The first time I encountered the clinical aspects of child abuse was when I was a third year medical student doing my pediatrics rotation. The outpatient portion of my rotation had me going through all the various subspecialty clinics. One of these subspecialties was child abuse.

I would shadow the attending for one morning every week. Unsurprisingly, it was an eye-opening, heart-wrenching experience. One of the more horrifying cases I remembered was a child whose face and chest had been deliberately scalded by her mother with boiling water, because the child had angered her somehow. After each clinic session, I would go to lunch, and sit by myself in silence and brood, thinking to myself what an awful world we live in, and how so many people truly suck.

In my third year of residency while I was in the pediatric ICU, we had a two year old come in comatose, with his skull and his ribs fractured, having beaten to an inch of his life, and even bitten on the face, too. The assailant was the mother’s boyfriend. His arrest was pretty dramatic. The police basically rushed into the unit with guns drawn and handcuffed him in front of the child’s family.

But the first time I had to call DCFS myself wasn’t until my fourth year in residency. I was just covering for 24 hours over the weekend, and one of the cases the overnight moonlighter signed out to me was a baby who had come in vomiting blood, with a distended belly. The x-rays weren’t particularly revealing, but a CT scan was still pending. All the moonlighter could tell me was that the mother said that the baby “fell” from a workout bench in the garage (what the hell was the baby doing on a workout bench in the garage?) The moonlighter was distinctly uneasy about it, telling me that everyone in the room seemed a little “squirrely.” I didn’t dwell on it too much, since I had about twenty other patients to figure out, but then the CT scan report came in.

The baby’s liver was essentially shattered, the only thing keeping the child from bleeding out was the capsule of connective tissue that encases the liver. First, I had to call the surgeon. But this clearly wasn’t the type of injury you would get from falling from a height of two feet, even if it was onto cement. I talked to the CPS attending on-call, and they took care of everything.

Since then, I’ve had to call DCFS twice more, perhaps in far less dramatic circumstances, although no less terrible. I hate that we live in a world where there has to be a system to handle this kind of problem. Don’t get me wrong. I’m very glad DCFS exists. But I hate that it has to, that there are people out there who deliberately harm and exploit children.

The other thing I hate is that it destroys my trust in everyone. I can’t trust teachers. I can’t trust child care providers. I can’t even trust the child’s parents. I start thinking everyone has a motive for filing a false claim. Is the child just an unwitting pawn in some awful game being played by parents in the midst of an ugly divorce? Is this just a manifestation of some irrational hatred between the people involved? Is the person abusing the child the very person who called in the report in the first place?

The Calvinists, the Hobbesians, the Social Darwinists, the Randians would have us believe this is human nature. It happens. Get used to it. Everyone out there is out to destroy everyone else to try and gain an advantage. Humanity is inherently depraved. No one is innocent, not even children. I find such a worldview bereft of any redeeming qualities. If it’s true, what’s the point? But at times like this, I can’t help wonder if I’m just deluding myself and refusing to listen to the truth.