all there is compassion and attention to the long-term consequences. Interwoven in these tragic cases is the data, the real science of child maltreatment. Is there hope? Are there opportunities for intervention and prevention? Read it, cry for the children, but think about how as communities we can make the lives of families and children better through the efforts of all of us.
As a child abuse pediatrician, I am often asked how can I do this work? My answer is, "How Can I Not?" I have never doubted that as I help to protect the health of my young patients, particularly those who have been abused or neglected, it will impact them across their entire lifespan.
This book chronicles the difficulties in dealing with child maltreatment in rural Pennsylvania as well as the local, state and federal problems that are inherent in the multifactorial, multigenerational, and multidisciplinary issue. Clinical cases are utilized to illustrate the complexities and cracks that exist when health care, law, social services, and cultural norms and practices converge.
In the book there is, at times, great suffering and even death. Sometimes there is reconciliation and rehabilitation. Through it all there is compassion and attention to the long-term consequences. Interwoven in these tragic cases is the data, the real science of child maltreatment. Is there hope? Are there opportunities for intervention and prevention? Read it, cry for the children, but think about how as communities we can make the lives of families and children better through the efforts of all of us.
CHAPTER ONE
UNENVIABLE START TO MY SOLO PEDIATRIC PRACTICE
âNot enjoyment, and not sorrow, is our destined end or way; But to act that each tomorrow finds us farther
than today.â   Longfellow
In 1977, after one Pediatric position misadventure with a multispecialty group which turned out to be clinically uncomfortable, I found myself in the unenviable position of starting a solo Pediatric practice in the rural town of Sunbury, Pennsylvania (population of 10,000). Unenviable because nobody in their right mind would start a solo private Pediatric practice. Unenviable because I had no money (Pediatric residents made around 7000 dollars per year) and starting any practice from scratch required significant funds.  Unenviable because none of my Pediatric mentors thought that being a solo Pediatrician in a rural area would be consistent with a healthy lifestyle. Unenviable because none of my Pediatric mentors ever mentioned solo Pediatric practice as a future endeavor nor did they prepare us for that possibility.  Unenviable because I would, for the most part, be on call 24/7 for the Emergency Room, Nursery, Pediatric floor and my practice. Unenviable because nobody teaches Pediatric residents the business of medicine. Unenviable to a degree because I was the only Pediatrician in all of Northumberland County whose census at the time was 100,000. Unenviable to a certain extent because the General Practitioners/Surgeons and the hospital administrators were hoping that my presence would mean that infants and children with significant illnesses would stay at the Childrenâs Ward in the Sunbury Community Hospital rather than being transferred to the nearby tertiary care Geisinger Medical Center. My training, of course, would mean that children with significant illnesses would have to be transferred to the tertiary care center at Geisinger.
Fortunately, there were some significant positive factors as well. First of all, the Sunbury Community Hospital wanted to support me financially until my practice was somewhat established. Their help was buttressed by a business manager who taught me the ins and outs of the business aspect of medicine. Secondly, the medical and surgical community welcomed me with open arms. In particular, Dr. John Pagana helped me to get started, covered for me when I was away and became my lifelong friend. Thirdly, my brother-in-law and his wife (Dr. William and Mrs. Mary Ann Weader) allowed my family to stay rent free in their vacation A Frame just outside of Selinsgrove, Pennsylvania. Fourthly, Geisinger was twenty minutes away for my patients who were in need of subspecialty care or inpatient admissions. There were many other positive factors since we were living so close to both of our families.
So, the practice started and grew exponentially.  Immediately I started having referrals for infants and children who were being physically and sexually abused. I was the only Pediatrician in all of Northumberland County, so those Children and Youth referrals were being sent my way. There was no question that I felt woefully inept in those initial evaluations. My training in those areas was inadequate as it was for most Pediatric residents at that time. Child maltreatment has existed forever, but it was just being recognized as a clinical entity in the 1960s and 1970s. I, along with my peers, who started doing this work of evaluating children who were abused, always felt that this aspect of our practice chose us; we did not choose it. But I was determined to aim high and do the very best that I could for those children.
âTHE GREATER DANGER FOR MOST OF US IS NOT THAT OUR AIM IS TOO HIGH, AND WE MISS IT, BUT THAT IT IS TOO LOW, AND WE REACH IT.â
MICHELANGELO
Reading Pat Brunoâs book How Can I Not?, a pediatrician's perspective of child abuse and maltreatment in the USA can make you deeply sad, angry, and revengeful. It reveals cruelty inflicted on infants of a kind you may not believe is possible among humans. Parts of it are stinging. And you feel worse when you discover that the main perpetrators (over 90%) are the parents themselves! You sober down when you realize that many concerned folks in the collaborative socio-medical-legal-judicial workforce that provides protection/rescue/care are already doing their best to save/rehabilitate suffering kids. But if youâre like me, even after youâve calmed down, youâll find yourself weighed down by a sadness that you canât forget easily. Can God alone help?
The author makes an excellent exposition of whatâs happening: the increasing incidence of child abuse, the kinds of abuse perpetrated, the roles played by rescue/protective services, and so on. With the trained mind of a medical doctor, he gets down to the painful points quickly. His narratives are seldom happy stories. On the contrary, quite a few are diabolical, ending in a child's (children's) death. Thereâs room for significant improvement in the workflow processes and procedures in force in rescue/protection to make them child-friendly and efficient. And while plenty of volunteers are already out in the field, there is a pressing need for many more to join their ranks quickly. Most importantly, the book sends out a message to all readers: âDonât be apathetic, cold, and uncaring, P-L-E-A-S-E!â You matter!! Sure, you may not be able to do big things, but the little things you can do can make a big difference. For example, if you report a case of abuse you observe to the authorities, thatâs plenty of help, but if you look the other way, youâll be leaving a hapless child to die a miserable death, in stages, in the hands of their abusers.
The book is short but pithy. It has an apt and compelling cover. The author is so dedicated to his cause that he cannot think of stopping work, ever. Very likely, the bookâs title âHow Can I Not?â is another way of saying âWho will if I (and others like me) don't? While infant lives are at stake, can I sit by quietly and be at peace with myself? Never!âÂ
This book is for the public and a must-read for all Americans with a caring heart. It seeks to make you aware that the kids in your neighborhood arenât safe. Nearly one in four kids is a victim of abuse, right now. They badly need your intervention. Those who are silently working to restore sunshine in the lives of these unfortunate kids are truly heroes. You'll do your bit, however small, to help, won't you?Â