MY INTERNSHIP and pediatric residency was in a poor section of Chicago, noted for its high rate of drug abuse, illegitimacy, and violence. Knifings and sexual assaults were nightly fare in our emergency room. The corpses we pronounced dead were seldom reported in the daily newspaper. We assumed that if other area hospitals received a like number, they were just too common to be newsworthy.

In back of our well-lighted, well-policed hospital area was a ring of condemned buildings, black shells with cracked walls.
Hungry rats and stray dogs poked through the piles of rubble. Still farther away, there rose a series of stark angular high-rise apartment buildings.
Each was spaced an equal distance from the other, and each looked exactly like its neighbor. They were dark gray, constructed of cement and steel, and designed for low-income families.

The children of the high-rise buildings received care through our pediatric emergency room. A mother might wait for six hours to have her feverish infant seen by a harried resident.
A different child was examined every five to ten minutes until the resident was so exhausted that one face became indistinguishable from the next.
Children were seldom returned for a recheck and we rarely saw an infant who was well enough to be given his long-overdue routine immunizations. Head lice and the crusted sores of impetigo were common.

After several months of this assignment, physicians became callous and worked much as if they were checking parts in an assembly line. Instructions to parents were curt and little opportunity was given for discussion. We were unable to stem the rising tide of human misery.
Our department of pediatrics recognized the dehumanization of this experience. In an effort to reinvest us with charity, they assigned each resident the care of the children in one of the high-rise dwellings.
We were to make house calls, vaccinate, recheck ears, and give well-baby follow-up examinations- providing the families permitted.

On the first day of my assignment, I approached my tall gray monolith with misgivings. It was a muggy summer, and wet sheets hung from open windows.
No nurse backed me up and no one had requested my services. Placing a few instruments in the pocket of my white coat, I entered the building only to find that the elevator was out of order.
Breathless after climbing six flights of stairs, I paused on the landing to find myself scrutinized by five small bright pairs of eyes, none of which were higher than my knee. Here were my patients, partly clothed, alone and untended on the filthy floor.
There were no toys and no furniture. A soggy diaper, several empty cans, and old potato chip bags littered the floor.

© 2008