Dr. Kay Rauth-Farley is checking on a toddler named Alex in the pediatric ward of St. Joseph's Hospital. The 1-year-old has a fractured skull, and he's whimpering in his bed.
"Oh, baby," she says soothingly.
The pediatrician feels for the large mushy spot on top of the baby's head. Alex wails.
Rauth-Farley reverts to a clinical manner. "He realizes that his mom and dad aren't here anymore," she tells Dr. Melinda Paradis and a young resident, Dr. John Elliott.
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
Dr. Kay Rauth-Farley is at the Orpheum Theatre, waiting to participate in a television forum on "children and violence" to be hosted by CBS's Dan Rather. She has a request of the makeup artist.
"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.
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.
"My job evolved out of a community need," she tells Sharon Simone, a fellow panelist seated next to her in the Orpheum dressing room.
"Nobody else wanted to do it, and someone had to do it," Rauth-Farley says. "But being a CPS caseworker is harder. At least I have a scientific basis to my job."
Panelist Simone is a Massachusetts woman who successfully sued her father, an FBI agent, for having beaten her incessantly as a child and young adult.
Nearby, radio personality Pat McMahon is chatting to sports czar Jerry Colangelo. Dan Rather--shorter, more crinkled and warmer in person than he seems on television--holds court in a nearby hall. Rauth-Farley wonders how she wound up in a forum with such dignitaries.
"I'm no big shot," the doctor says. "I just treat kids."
As it turns out, Rauth-Farley's talk with Simone is more compelling than the star-studded symposium.
Simone explains that, years earlier, she'd started to treat her own children like her father had treated her. That prompts Rauth-Farley--herself the mother of two college-age children--to speak of her own past.
"My first kid [Megan] was so colicky," she says, "and I didn't know what to do, even though I was in medical school at the time. Many a night, I thought I was one step away from losing it. But we were a two-parent household, and I'd hand her off to my husband. He'd calm her down, and calm me down. What if I hadn't had anyone to turn to, if I didn't have the resources or the education? Without the grace of God, I could have shaken my kid, boom."
Rauth-Farley reminisces of her early days in medicine: She tells of a doctor--a woman--who said she wasn't assertive or physically strong enough to be an orthopedic surgeon, and suggested she try nursing instead. And there was the male surgeon who rubbed up behind her suggestively as she treated an anesthetized patient.
"What did you do?" Simone asks.
"Absolutely nothing," Rauth-Farley replies. "This guy could have made life miserable for me at school. Still, I kind of wish I'd cleaned his clock right there and then."
She tells of joining the staff at St. Joseph's Hospital in 1989 as a teaching pediatrician, then working two mornings per week at the newly formed Child Abuse Assessment Center.
"The things I learned!" Rauth-Farley says.
One important lesson was that many of her peers are ignorant of basic facts involving the physical and sexual abuse of children:
"Here's one. A family-practice doctor sees a father and a daughter for herpes. The doc treats the dad, but he won't report anything about the daughter to authorities--to spare her reputation. Yeah, right. He never puts together that she got herpes from dad. I could have shot the guy [the doctor]. I've bitched about this kind of thing with BOMEX [Arizona Board of Medical Examiners] and the county attorney for nine years. Nothing ever happens."
Rauth-Farley recalls a 13-year-old sex-abuse victim who asked about not having orgasms.
"I'm thinking abuse, she's thinking orgasms," she says, incredulous. "When I was her age, I didn't care about or know about orgasms. I was playing baseball."
Finally, she tells about a northern Arizona teenager who allegedly had been subjected to ritual abuse. The girl had been diagnosed with Multiple Personality Disorder, with one "personality" claiming she'd be sacrificed at age 21. Rauth-Farley was asked to examine the girl for signs of abuse.
"So I'm . . . between her legs starting to check things out," the doctor says drolly. "She goes, 'The little ones want you to stop,' referring to some of her personalities, some of which are boys. I don't know if she's pulling my leg or not, but I don't care, as long as I can finish my exam. Suddenly, she bolts upright, which wasn't easy to do in her situation, believe me. I almost asked her to tell the 'little ones' to cool their jets for a minute."
Rauth-Farley laughs loudly. In her line of work, laughter is a godsend.
The forum at the Orpheum goes as well as can be expected with a full stage of talking heads discussing questions that are unanswerable. Rauth-Farley utters only a few comments before Rather turns to someone else.
That's too bad, because she's a passionate and convincing advocate, and a skilled debater.
