Whenever the child abuse cases, or “non-accidental traumas (NATs)” come into our unit, a very tender unsettledness, laced with anger, descends upon all the staff. We hate all kinds of suffering that our little patients endure, but the suffering that comes with intent and disregard from the hands of the very adults who are supposed to be nurturing and protecting them is particularly disturbing.

I find myself thinking a lot about a severe child abuse patient who I cared for earlier in the year. On my first shift with them, they still had a breathing tube and were being kept sedated. I had heard the conflicting stories and didn’t know who was telling the truth about what happened. I only knew the patient as a very cute, small-for-age child, marked by multiple injuries throughout. 

“This is our suspected NAT, with [these listed injuries], currently being supported and treated by [these interventions and medications.]”

On this day, my actual conversations ended up being with any family members who happened to be at the bedside, and I struggled deeply with setting suspicions and judgments aside when the truth had not yet been uncovered. How do I read a flat affect? Is it the result of shock and trauma, or an attempt to hide and disengage my questions? How do I read an emotional affect? Is it an attempt at theatrics and deception, or do I invest a lot of energy in comforting the sobbing individual? 

Knowing the patient would likely have the breathing tube removed before my next shift two days later, I requested to be their nurse again.

I leaned in, knowing the emotional, mental, social, and spiritual cost. It was beyond messy and complicated, with all parties holding complex emotions, withholding stories, hurting and hardened and lost. 

But I wanted to know who this patient was without the breathing tube, without sedation. I wanted them to look into my eyes and see kindness. I wanted them to hear me tell them, “You are such a good kid. This is not your fault.” 

I was also curious about the family. There are so few opportunities in life to actually interact with people actively caught up in this acute scenario, and I wanted to know how people behave, how they cope, how they talk. I wanted to be open to any discerning opportunities for connection, even compassionate care where it might feel appropriate. I also knew I was opening myself up to people with a lot of potentially cloaked anger and violent tendencies. I had no idea what I would encounter, and I would need to be ready for anything. This is what nurses show up to. 

The child was a treasure. A hint of playfulness, half-formed words, they surprised me with a hi-five when I briefly had my hand up in front of them for something or other. They asked for a blue glove like mine, so I slipped one over their little hand and they giggled at the oversizedness of it. They were more submissive than they should have been to unpleasant medical interventions like lab pokes. I couldn’t help but wonder if they had learned from day one, you don’t fight the adults who hurt you or you pay a price. 

As a child abuse victim, I imagined they paid a price from an empty pocket, even if they hadn’t started any fight with the adults. 

When I had to be in the room for medical interventions, I ached with the question, “Can this child even distinguish between pain meant to harm, and pain meant to help?” I hated being an adult who participated in any unpleasant procedures for them, stroking their head with kind words but allowing any bit of pain to reach their little body. How does a child process this kind of bizarre interaction from adults? Too young to reason, they only feel what they feel, safe or unsafe. Gentle or painful. Comforting or scary. I hope at the end of the day, they knew everything I did for them was meant to help and heal. I will probably never know what becomes of their life. 

Some will say it hurts too much to let ourselves get close and really feel. But these are the kids who need people to hurt for them, so that the fire will be lit for us to tell their stories with passion and advocacy and desperation, to not let their voices get buried in our insistence on ‘good vibes only’ because it’s too hard for us to bear the reality of their suffering and need.

I will never forget this little one. The one who wanted my blue gloves and looked at me with those big round eyes, looking for love. I hope they found some in me.