THE VIRGINIAN-PILOT
Copyright (c) 1996, Landmark Communications, Inc.
DATE: Tuesday, April 30, 1996 TAG: 9604300028
SECTION: DAILY BREAK PAGE: E1 EDITION: FINAL
TYPE: PROFILE
SOURCE: BY ELIZABETH SIMPSON, STAFF WRITER
LENGTH: Long : 289 lines
DR. JOHN DE TRIQUET doesn't wear smiley bears on his starched oxford shirt.
The pediatrician doesn't try to make children laugh, or distract them with stickers.
``I want to be unique to that child, unique to that moment,'' he says. ``I want them focused on me.''
``That moment'' is when a child is examined for abuse. And while the experience may be unique for the child on the table, it isn't for this 47-year-old doctor.
De Triquet examines 50 to 70 children a month - 600 to 800 a year - for abuse. When children are reported abused in Hampton Roads, de Triquet is usually the man they see.
As the area's leading expert in child-abuse detection, he's often a witness in court. His findings can help end abuse, unravel a family. And the exam itself can cause a child to revisit the act of abuse.
Because of that, de Triquet has developed a routine:
First, he speaks to the child, not to the parent or the social worker. He tells the boy or girl he's a doctor. Asks if they know why they're there. Shows them the instruments he's going to use. Tells them exactly what he's going to do.
Then he looks the child square in the eye and asks a question:
``Do you trust me?''
In the thousands of children he's seen in more than 20 years, de Triquet has only had a handful say no.
``He's able to convey something that enables a child to trust him,'' said Betty Bryan, a former child abuse investigator and now a coordinator at the Child Abuse Center of Hampton Roads.
``We've never had a child refuse to be examined by him, and that speaks highly of his ability.''
As meticulous as he is, de Triquet no longer tries to remember the children's names.
He did in the beginning when there were just a few cases a month. Now there are too many.
But this morning in March he sees something familiar in the face of the 6-year-old girl in the examining room of Children's Hospital of The King's Daughters, where he's an attending pediatrician.
``You look really familiar to me. Have you seen me before?'' he asks the girl. She says no.
``I know I've seen you,'' he says.
The girl's caseworker tells him he examined the girl four years ago when she was 2. At that time, de Triquet found physical evidence she had been sexually abused. The father was arrested. De Triquet testified in court. The father was convicted.
Now there's evidence she's been abused again, by someone else.
``It's a disturbing fact that many youngsters are embroiled in an environment of violent maltreatment,'' he says after the exam. ``It's a persistent and pervasive exposure.''
He says this without emotion and writes ``Abnormal genital examination consistent with hymenal penetration'' on a form that will be faxed to the girl's caseworker. Then he moves on to the next patient.
It is this constant pushing from case to case, this refusal to let frustration trip him up, that has kept de Triquet on the front line of child abuse investigation for two decades.
His smooth, low-key routine belies the drama of what he sees every day:
Twisted leg bones. Broken ribs. Scalps ripped away from skulls. Torn vaginas. Fractured skulls. Burned genitals. Bashed-in faces.
Often he sits in the same room as the abuser.
``I won't say my approach is unemotional, because you can't see babies with bruises and blood and broken bones and not be affected.
``But I take that anger and anguish, translate it into dispassionate, analytical evaluation. There are physicians here who are brilliant beyond my meager capabilities, but the break point is getting over that hurdle.
``They get angry about cases. I don't. I don't any more.''
This first case of the day speaks to the exasperating nature of his work, a field that has virtually exploded since de Triquet entered the field in 1977.
It is a field over which a physician has little control. A doctor can do the best he can today, but still know a child may continue to suffer, and that child abuse will continue to happen.
``This is not a scientific experiment where you can pick your variables and control them. We do everything that has to be done, but there are factors out of our control.
``I gave up long ago seeing myself as a knight on a white horse. I'm an ordinary guy doing an ordinary job in an ordinary world.''
The small-framed, precise pediatrician didn't deliberately choose child abuse as a field of expertise.
While he was a second-year resident at Portsmouth Naval Hospital, a 6-week-old boy was admitted for irritability.
It was the baby's third visit for the same symptoms.
De Triquet ordered the usual blood work, conferred with interns and physicians. Then he looked at an X-ray of the baby's ribs and saw five healing fractures.