And she's not impervious to the grim realities of her job. Her eyes well with tears when reliving an unsolved child murder.
She's persevered personally and professionally, she says, by virtue of her solid upbringing and her faith in God. But the road hasn't been easy.
As a teen, Rauth-Farley vowed to become a doctor. But her first try to get into medical school failed. Undaunted, she earned a master's degree in biology, gave birth to two children and completed medical school with her toddlers in diapers. She's suffered through her beloved son's serious illness, lupus.
Professionally, she tries to heal broken children day after day, year after year.
"She has intuition, knowledge, skill and grace," says Dr. Tascha Boychuk, an Arizona State University professor who worked with Rauth-Farley at St. Joe's.
"Wrap that up with compassion and understanding and you have a remarkable person. When Kay takes up someone's struggle, she doesn't need something for herself in the process, like so many do in this business. She's always taught us lessons in courage, and that the value of the struggle goes beyond your personal stake. And she also has a great sense of humor."
Rauth-Farley isn't afraid to stand up to the big boys. In 1996, for example, she wrote a letter berating County Attorney Rick Romley for what she called a "cavalier approach" toward child pornography cases. The doctor says the clash marked "the biggest nightmare" of her nine years in Phoenix, and that her relationship with Romley's office never has quite mended.
Rauth-Farley is direct with everyone, and rarely, if ever, goes along to get along--even with cops.
"We try to be helpful," she says, "but we're here to heal kids, not to be an arm of law enforcement."
Phoenix sex-crimes detective Judy Townsend has had no problem with that.
"Here's an example," Townsend says. "There was a little girl of 6 or 7 whose mother took her to the ER. The doctor over there examined her and said she'd been sexually assaulted. Dad had custody of the kid, but Mom had her on weekends. I talked to her and she insisted that nothing had happened, and she seemed as happy as any other child.
"The guy probably would have been arrested that night. But Kay examined the girl, and she concluded it was a dermatology-type disease that appears like massive bruising. The other doctor was furious at me for letting the girl go home with her dad. If Kay hadn't been there, this guy conceivably could have ended up in prison. She's done more to help make our cases and to set us straight than anyone I know."
Young doctors could do no better than to emulate Kay Rauth-Farley.
"She's got the most integrity of anybody I've ever known," says Wendy Dutton, a forensic interviewer who has worked with Rauth-Farley since 1992. "She's straight-up, honest, and you know where you stand with her at all times."
Rauth-Farley's son views his mother through a different prism.
"My mom had a day named after her, okay?" says Michael Farley, a recent Brophy Prep graduate, referring to a proclamation in May from Governor Jane Hull. "Steven Seagal got a day, my mom got a day. How many moms get their own day? My mom is exceptional."
Those in her inner circle also know how exceptionally stubborn Rauth-Farley can be. Says her mother, Betty Rauth, "Kay once told me, 'You can make all the suggestions you want [about child-rearing], but I may not take them.'"
Rauth answers quickly when asked if she challenged her daughter on that point: "Wouldn't think of it."
Rauth-Farley's daughter, Megan: "My friends all ask me, 'Why do you have to get home by midnight? You're almost 20 years old.' I tell them, 'Trust me. You don't want to fight with my mom when she thinks something should be a certain way.'"
Rauth-Farley will leave the Valley soon to join her husband of 22 years, Mark, in Missouri. (Her successor at St. Joseph's Hospital will be Kathy Coffman, a New Jersey pediatrician.) A golf professional who now works for Karsten Manufacturing, Mark Farley moved back there months ago.
"Mark has moved three times for me since we got married," she says. "Now it's time for me to move for him."
Rauth-Farley is thinking about a half-time job with a Kansas City hospital, as she insists to family and friends that she wants to "slow down" for a while.
Her husband doesn't buy it.
"She's still a go-getter in a field where people burn out," says Mark Farley. "When I tell people what she does, it's like, 'She does what with kids?' She's in this taboo area. I couldn't do her job--I'd be in jail for killing someone who beats up their kid. I don't know how she does it."
A person is a person, no matter how small
--caption added to a self-portrait by 6-year-old victim Amber Bass, on Dr. Rauth-Farley's office wall
"I'm Kay Farley and I'm a pediatrician," the doctor tells a gathering of attorneys at a Maricopa County Bar Association meeting. "I'm also very uncomfortable in a roomful of attorneys."
Most in the audience are criminal-defense attorneys.
She's a few inches over five feet tall, and is a few pounds over her fighting weight, literally. (The doctor was nearly a black belt in tae kwon do before getting hooked on scuba diving a few years ago and switching hobbies.)
