Faculty Bibliography

I heard Larry's frightened voice on the phone: ''[Benjamin]'s been burned. I'm bringing him to the emergency room. Meet us there!'' Click. I am sure it never occurred to them to equate our situation with that of, say, a mother working the night shift in a factory, while her husband, exhausted from his own day shift, took care of the child (Family under extreme stress . . .). Still more fortunately, just as I was about to suggest that someone call the restaurant to verify the story, Benjamin decided to tell his own version. No longer in pain, he was now immensely pleased to be the center of attention, and he favored the assemblage with a dramatic account featuring ''bad dumb man'' with ''bad dumb cigarette.'' More disturbingly, we seem more alert to possible child abuse among the poor. The extreme end of the spectrum is the doctor-parent, that is, me in my scrubs sitting there and reminding doctors, you are dealing with people who are just like you, your profession, your social class - could such people possibly abuse their children? In our hearts, most of us are all too inclined to answer no, though we shouldn't have needed the Joel Steinberg case to remind us that child abuse can exist at all social levels. Still, it seems that, given any level of suspicion, the poor are more likely to be reported, more likely to have their children taken away. Most of us, working the pediatric emergency rooms, know this. The fear in my mind is always that I will take care of some upper-middle-class child, elect to believe the parents (who speak my language), send the child home with them - and the child will come back dead. So I push myself into asking more and more questions of these parents, annoying them, sometimes embarrassing myself. Then I still have to decide whether or not to call in social service. If I do, the social worker will reinterview the parents, will decide with me whether to file a legal motion, informing the state that a child is at risk. If we do, the Department of Social Services will investigate the family, and decide whether to ''substantiate'' our motion. It's a cumbersome process, but it's the only means at hand, the only way to protect the child at risk

I'VE BEEN ON THE TELEPHONE now for two hours, trying to track down a 1-year-old boy with a positive blood culture. He came to the emergency room two days ago with a fever of 103.4. The doctor diagnosed an ear infection but, before sending the child home with a prescription for amoxicillin, he drew a blood sample and sent it to the laboratory. Now, with the aid of a telephone operator enlisted in this medical emergency, I finally reach the mother at work. ''Bring the boy back in today, please,'' I say. ''We need to check his blood again.'' She does. But now he has no fever. He wants only to run back and forth at high speed in the hallway, making a noise like a fire engine. So why has all the fuss been made over a simple ear infection? Because of the fever. Meanwhile, another baby has been brought into the emergency room, and I glance at the nurse's clipboard - at the age of the child, 3 weeks, and the vital signs: the temperature, heart rate, respiratory rate and blood pressure. I call Admitting and book a bed even before examining the baby. Why? Because of the fever. Children seem to get fevers from almost anything (execpt, contrary to common belief, teething): from colds, sore throats -and yes, ear infections. Fevers can spike high, as we say, in these very young, very hot tots. A 2-year-old with an ear infection and a temperature as high as 104? Happens all the time. But you rarely see a 12-year-old with a temperature that high. As a consequence, I often find myself reassuring parents of infants: no, the fever itself won't do him any harm, his brain won't melt (this was my own private anxiety when my own son was going through the ear-infection stage), give him Tylenol every four hours and sit him in a lukewarm bath. If there is no apparent source for the fever - no obvious infection, and if the child doesn't look especially ill, the pediatrician will probably make the diagnosis of viral syndrome, the catch-all medical term for ''some bug's going around.'' The treatment, as everyone knows, for the bug that's going around is to drink lots of liquids, take two aspirin - or, if you're a child, an acetaminophen - and call the doctor in the morning. Antibiotics won't help. They don't work on viruses. And we no longer routinely use aspirin for children; it can lead to complications after chicken pox and other viral illnesses

A short story examines Alex's desire for the romantic companionship of Carla, his lab partner. Carla, however, is involved with a married man

The author comments on the problems that hospitals and their doctors face due to doctor illness. Hospitals are filled with viruses and bacteria, and doctors often fall victim to them

Simple tests using play can often detect early signs of pyschological problems--even in infants

