I click open the x-ray viewer. After 4 years in emergency pediatrics, I am not really surprised that a tibia fracture underlies the bruised ankle I unexpectedly encountered on physical exam. Yet I audibly gasp as the chest x-ray loads. The torso in question belongs to a chubby little cherub of a 3-month-old in room 11, brought in for red eyes. I begin to count the fractured ribs — 1, 2, 3, 4, 5. I pause. That’s just the left side.
His 17-year-old mother sobs as the caseworker takes her son from her arms.
“He smiles when you kiss his face,” she calls as she’s escorted out of the ED, “and he likes it when you read him books. Someone has to read him books.” She looks towards me. I look down.
She admits to the social worker that she gets overwhelmed. His father, also 17, has a short temper. He works third shift, she works days. They pass the baby off. I don’t ask when they sleep.
“Having a baby,” she whispers, “is harder than I thought.”
I want to tell her not to worry. I want to tell her he’s in good hands, that he’s safe now, that someone will read to him and kiss his face and make him smile.
I don’t tell her about the toddler twins I admitted last week, profoundly dehydrated after days of not being fed by their foster parents.
I don’t tell her about the preteen I saw just hours ago, pushed out a second story window by her foster mother during an argument.
I don’t tell her that, on average, a child will spend 3 years in the foster care system and traverse through three placements before reuniting with their family. That he may be walking, talking, and calling someone else “mommy” by the time she’s able to navigate the court system and regain custody.
Statistics on abuse within the foster care system are nearly impossible to find, though anecdotes abound. This month, an 11-year-old foster child was found handcuffed on his front porch with a dead chicken hung around his neck. In 2003, a Pennsylvania foster mother was arrested after her foster daughter died of asphyxiation when duct tape was used to enforce a time-out. An inquiry into the Trenton, New Jersey foster care system that year found that up to 1 in 5 children within their foster system were abused at a foster home.
In Indianapolis, where I practice, the Department of Child Services (DCS) has undergone budget cut after budget cut over the past decade, $100 million in 2011, $16 million in 2012, and, most recently $10 million in 2013. The national turnover rate for DCS caseworkers is above 20%, with low salary, inadequate support, and excessive workload cited as the most common reasons for leaving. In my own encounters with DCS as a prospective adoptive parent, my caseworker changed three times over a 12 month period, with our final caseworker never responding to our emails. The social worker teaching our parenting course readily admitted at the start of our class that she had no experience with children, but had taken the job to cover until the position was filled.
I see extraordinary foster parents at my job every single day and have the honor of working with caseworkers who commit their lives to caring for and protecting children. I also witness the consequences when the system fails the very children it is charged with protecting.
So I don’t tell the young mother that her son is safe, that he’ll be cared for, that he’ll be back with her soon. “I’ll read to him,” I promise her.
S. Terez Malka is a pediatrics resident.