Desmond Runyan has always liked children, their constant comedy and buoyancy.
But as a young man launching a medical career 30 years ago, it never occurred to him to study children. Particularly, the most fragile of them.
Tropical diseases and the tumult of health care in developing nations had drawn him to medical school after an internship working for the health department in Nigeria. Runyan decided to tackle a master's in public health, too.
As he was poised to write a thesis, his adviser dictated the topic: child abuse.
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"I'll never know what he saw that I didn't," Runyan says.
Three decades later, Runyan is considered one of the nation's most renowned child-abuse experts, having published hundreds of papers on unspeakable topics. He has urged Congress and federal agencies to devote more resources to studying child abuse.
At his home base, the University of North Carolina at Chapel Hill, he has tended to hundreds of battered babies kept alive by machines and medicine in the neonatal intensive-care unit at UNC Hospitals.
Runyan, 58, came to Chapel Hill in 1979 for what he thought would be a brief detour. He and wife Carol both had jobs awaiting them at the University of Minnesota. The hospital in St. Paul agreed to wait while he completed a Robert Wood Johnson clinical scholars program at UNC Medical School, an endeavor so frenetic Runyan describes it as a "two-year scholarship for crazy people."
Two years became three. Chapel Hill became his home, where he and his wife, a professor in the public health school, would raise a son of their own. Alex is now grown, and Runyan says his son jokes that he was fortunate that at least his childhood abuse came at the hands of experts.
Runyan completed a doctorate in public health at UNC-CH and was tapped to teach students about epidemiological studies. He has headed the medical school's Department of Social Medicine and headed the state's system to evaluate abused and battered children. All the while, he treated the youngest patients shuttled into UNC-CH.
"It's such a privilege to be able to care for patients and their families," Runyan says. "Plus, I get to have stand-up comedians walk into my office. Kids have such charm and humor and spirit."
Runyan tries to match their humor, even in the most difficult circumstances.
"He approaches kids the way a good old-fashioned pediatrician does," says Adam Zolotor, a family physician at UNC-CH's Department of Family Medicine who has worked with Runyan on several research projects. "He gets on their level. Somehow he's able to make abused kids feel comfortable with a really uncomfortable exam."
Runyan is a slight man, with a soft voice. He speaks quickly and frankly, a combination that captivates students and bemuses some in the halls of the state legislature, where he sometimes testifies about or lobbies for abused children.
"There's a melody to his voice. It kind of lures you in," says Tom Vitaglione, chairman of the N.C. Child Fatality Task Force, a legislative study commission on which Runyan served years ago. "He has this real talent for taking complex medical research and making it completely understandable to those of us on the outside of that."
Runyan also has a knack for calming parents facing their worst moment: the death of a child. He lets them digest the news, keeping quiet and giving them time. He also teaches young doctors how best to guide families down that dark path. As a young resident decades ago, Runyan found himself braving these conversations with families, his attending physician conspicuously absent.
"You cannot do anything worse to an adult than let their kid die," Runyan says. "It rips their heart out. As a doctor, you need to give them time, keep your mouth shut."
A decade ago, Runyan and some fellow pediatricians noticed an alarming number of babies devastated by violent shaking. Runyan launched a study and determined there was a startling prevalence of babies shaken in North Carolina each year: about 2,000 children under the age of 2.
'30 seconds of stupidity'
The problem weighed on Runyan, who thought most of the incidents arose from frustrated parents or caretakers who snapped while dealing with a fussy baby.
"There are clearly people who are just violent," Runyan says, "but there are a lot of 19-year-olds who don't know how to make a kid stop crying and they've run out of gas. "It's 30 seconds of stupidity."
Early last year, Runyan helped spearhead a five-year campaign to address the tragedy of babies who are violently shaken. The prevention program teaches parents of every newborn in North Carolina maternity wards about a baby's crying patterns and how best to respond when nothing seems to pacify. Runyan and other researchers at UNC-CH and Duke will monitor the program to see whether there are fewer shaken-baby incidents in coming years.
Though Runyan has had a front-row seat for some heartbreaking dramas, Runyan has somehow maintained the faith that most people mean to do well by their children. He also thinks that things not only can but will get better.
"He has this enduring vision that there will be a time when children will be nurtured and cared for," Vitaglione says. "He's able to keep that vision when the rest of us are worn-out."
Runyan is casual about his optimism. He credits an appreciation for time and history. In antiquity, children were put to death for indiscretions such as talking back to a parent. During the industrial resolution, children worked in textile mills. That perspective keeps him from getting angry or frustrated every time he meets a child broken by senseless violence.
"You have to have a thousand-year perspective in this work," Runyan says. "Kids have it better than they ever have. It's not good yet, and we certainly can do better. We'll keep working."