AMSA's 2015 Annual Convention
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February 26 - March 1, 2015 

Indiscriminate Hands

Care should be as blind as justice

The New Physician March 2007
“All rise,” a booming voice thundered throughout the room.


I wiped my face with the back of my sleeve, trying to remove the evidence as swarms of people returned to their places in the courtroom.


My eyes remained fixed on the young man who stood so near to me, but a few feet closer to the judge’s podium. We wore identical khakis, similar button-downs and the same serious expressions. Only a mahogany railing separated us; with just a few steps, I could easily have changed places with the young man.


But I knew he would never have the option of moving those few feet backward to the other side of the railing where people with hopes and dreams and viable futures sat watching.


A stodgy-looking old man stood next to the defendant, repeatedly glancing down at the yellow legal pad in his hands, as if searching for a clue on how to proceed. The paper was sparsely covered with lines of illegible script, indicating that the lawyer probably would not find what he looked for there; it appeared he had carelessly scribbled down those few sentences on his way to the courtroom that morning. He finally decided on some combination of thoughts and stood to address the court, his absence of enthusiasm immediately apparent in the drone of his voice. Anyone would have surmised that not even the defendant’s lawyer believed his client’s plea of innocence.


As if anticipating the lawyer’s canned comments, the judge stopped him mid-sentence and requested that the defendant stand to address the court himself. “You, the defendant, are being tried for the charge of child abuse,” the judge intoned. “If convicted, you could serve up to 25 years in prison. Do you understand these charges?”


The young man appeared visibly shaken; his voice quivered as he responded that he did understand. While he spoke, I bit at my lip, realizing that the duration of the possible sentence probably exceeded the defendant’s young age. Nevertheless, I wanted to hate him, feeling as though each moment of sympathy I experienced somehow slighted the injustices he had committed against his child.


Just a few weeks earlier—the first time I’d felt the tears—I would have instantly tossed aside any feelings of sympathy. At that point, I’d had only a few days of experience working with the city’s child-abuse team. But in that short time, I had already developed strong feelings against people who hurt their children, although I felt oddly unsettled by harboring such powerful negative emotions. Until that point in my life, I could argue that I had never actually experienced hate. For me, the word held the same dirty connotations associated with other four-letter words. I used the term sparingly and when I did, it was still only something I thought I knew about from reading historical accounts of crimes against humanity.


But this changed the moment I set eyes on a bloody, puffy infant that lay cocooned beneath layers of plaster and gauze. There, leaning against the cold steel railing of the hospital crib, I felt hate. The sensation caught me by surprise as it oozed into my veins and coursed throughout my body, boiling over into clenched fists and grinding teeth.


The father’s hands had beaten without discrimination, breaking his baby son’s leg, crushing his ribs and bruising his face. The X-rays revealed old, healing rib fractures. This time the mother had summoned enough courage to bring her child to the hospital, although her inability (however understandable) to indict the father for his wrongdoings made me seethe with anger.


I remember walking out of that hospital room hoping that the child would never have to see his father again. I wanted to imagine the father behind bars in a small prison cell, miserable and remorseful over what he had done.


A few moments after answering the judge, the defendant spoke again. “Judge…judge?” As he stammered, most pairs of eyes in the courtroom focused on the young man, waiting to see how the judge would punish this unsolicited outburst. Before the judge could react, however, the defendant teetered to the side and slumped against his unsteady lawyer, who provided even less physical support than he did legal support. Caught off guard, the lawyer fell to the ground with a thump, followed soon after by the sound of his client’s limp body crumpling onto the floor.


In an entire courtroom full of people, only a single person sprang into motion. In one fluid movement, the physician sitting next to me—the same one who was to testify against the defendant—traversed those few feet of space, lifting himself over the mahogany railing and landing squarely next to the defendant’s body. Without hesitation, he instructed the court deputy to call an ambulance while he placed his ear close to the defendant’s mouth, listening for breath sounds, and his hand across the defendant’s neck, feeling for a pulse. He found both and within a few short moments, the defendant’s eyes opened, signaling that he had come to.


After a bit of questioning, the physician ascertained that the defendant had not eaten a real meal in the past 24 hours. He continued to ask the defendant about his medical history, concerned there might be some other underlying condition. All the while, the physician held the man’s hand for the primary reason of monitoring his pulse, but perhaps also to provide reassurance to the scared, almost childlike man who had likely fainted from raw fear of his bleak future. The physician made it known in those few, brief moments that the defendant was not alone; not every person in that courtroom hated him.


Aside from the physician and the young man lying on the ground, the rest of the courtroom carried on with surprising normalcy. The judge retired to his chambers, the district attorney used the time to study his notes, and the courtroom audience turned their discussion to the latest tabloid news. The court deputy rolled in a tray of food and soda, slowing only to maneuver the cart around the defendant’s body, and made his way toward the judge’s chambers. The defendant’s own lawyer sat in a chair, shaking his head, as if he had just endured some grave injustice. Under his breath, he vowed to file a claim for any damages he incurred in his fall.


Perhaps most unsettling, as everyone busily tended to their own needs, was how the physician continued waiting for someone to bring the defendant a glass of cold water. No one had thought to offer a can of soda or juice. In fact, once the defendant had opened his eyes, no one seemed to think much of anything about the young man. Blatant contempt had quickly replaced the fleeting sympathy he had commanded in his moments as a patient.


Finally securing a glass of water and a damp towel, the physician dabbed the defendant’s head with a knowing touch and continued to monitor his pulse, waiting for the ambulance to arrive.


For the third time this month, and for reasons unique from the first two, I again felt the salty tang against my lips. I experienced a profound sadness, not out of sorrow for the abandoned defendant, nor simply for the grave injustice of a beaten baby, but because of the realization that humanity could not straddle those two extremes. A rare few can shelter both an abused child and the abusive parent in their arms.


The attitudes apparent in the courtroom—from the stark indifference of the court to my own inability to reconcile my emotions—revealed how hard most of us struggle with the idea that people who abuse children require just as much help as the children they hurt. Most of us.


Except, of course, for those charmed people who touch the world with unprejudiced hands, stroking the foreheads of both a black-and-blue baby and a devastated child abuser.


Perhaps that’s the true reason I wept—the world had just let me in on its little secret: They really do exist, those people with indiscriminate hands and unconditionally accepting hearts. I promise.
James A. Feinstein is a fourth-year at the University of Pennsylvania School of Medicine. This is a fictionalized account of true events; all identifying material has been changed or removed.