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"Oh, baby," she says soothingly.
The pediatrician feels for the large mushy spot on top of the baby's head. Alex wails.
She turns back to the baby and is comforting again, whispering, "That's all right. That's okay."
Rauth-Farley asks Elliott to find a toy for Alex. He grabs a plastic dinosaur and places it next to the toddler.
"He's doing better than he was yesterday," Rauth-Farley says. "More alert. Not quite as uncomfortable. But it's got to be hurting him pretty badly."
Alex's mother and father stand near the nursing station, after a short visit with their injured child. The mother, a diminutive Latina, gnaws at her nails. Her husband stares down at his feet.
Alex has been at St. Joseph's for a few days. His mother earlier told Rauth-Farley and detectives that, about a week earlier, she'd seen a small lump on the back of the baby's head. She took him to an emergency room, but doctors soon sent him home without a diagnosis.
Three days later, she noticed the lump had grown, and returned to a hospital. This time, the doctors took an x-ray that revealed a long skull fracture and subdural hemorrhaging--which is why the baby's head is so swollen.
Mom and Dad are adamant that neither they nor their baby sitter knows how Alex got hurt.
After checking up on Alex, Rauth-Farley spends a few minutes with a Phoenix police detective who plans to question the parents. He asks the doctor what may have caused the skull fracture.
"Something hit his head or his head hit something, but it wasn't an edge," she says, basing her analysis on the length of the fracture. "I don't think the baby was shaken, and I think we're dealing with a one-time head injury. All the force was concentrated in one area, like hitting your forehead on the windshield of a car. But we've locked them in to their story--that they have no clue about what happened."
The detective's questions are multipurpose: He may ask for a search warrant to look for whatever blunt object may have caused the injury. Beyond that, when the cop urges the couple to recall everything that happened, they might say, "Oh, we do remember now. He hit his head on the edge of a table," and he'll know they're lying.
Rauth-Farley says Alex most likely struck or was struck by something flat, "like a Bible . . . but not by a ball-peen hammer."
The doctor and the detective compare notes--including the fact that Alex suffered a fractured arm as a 3-month-old, but that the state Child Protective Services closed its file on that incident last December. Rauth-Farley also points out that the couple has a history of domestic violence.
After the detective leaves with Alex's parents, Rauth-Farley instructs Dr. Elliott on what's just transpired.
"We're trying to sort out how it could have happened," she says, "and we're trying to understand if this is an accidental or a nonaccidental injury. There are a lot of troubling aspects to this one, a lot of work to be done."
A few days later, Alex is discharged from the hospital into foster care. The investigation is continuing.
You lookin' for fingerprints down there?
--a 12-year-old girl to Dr. Kay Rauth-Farley during a genital examination at St. Joseph's Hospital
"Could you please stick a little more lipstick on me?" she asks, scrunching up her face in the brightly lighted dressing-room mirror. "I'd like more of a Cupid look. I'm looking far too old."
She says this in the nasal twang of her Missouri roots, tongue only partially in cheek. She actually looks younger than her 47 years, but Rauth-Farley could be excused if she didn't.
As medical director of St. Joseph's Hospital's Child Abuse Assessment Center, she's examined more than 2,500 kids suspected of having been physically and/or sexually abused.
Professionally, hers is a strange and specialized world.
Rauth-Farley sees, touches, contemplates, feels and analyzes the unthinkable almost every day. She knows firsthand that bad things happen to children, and that adults often are responsible.
She examines children--infants to teenagers--who have been burned, choked, pummeled, scalded, shaken, stabbed, raped or merely fondled. Too often, she attends the autopsy of a murdered child.
Rauth-Farley's task is to identify and organize the medical evidence that may answer the how and what, if not the why.
Often, she succeeds. Sometimes, she doesn't.
Rauth-Farley is one of only two doctors in Arizona and one of about 100 nationwide who deal solely with abused children. She's testified in countless criminal trials in Maricopa County and elsewhere.