Rauth-Farley first discusses the medical evidence of child abuse--or lack of it--in criminal and custody-dispute cases. She provides a chronology of what happens at the clinic when a child is referred there for an exam.
"What the child is telling you is the most important," Rauth-Farley says, "but I'm not the one who interviews the children about the allegations. That's Wendy Dutton's job."
As the clinic's gatekeeper, the doctor explains, Dutton hears what a child has to say about when and if she (a majority of the kids seen at the clinic are female) was abused. Dutton reports her findings to Rauth-Farley, who decides if a physical exam is called for.
"We could collect our $350 from the state and move on," Rauth-Farley says, "but I need a reason to believe something's happened to the kid. Then we'll examine. The child doesn't necessarily have to disclose something. Sometimes it's instinct, but I do go on something. . . . Not that the exam is traumatic, it's just not fun."
Each child who does get a physical exam undergoes a 90-minute drill: It's a checkup that ends with an examination of the genitals using a device called the colposcope. A series of magnifying glasses, the colposcope doesn't touch the subject, but allows the trained observer to better determine if abuse has or hasn't occurred. If evidence emerges and the police don't know about it yet, Rauth-Farley is mandated by law to report it.
She says most doctors are untrained in how to analyze sexual abuse, often with grave repercussions. She describes how, time and again, an emergency-room doctor or a family practitioner will tell a parent that a child has been abused, solely because of a hymenal tear.
"That's not necessarily true," Rauth-Farley says. "Too many doctors don't know a hymen from a head, or that the myth about 'busting the cherry' is just that, a myth. Even then, a perfectly normal exam can still be consistent with sexual abuse, depending. We doctors don't always have answers . . ."
The doctor tells a story of an 8-year-old girl whose minister father took her to the ER at St. Joe's. The child was bleeding badly from her vagina, and was too traumatized to talk.
"It looked for all intents and purposes that she had been raped," Rauth-Farley recalls. "They took her to the operating room, with the dad in the waiting room. Everyone was treating him like crap, very accusatory. As it turned out, I was thoroughly embarrassed by how they treated this man. They called me down there, and I spoke to the dad. He said they were coming back from church and his daughter was on her bike, that's all he knew."
She says she asked the police to check the little girl's bicycle. They discovered the child had impaled herself on a bracket that attaches to a reflector behind the seat.
Almost in passing, Rauth-Farley says prepubescent females may not be able to distinguish vaginal from labial penetration if it's momentary. In the audience, assistant public defender Candace Kent takes careful note. The attorney has a client accused of sticking his finger in his step-granddaughter's privates. Rauth-Farley is listed as a prosecution witness.
A month later, the case comes to trial. Rauth-Farley walks briskly to the witness stand in a Maricopa County courtroom. She's toting a black purse, and is dressed in a white pleated dress and red jacket, looking sharp and professional.
Waiting in the lobby minutes earlier, Rauth-Farley realized that the prosecutor accidentally had handed her a report from another case. A less experienced hand may have panicked, considering that the doctor hadn't looked at the correct file in more than a year.
The prosecutor leads Rauth-Farley through her resume--undergraduate, graduate and medical school degrees from Creighton University in Omaha, Nebraska, residency at the University of Nebraska-Omaha, a pediatrician for 16 years, at St. Joseph's Hospital since 1989.
She makes eye contact with the jurors, and is serious but relaxed on the stand.
This case is a tough one for the prosecution: When the little girl was 5, she told her mother that grandpa had stuck his finger into her vagina. He says he may have accidentally touched her genitals briefly when she was sitting on his lap.
Rauth-Farley tells jurors that the girl's exam showed no signs of injury. She says she saw signs of redness outside the child's labia, but that it wasn't a significant finding.
Candace Kent asks the doctor, "The bottom line with a history of touching, you wouldn't expect to find any physical signs?"
"And if the touching is momentary and accidental, you're not going to find any physical signs?"
Kent asks Rauth-Farley to recall what she'd said at the Bar meeting in April. The doctor sticks to her earlier comment, that prepubescent girls sometimes mistake touching as penetration.
As she leaves the courtroom, Rauth-Farley passes a little blond girl engulfed by family members. It's the alleged victim.
The doctor turns to a young resident at St. Joe's who watched her testify.
"I have to tell the jury what I found," Rauth-Farley tells him, turning her testimony into a teaching lesson, "and I can't be evasive. That's not right. I have to tell it like I see it. Do I think the little girl is telling the truth? Sure. But it's not my job to sort that out."
