Working in a hospital brings exposure to the human condition in the way that no other job can. Of course you see birth and death, but you also see the results of human foibles like rage, anger and despair. All too often, mental illness plays a (usually harmful) role. Eventually, patient behavior, no matter how bizarre, loses the power to shock. That does not apply to the behavior of the staff. It’s still shocking when they begin to behave like they are crazy.
The story of The Baby in the Wonderbread Bag begins like so many stories of teen pregnancy, with a young girl who has successfully concealed her pregnancy from family and friends. In this case, the 16 year old girl also had a history of mental illness. She appeared in the emergency room complaining of intermittent abdominal pain. Because she looked well, she was advised to wait while patients who were seriously ill were seen before her.
No one paid her much attention until she went to the Ladies Room and blood was seen to flow from beneath the door. When Security broke down the door, the doctors found that the girl had given birth to a premature baby. She had stuffed the baby in a Wonderbread bag, and, at the moment Security had broken in, she was attempting to flush the baby down the toilet.
They rescued the baby from the toilet bowl and pulled him out of the plastic bag. The neonatologist rushed down from the neonatal intensive care unit and resuscitated the baby. He appeared to be about 7 weeks premature, and smaller than expected for this stage of pregnancy. Nonetheless he was healthy and vigorous, despite his brief time in the toilet, and was swept off to the NICU for further care.
That’s when the story gets weird.
Several days later, in my capacity as a chief resident in obstetrics, I was called to the weekly Social Service meeting to provide my input in difficult cases. When I arrived, I found that the Social Service staff calmly discussing whether the Wonderbread Baby should go home with his mother, as if it were perfectly reasonable that she had tried to flush her baby down the toilet. That shocked me.
It’s not that the Wonderbread Baby was the most bizarre thing we had ever seen; it didn’t even come close. The combination of youth, concealed pregnancy and mental illness is all too common at an urban hospital and the results are usually far more deadly. Indeed, even during my years of medical school and residency, the results of this toxic combination had been getting steadily worse.
When I started medical school, a baby born addicted to cocaine had been a standard reason for removing the child from the mother’s care. During the intervening years, cocaine addiction had become so common that it was no longer considered a reason to remove a child. We had been, in the words of a famous sociology essay, “defining deviancy down.” As abuse and neglect of babies had become more common, we kept readjusting the definition of abuse and neglect, so we could continue to send babies home instead of into the foster care system.
Even so, I was not prepared for a staff meeting with participants calmly discussing flushing a baby down the toilet as if it were some sort of reasonable response to an unwanted pregnancy. They asked for my input, and they got much more “input” than they had bargained for. I had been on call and awake for most of the previous night. Therefore, I exhibited somewhat less restraint than I might have otherwise.
“My input? MY INPUT?” I replied, my voice rising in volume, “Have you people lost your minds?”
“This teenager put her baby in a plastic bag and tried to flush him down the toilet!” I continued, “Is it really that hard to figure out that she should not be allowed to take this baby home?”
The lead social worker seemed defensive.
“You don’t have to get so angry about it,” she chided.
I wasn’t finished with my tirade.
“Evidently I do have to get angry, since you don’t seem to realize how bizarre it is to ask for input about whether flushing a baby down the toilet is a risk factor for abuse.”
The whole team looked hurt.
“It is a risk factor. It is a very big risk factor!” I went on. “I’m going to put myself on the line here and state unequivocally that anyone who tries to flush their baby down the toilet should not take that baby home.”
“Well, if you feel that way about it,” the team leader huffed, “then we won’t send the baby home with her.”
“Yes, I feel that way about it,” I huffed back.
The meeting ended on that less than cordial note.
Looking back on it, I can see that what filled me with anger and despair was not the fact that a teenager had tried to kill her baby. Mental illness and desperation are often a lethal combination. What filled me with despair was that seemingly sane people were discussing whether or not flushing a baby down the toilet was acceptable, as if the conclusion might be in doubt.