``Here we were, trying to ferret out a rare, unusual disease that was causing this child to be irritable. And the cause was probably the most prevalent disease in Western civilization: violence.''
He told the attending physician he'd like to see the case through. He did some research. Met with a social worker. Typed up a report. Received his first subpoena. Testified in court.
After that, his colleagues looked to him whenever a case of child abuse arose. The more he was consulted, the more experience he gained, the more expert he became.
The second case of the day is that of a 2-year-old boy who has been using sexual terms. His mother is worried he's been molested.
The exam shows nothing unusual.
``This isn't rare. Parents will observe kids acting out sexually or verbalizing sexual terms and wonder whether the child has been sexually abused.
``In the vast majority of cases, they haven't. But in the greater sense, they have been because they've been exposed to sexual material that's not age-appro-priate.''
In about 20 percent of the cases, de Triquet finds physical evidence of abuse. That doesn't mean the remaining 80 percent have not been abused. Some children he's examined have had a normal exam, only to return later with physical evidence of abuse.
Sometimes de Triquet has a gut feeling, based on interviews and a mental catalog of cases, that a child has been abused even when there is no evidence. He keeps that opinion to himself.
``I don't see child abuse behind every tree. I don't try to squeeze the diagnosis of child abuse into every child. That's not valid science.
``What I do is evaluate every injury as to whether this was inflicted or not. Sometimes I have the opinion it could be an accident.
``Do I think I have ever missed a case? Sure. That's part of the burden, part of the anxiety that I feel. If I did this,'' he goes through a rubber-stamping motion, ``I would not miss a case.
``Would that be emotionally safe? Yes. Would that be intellectually honest? No.''
Facts and data, rather than gut-level feeling, are the tools of his trade. The facts of a case; the data he gathers from medical journals, texts and decades of examinations.
While he often gives lectures on child abuse detection at conferences, he won't put child-advocate bumper stickers on his car or otherwise present himself as a crusader for children.
``I am not an advocate for children. I am an advocate for the facts, for the truth.''
A 1988 case shows the importance of being objective. De Triquet examined a 3-year-old girl and found evidence she had been sexually abused. The man accused of the abuse pleaded guilty and was sent to the Chesapeake City Jail to await sentencing.
A few weeks later de Triquet was driving home from work when he heard a report on the radio that the man had committed suicide.
De Triquet stopped in the middle of traffic. People honked their horns for him to move on. He pulled over to the side of the road, turned around, and went back to his office.
``I had to check my notes. I had to make sure I did everything right. I felt responsible for his death.''
His notes confirmed the physical evidence he had found. Still, the case led him to set up a more rigid, three-tiered system of classifying cases, to be even more certain of his evaluations.
His uses these classifications:
``Diagnostic'' findings, which describe injuries that have the physical characteristics of abuse. For instance, an impression of a belt across the buttocks.
``Suggestive'' findings, which describe injuries that could occur accidently but are statistically more common in abuse cases. Bones that are chipped at the joint would be more common in a twisting, abusive act rather than an accidental one.
``Non-specific'' findings describe injuries that could be accidental, such as a leg broken in the middle of the bone rather than chipping at the bone ends.
``The diagnosis of child abuse is not a shot in the dark,'' says de Triquet as he walks quickly through the narrow back hallways of Children's Hospital, a stethoscope dangling from his neck.
``It's a clinical process.''
It's 11:30 a.m. and the last outpatient cases of the day are two sisters. They told a school counselor they were being sexually abused by their father. The counselor reported the abuse to Child Protective Services. The girls' mother said she didn't believe it. The girls recanted.
``When faced with denial from adults, children will back off,'' de Triquet says. ``They retreat into themselves.''
The exam shows clear evidence that the girls have had intercourse.
``Sometimes facts are a powerful motivation for a youngster. They now have an adult telling them that what they're saying is true, so it empowers the child. The mother knows I validated what they said so the mother may open up and be a resource.''
But that's for someone else to figure out. The cases he sees get referred back to Child Protective Services or the Child Abuse Center of Hampton Roads, which will continue with more investigation and treatment, if needed.
This particular day's cases reflect the growing percentage of cases that involve sexual abuse. During the last six months of 1995, nearly 80 percent of de Triquet's cases involved suspected sexual abuse.
Those exams are particularly sensitive, because they can force children to relive the crimes.