The defendant is acquitted on one charge, with the jury deadlocked on the other. Prosecutors say they plan to retry the man on the remaining count.
Kay once told me that there's never a day that she doesn't want to take a child home with her.
--Rauth-Farley's mother, Betty Rauth
When Kay Rauth-Farley was about 14, her younger sister, Jeanne, hurt an arm horsing around in their front yard.
Betty Rauth looked at the arm briefly, then sent Jeanne off to bed. That night, Jeanne slept fitfully. In the morning, her parents saw something that became the stuff of family legend.
"Kay had gotten two rulers and some dish towels and wrapped up Jeanne's arm in a kind of splint," Betty Rauth recalls. "I guess it was the born doctor in her coming out."
The Rauths took Jeanne to the family doctor that day. Indeed, her arm was broken.
Mary Kay Rauth-Farley was the third of seven children born into what she calls a "classic Beaver Cleaver, 1950s-type, middle-class white" family.
John Rauth was a World War II hero who owned a construction company in rustic St. Joseph, Missouri. Betty Rauth was a homemaker who took her job seriously.
"I guess you could say we are traditionalists," says Betty Rauth, now in her 70s. "We had family meals together every night, and the person who finished first couldn't leave until everyone was done. We went to church together--we're pretty devout Catholics. You could say we were very strict with the kids."
Even as a youngster, the Rauths say, Kay stood out for one trait.
"She always was a very determined little lady," her mother says. "I mean, very determined. When she set out to do something, she did it."
Musically inclined, Kay learned to play the accordion before she was 10. In high school, she sang in the church chorus and with a group of other teenage girls called The Daisies.
She also developed a work ethic.
"We told them all we'd send them to college," her father says, "but they had to work at school and in the summers. To us, there was a fair deal."
Kay's jobs during high school and college ran the gamut:
"Before I was 16, I spent one summer detasseling corn, you know, so the corn wouldn't have sex with each other, wouldn't pollinate. It was hot and sweaty work, but with this ice-cold irrigation water coming up on our legs."
Rauth-Farley was a maid at a hotel, a factory worker, a cashier, and a surgical tech, among other jobs. All the while, she remained fixated on becoming a doctor, even after she passed out in high school while watching a gory auto-safety film.
She and her sister Patty were close in age and were inseparable. Patty followed Kay to Creighton University, a Jesuit school in Omaha, about 150 miles from St. Joseph. (Patty Hayes is a pharmacist in St. Joseph.)
Even as an undergraduate, say those who know her best, Rauth-Farley was intense, driven and focused.
"She knew her whole life what she wanted to do--she's one of those," says her husband, Mark. "She has never understood the concept of unmotivation, if that's a word."
Mark Farley also grew up in St. Joseph. But he's about three years older than Kay, and the two didn't click romantically until after she went off to college, and he returned from a tour in Vietnam.
Rauth-Farley graduated from Creighton University in 1973, with a bachelor's degree in biology. Thrilled that her dream of becoming a doctor was getting closer, she applied to the university's medical school. She didn't get accepted, which devastated her.
"To this day, Kay lives with a fear of failure more than most," Mark Farley says. "She wants everything right and perfect in her life, again more than most. But she won't quit when things go against her, not hardly."
Instead, she entered Creighton's graduate program, and earned a master's degree in biology in 1975. She reapplied to the university's medical school, and this time was admitted.
By now, she and Mark were a serious item, and he asked her to marry him the night before medical school started.
"There were 100 men and 10 women at the school," Rauth-Farley recalls, "but the cool guys were already taken anyway, and the single guys were nerds."
The couple married in 1975. Rauth-Farley was 25.
She graduated four years later, then completed a three-year medical residency program at the University of Nebraska-Omaha.
"A lot of my ability to get through it all is due to Mark," she says. "He'd have our two babies by himself for days on end when I was on call at the hospital. And he was working hard himself. . . . He made things possible for me."
Mark Farley's version: "What she's saying may be true. But Kay would have crawled across the desert on her hands and knees to become a doctor."
After Rauth-Farley finished her pediatric residency in 1982, she and her young family returned to St. Joseph. There, she started a solo practice as a pediatrician. The hometown girl's reputation and practice grew steadily, if not her bank account.
"This was the early 1980s," she says, "and the Midwest was going through the farm crisis. A lot of my patients couldn't pay me, which was fine, except we had our own money problems."