LEAD: SHAKESPEARE, ALLOWING RICHARD III to explain the origins of his villainy, had him announce that he had been ''Deformed, unfinished, sent before my time/ Into this breathing world scarce half made up'' (Act I, Scene 1). What could be worse than a birth defect, what tragedy greater than a baby born abnormal? SHAKESPEARE, ALLOWING RICHARD III to explain the origins of his villainy, had him announce that he had been ''Deformed, unfinished, sent before my time/ Into this breathing world scarce half made up'' (Act I, Scene 1). What could be worse than a birth defect, what tragedy greater than a baby born abnormal? Ultrasound may or may not be accompanied by amniocentesis, in which a sample of amniotic fluid is withdrawn by needle, and the fetal cells are cultured and their chromosomes analyzed. This test is now recommended for women over the age of 35, a somewhat arbitrary number. As women age, the frequency of Down's syndrome in their offspring increases, and 35 marks the age at which this risk was thought to surpass the risk to the fetus from the procedure itself - there is a small incidence of miscarriage following amniocentesis. Now, women over 35 tend to have amniocentesis done, and the vast majority of babies with Down's syndrome are born to younger mothers; the younger group has a lower frequency of the defect, but a much higher birth rate, so the rare events add up

''What we tell the families,'' says Dr. Ellen R. Cooper, medical director of the pediatric AIDS program at Boston City Hospital, ''is that we're left confused. It's not clear till 15 months, unless the child becomes sick. So we tell them that we're happy as long as we're confused, and the longer we remain confused, the happier we are.'' Still, ''My first reaction was 'sure,' '' says the foster mother. ''I knew very little about AIDS - I knew enough not to get hysterical, and the nurse came out and talked about universal precautions, always wearing gloves to change diapers, washing my hands a lot.'' She was not worried that her other children might catch the virus. In fact, her concerns ran in the other direction: ''I said, are we exposing this baby to more infections, having her in a home with a lot of kids? I can't have my own children leave if they get sick, but I can be more careful about letting them slobber all over her.'' People outside the family, however, are not told about the baby's possible diagnosis - ''I don't think it's anybody's business,'' says the mother. ''What makes me angry is dealing with professional people who are not educated. When she was in the hospital, one nurse wore a mask, gloves and a gown. I mean, really!''

A resident in pediatrics describes a success in saving the life of an infant by using ECMO (extracorporeal membrane oxygenation). The baby, whose lungs do not function properly, is saved as ECMO takes over for them

I don't mention the possibility of head bleeds, though very premature babies are at high risk for blood-vessel ruptures in their heads. Most of these bleeds are mild, some severe (with resulting brain injury). I don't mention the dangers of mechanical ventilation of tiny babies - you may have to use high pressure to blow open the air sacs in the lungs, and if the pressure gets too high, an alveolus can spring a leak, necessitating a tube in the chest to suction out air and allow the lung to expand. I don't mention necrotizing enterocolitis, a sometimes-fatal syndrome that can destroy the intestine. These are all everyday terrors of intensive care. But it seems to me that they are more than the parents need to know, right now, as they wait to see whether the labor can be stopped, wait to see how the baby will do. One thing at a time. What about that baby who is on the borderline? That 24- or 25-week-old whose chance of survival is somewhat better than 50 percent, but probably a much lower chance of surviving intact? There's a very high risk of head bleeds, devastating infections and oxygen deprivation. There's the risk that the baby will become dependent on the ventilator, which in itself can damage the lungs; a 3-month-old with the lungs of a 75-year-old chain smoker, the radiologist may comment. And the process of keeping this tiny being alive will involve needles, tubes. The very premature baby does not live comfortably. Even doctors who believe in what they are doing sometimes feel like torturers. Until recently, there was some controversy over whether preemies had nervous systems that were too immature to feel pain. Surgery on such babies was often done without painkillers. It is now accepted that the babies do feel pain, though we still don't give them painkillers when we put in tubes - the risks are too high. I like saving babies. I have been at deliveries of babies obviously too small to survive, but much wanted; the parents were eager to have even a severely damaged baby, as long as they could have a baby. I have stood there with my colleagues and wished for the baby to give us a sign: to cry, to kick, or somehow otherwise prove us wrong, signaling us to try our bag of tricks. It's very hard to know what I would want if I were in the situation faced by those women. I've thought about it a lot, and what I think is, if I were in labor very prematurely, if the labor wasn't stopping, I would want to be at some small remote community hospital where they might understand that a 24-week preemie was just too small to save. I hear comments like that from other doctors and nurses, even as they struggle, day and night, over the tiniest patients anyone has ever cared for. I'd drive off into the woods, people say, and have my baby there. There has to be such a thing as just too small.