One of the unique rules of emergency medicine is that social norms often don’t apply inside the ER doors.

Often patients can’t tell you what is wrong or even where it hurts, because they are in denial or in some sort of personal crisis, and that can make doctors’ and nurses’ jobs much more complicated.

One day, more than a decade ago, about this time of year, I was working a shift when a young woman, about 16 years old, came in accompanied by her mother.

She was impossible to ignore, screaming at the top of her lungs in pain and fear. Her mother was deeply worried and also angry, yelling at anyone and everyone to help her daughter.

A nurse and I moved the young woman into an exam room and I began a quick exam. I asked if her head hurt, if she had trouble breathing and if her abdomen hurt. She answered, no, no and, “I don’t know, maybe.”

Having gotten a “maybe,” on the abdomen and noticing a tightness in her belly, I began to focus on the possibility of an ectopic pregnancy – a pregnancy in which the embryo is outside the uterine cavity. Given her age, pregnancy was one of the more likely possibilities and an ectopic pregnancy was potentially fatal and needed to be ruled out quickly.

I asked the young woman if she could be pregnant and she answered that that was impossible. She had just given birth six months ago and had not had sex since. She hadn’t even started her period again.

I listened and nodded and once the nurse had started an IV and taken blood and urine samples, I explained to the young woman and her mother that we needed to do a pelvic exam.

The nurse and I helped her into position and as I was about to begin the exam, she abruptly delivered the smallest baby I have ever seen.

Her reaction was to yell, “That is not my baby.” Her mother’s was to focus all her anger on her daughter, shouting, “How could you be pregnant? When did this happen?”

The room was in chaos and as I looked down at the tiny infant, who fit easily into my hand, I felt a sense of deep sadness. He weighed a little more than a pound and seemed too small to be able to survive. But then, he made a noise somewhere between a hiccup and a cry and tried to take his first breath.

My sadness instantly became fear. A lot of intricate and difficult medicine needed to happen quickly to give this tiny baby a chance at life.

I cut the baby’s umbilical cord and took him to the resuscitation room, where I intubated him, started an IV and contacted the neonatal intensive care specialist for help. Then, because it was a busy shift, I moved quickly to the next patient.

Meanwhile, the mother was taken to labor and delivery for the rest of her care.

A day or so later, she left the hospital without ever visiting her baby.

In the following weeks, the baby did incredibly well, surprising us at every turn. A nurse in the neonatal unit bonded with the baby and eventually adopted him. The last I heard, he was still doing well.

The child's future will in all likelihood not be easy. Premature birth can cause all sorts of difficulties, but with the right care and attention, the baby, now a boy, has a fighting chance.

When I think of the two of them – the baby and his biological mother – I am more optimistic about the baby’s future for reasons that have nothing to do with medicine.

Human beings need good, strong, positive connections to thrive and the baby went home with the best kind of support, a loving family.

We can’t offer that to most of our patients, but medical systems everywhere are trying to do a better job of offering more than good medicine to the people who come into our emergency departments.

We are working with emergency medical technicians and paramedics to reach people who can’t drive themselves to a doctor. Through home visits, paramedics can check if they are taking their medications, test their blood sugar or just make sure they have enough food in the fridge.

We are also working harder to make sure that when a patient leaves the emergency department, they are connected to a primary care provider who can help them avoid a re-occurrence of the problem that brought them to us in the first place.

If it works, it will be cheaper than the system we have now and it will make for healthier communities. I also hope it will mean more babies are born full-term and healthy to moms who are ready to care for them.