In 1985, Rauth-Farley recruited a young doctor to help carry her growing workload. But that arrangement fell through, and she and Mark stunned their families by announcing they were moving to Houston.
Rauth-Farley took a job there as a pediatrician with CIGNA. Mark Farley landed on his feet, later becoming the head golf professional at a posh country club.
Rauth-Farley toiled for CIGNA until 1989, when, bored with her job, she applied and was hired at St. Joseph's Hospital in Phoenix.
For the third time, Mark Farley followed his wife to a new town, a new job. He picked up work at Moon Valley Country Club and eventually became head pro. Their children were still in grammar school.
In 1989, child-abuse investigation and treatment in the Valley was prehistoric. Child sex-abuse victims usually had to wait weeks for their physical exams. The state of Arizona--which still is behind the national curve in funding children's services--was even more deficient.
At St. Joseph's in those days, Tascha Boychuk would interview abused children in a small room that passed for a "clinic." Four doctors on the hospital's pediatric staff rotated there for a few mornings each week.
Rauth-Farley became one of that quartet soon after arriving at St. Joe's. Within weeks, she resolved to do more.
"She was the one who had the clarity of vision of what the clinic could be," Boychuk recalls, "and she asked to be put full-time on it. St. Joseph's had the foresight to accommodate her, and to get behind a full-blown clinic, the one that they have now.
In 1991, then-governor Rose Mofford led the dignitaries at a ribbon-cutting ceremony that opened St. Joseph's Child Abuse Assessment Center, at 124 West Thomas Road.
Now, seven years and a few thousand exams later, Rauth-Farley is about to leave her "baby," as she calls it, in other hands.
When a Child Is Born, the Angels Sing
--a sign tacked to Kay Rauth-Farley's office wall
It's 7 a.m. on a June weekday, and Kay Rauth-Farley is alone in her second-floor office at her clinic.
"It's a time to catch up with reading, writing, some thinking," the doctor says.
Her office is small, with the requisite computer, scientific journals and piles of paperwork. What makes it unusual are the dozen or so Post-it notes above her desk.
On each, she's written the name of a child who died at the hands of an adult--"Brenae Rettig--9.5.95 to 3.7.96"--Strangulation and skull fracture."
Some of those responsible for the crimes have been tried and convicted; others haven't.
Rauth-Farley talks about each victim, pausing when she reaches the note with the name of 6-year-old Amber Bass.
The west Phoenix child's horrific death haunts her.
Amber was pronounced dead on arrival at St. Joseph's Hospital on Valentine's Day 1994. She'd suffered severe injuries to her vagina and rectum, and had bled profusely. Called to the ER to examine Amber, Rauth-Farley determined Amber's injuries had occurred in the last day of her life.
But the county medical examiner ruled the girl had died of "natural" causes because of a congenital heart condition.
Rauth-Farley is certain Amber died because someone raped her. And if the sexual assault did lead to the child's death, it would be a "felony murder"--the equivalent of first-degree, premeditated homicide.
But no one has been arrested in the case, and its resolution seems doubtful. One reason, common in child-abuse cases, is that several adults had access to Amber during the hours before she died--and none have implicated themselves or others.
"Amber," Rauth-Farley says, in a momentary trance at the indelible memory of the ravaged child on a gurney at the ER. "Amber."
She snaps out of it. Rauth-Farley's do-everything assistant, Diane Medina, isn't in yet, so the doctor herself answers the phone.
"Child Abuse Center, this is Dr. Farley. Yes, I'm one of the doctors here . . ."
An FBI agent calls from Flagstaff for advice about a child pornography case.
A St. Joe's doctor wants to know if he has to talk with defense attorneys about a new case. "I don't have to, do I?" he asks her.
"No, you don't, not right now, but I'd recommend that you do," Rauth-Farley replies. "That way, you'll get a feeling about what they're after, where they're going, what they're like. It's kind of a head start."
She's scheduled to submit to her own interview with a defense attorney in an odd case involving a west Phoenix boy whose genitals were burned by a hair dryer--allegedly wielded by his mother's boyfriend.
The police theory: An 18-month-old boy urinates on the floor of the couple's Glendale home. His mother offers to clean it up, but the boyfriend says he'll take care of things. Mom returns to the kitchen, then hears a hair dryer going in the bathroom. The door is locked and the child is crying. The boyfriend says he's drying his hair, that the baby is fine. After a while, the hair dryer stops.
The boyfriend later offers to change the child's diaper. But Mom sees nasty blistering on her son's right thigh, scrotum and foreskin of the penis. But the boyfriend doesn't want her to take the baby to a doctor.