De Triquet always explains to children exactly what he's going to do. He shows girls an instrument called a ``colposcope,'' which will be inserted into their vaginas to magnify the tissues.
He tells them he will stand outside the door while they remove their clothes and put on a gown. And when they're ready, he tells them, they should open the door and let him in.
``For a 4-year-old to get undressed, knowing I have told her I will examine her genitals, and then open the door for me, is a powerful thing. It's like saying, `It's OK for you to come in and examine me.' It gives them a sense of control.''
After making rounds at the child abuse clinic section of the hospital, de Triquet examines inpatients suspected of being abused. On this day, he sees a 2-year-old boy who allegedly was shaken so violently blood collected between the brain and the skull.
When the boy was admitted the previous week, he was unconscious and had a body temperature of 84 degrees.
That last symptom shows why keeping up with medical literature is so important. De Triquet remembers reading an article in a medical journal recently that said in some cases of shaken children, there's a disturbance of the hypothalamus, a gland that controls body temperature.
Two weeks later de Triquet is called to testify in a preliminary hearing in the same case.
Chesapeake Commonwealth's Attorney David Williams shows photographs of the boy in court that show burns on the boy's penis and on his inner thighs. Bruises on his thighs. Scars that look like the boy had been hit with a belt or hair-brush.
Although de Triquet's notes are full of words like ``ecchymosis'' and ``subdural hematoma,'' he testifies in layman's terms: Blood clots. Bruises. Scars.
``I see my role in court as that of an educator,'' he says after the hearing. ``I not only present facts, but I'm an educator, a teacher.''
In this case, enough probable cause is found to send the case to the grand jury.
In about 12 percent of the cases he handles, de Triquet ends up in court. It's a time-consuming process that a lot of doctors would rather avoid. But de Triquet views the court end of his work as challenging and necessary as the medical part.
When he started in the child abuse field, he sometimes became frustrated with the outcome of a case.
No more.
``You move ahead. You only control things within your sphere. If I review the needed literature, confer with the commonwealth's attorney, prepare my case authoritatively, then I did my job.''
That doesn't mean there haven't been times when he's wanted to quit.
He remembers one case in particular, in 1991, when a 2-year-old girl had been sodomized so badly the back of her throat was lacerated. Her scalp had been torn away from her skull. She had both vaginal and anal tears from being sexually abused.
After that case he decided to take three weeks off from child abuse work.
``I looked into the future and thought, `These are the type of cases I will see more and more of. Can I afford to keep doing it?' ''
He didn't last the three weeks. Doctors kept calling him for consultations. ``You get pulled back in.''
But it was that same case that led him to adopt a new philosophy.
``I don't get involved in it emotionally any more. In the old days I was as angry as anyone else. That doesn't mean I am uncaring now. It means I recognize my human frailty.''
His wife, Carole, remembers a time when he used to talk about his cases at home, but that's stopped.
``A lot of times he'll be thinking about something, and you know he has brought a case home with him. You know it's on his mind. But he doesn't talk about it.''
Instead of dwelling on his work at the end of the day, he plays the piano, talks with his children, Christine, 16, and John, 12. Or he focuses on his second job, that of Chesapeake city councilman, a seat to which he was elected in 1994.
``It's refreshing work,'' de Triquet of local politics.
``It's like you use different parts of your brain because you are not bound strictly by objective facts. You take into consideration the desire of the community. The need to compromise. You persuade, you trade off, you compromise, and that's how you resolve problems.''
In a quiet moment after the patients of the day have been examined and sent home, de Triquet drops his dispassionate demeanor for a moment.
He confesses to frustration with a society where child abuse is rampant. When he started his work in the field 19 years go, child abuse was a slap on the face, a dislocated arm, a whipping. Now child abuse is broken bones, cigarette burns, fractured skulls.
``That's become the way of the world. Violence is the thing to do. We have become increasingly uninhibited. It's the national signature.
``It's a never-ending saga, year after year after year. At the end of every year there are moments when I think, `This is it. I do not want to do this any more. It's time-consuming, and it's emotionally consuming.'
``But if you think what you do is valid, you keep doing it. It adds to the strength of the conclusion.'' ILLUSTRATION: [Color Photo]
HUY NGUYEN
The Virginian-Pilot
HUY NGUYEN
The Virginian-Pilot
Dr. John de Triquet, left, talks with a resident doctor at
Children's Hospital of The King's Daughters.
by CNB