The next morning, Mom takes the tot to a hospital and contacts police, who never find the hair dryer.
The boyfriend's story: He never heard the hair dryer when he was taking a shower. After the shower, he saw the child holding the hair dryer--which wasn't on--in his naked lap on the floor. He says he didn't do anything to hurt the child.
Kay Rauth-Farley examines the child two days later, after talking with his mother. The doctor reports second-degree burns, but doesn't see patterns that would prove the hair dryer had touched the baby's skin. Instead, she writes, someone likely burned the boy by holding the hair dryer near his genitals.
The doctor notes that the baby's injuries were not consistent with diaper rash.
"It sounds like it was cruel, not frustration," Rauth-Farley says as she awaits the phone interview with the boyfriend's attorney. "It's like he found a new method to discipline the kid, and it went a little too far."
For legal reasons, the jury never will get to hear that opinion.
Assistant public defender Joe Stazzone asks Rauth-Farley on the phone if the child's injuries could have been caused by a rug burn. No way, the doctor says, you wouldn't have had the blistering present in this case.
Stazzone asks the doctor why she wrote that the child's injuries hadn't been caused by a diaper rash.
Stazzone asks Rauth-Farley if she knows how hot hair dryers can get.
"I know they can get hot enough to burn you."
The lawyer asks if the child could have sustained the burns by accident.
Rauth-Farley says it's possible.
The interview ends, and the doctor moves on to her next task. She listens to Dr. Melinda Paradis and Wendy Dutton synopsize a new case, that of a 4-year-old who told her mother that her father had fondled her genitals.
But Dutton says the little girl hadn't revealed anything to her, other than wanting to go home.
"There were some big old tears," Paradis says.
"She can cry all she wants," Rauth-Farley says, "as long as she cooperates with the exam. Tell her it's important for us to see if she's hurt."
"She said she was fine."
"Well, we're not going to four-point her," Rauth-Farley says, adding that some clinics do hold down young patients to complete exams.
A 30-year-old mother of two, Paradis has worked with Rauth-Farley for a year. She, too, will soon be leaving St. Joseph's, to head a new child-abuse clinic at a Connecticut hospital.
"She's taught me so many little things," Paradis says of Rauth-Farley. "I used to tell my patients before doing an exam, 'We're only gonna touch,' trying to relax them. She told me that how I said it may have been just what the perpetrator said--'We're just gonna touch'--and might be difficult on the child. She's also taught me how to word reports, to stay conservative in my approach. She'll say, 'If you can't explain something simply in writing, how are you going to do on the stand?'"
The hair-dryer case goes to trial in early June. Rauth-Farley's testimony goes smoothly, but she's troubled.
"I may have assumed too much," she says of the prosecutor. "I thought we'd go over more before I testified. There were some things she could have asked me, but didn't. I think there may be problems getting a conviction in this one."
In closing arguments, the prosecutor reminds the jury that Rauth-Farley had testified the burns weren't accidental.
"This wasn't some freak accident," the prosecutor says. ". . . He [defendant] doesn't want his nasty secrets to come out."
But the prosecutor is wrong. In the pretrial interview and on the stand, Rauth-Farley had said the burns could have been accidental.
"Ask yourself what Dr. Farley has testified to," defense attorney Stazzone reminds the panel. ". . . She [says] it could have been accidental genital trauma that's caused the injuries."
The jury acquits the boyfriend--now the ex-boyfriend, by the way--after deliberating only a few hours.
Rauth-Farley is upset at the news.
"I let that kid down," she says. "Those burns were horrible. As if that baby inflicted them by himself. . . . I should have done more."
Kay Rauth-Farley walks the few hundred yards from her clinic on West Thomas Road to the main building at St. Joseph's Hospital. It's noon, but she usually skips lunch to attend Mass at the little chapel inside the hospital.
Today, Father Milt offers a prayer for those "taking leave of their jobs, of schools, for those who are ill." He also warns worshipers to beware of "savage bulls."
The metaphor is prescient.
Rauth-Farley knows that too many "savage bulls" remain on the loose, in Arizona and elsewhere.
"Where I'm going, I want to keep teaching others what to look for, how to deal with these cases," the doctor says, during the walk back to her clinic and another afternoon of physical examinations, decision-making and advice-giving.
"Becoming a doctor was something I needed to do. And I suppose that working in the area of child abuse is something I think I'm needed to do."
Contact Paul Rubin at his online address: firstname.lastname@example.org
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