“Nothing is insignificant.”
-Samuel Taylor Coleridge
Winter reminds me of an incident from my internship …
I was six months out of medical school and on-call at a local hospital. One evening, I was called to the Emergency Room to evaluate a 3-year-old boy with a bruise on his forehead. Through her tears, his mother told me what had happened. The toddler had gotten cold playing outside in the snow and his mother had filled the bathtub with water intending to warm him up. When she wasn’t looking, he had tried to climb into the bath on his own, slipping as he did so and banging his head on the side of the tub. Although the boy was now playing happily with a toy, the mother was clearly upset. She sobbed as I took the boy’s history.
“Tell me what he did after he fell,”
“He started crying immediately! He was so upset! Is he going to be OK?”
“I’m sure he will be fine. Has he been healthy?”
“He has been very healthy, just clumsy. He falls a lot.”
I looked him over and, indeed, he seemed fine except for a small bruise on his forehead and a couple of scars. No other obvious injuries. “I’ll be back in a minute,”
I said and slipped out to look at his old records.
I was surprised by what I saw in his old chart. This was his sixth visit to the Emergency Room over the past few months. Each trip had been for a traumatic injury of some sort: a bruised arm, a burn, a possible concussion, a fall, etc. His X-ray jacket contained at least four sets of skull films plus studies of a leg and his wrists. I was just starting out in my career, but it still seemed like a lot of injuries for someone so young.
I went back to the Emergency Room. “I need to talk to my attending,”
I told her, “but I would like to have him admitted to the hospital overnight as a precaution.”
The mother reluctantly agreed. A few minutes later, the toddler was settled into a bed on the pediatric ward.
I had other duties to complete overnight, but spent some time thinking about the little boy. Was I right to be concerned about a 3-year-old with multiple trips to the ER for trauma? Was he just clumsy, or was he being abused? I placed a consult and asked the hospital Social Service department to send someone by to evaluate his situation.
The next day, after being up all night, I was walking through the pediatric ward. As I looked in on the toddler, his mother immediately rose from her chair and walked directly toward me, glowering.
“You think I have been abusing my boy!”
I was taken aback. “I didn’t know what to think, Ma’am,”
I replied. “He has made a lot of visits to the ER this year, and I was just being careful.”
“The social worker came by and is having Protective Services come to my house! They are going to see if I am a fit mother!”
She nearly spat in my face, she was so angry. “How could you accuse me of such a thing?” “I’m sorry, Ma’am,”
I mumbled, escaping as quickly as possible.
I still remember how I felt as she confronted me: I was tired, overwhelmed, and confused. I also remember feeling that I had done the right thing by admitting the child for a safety evaluation, trying not to take any chances and looking for patterns of injury that might indicate abuse. On the other hand, had I done the family a disservice if the child was clumsy or had a subclinical neurological disorder? What if the mother was merely incapable of discerning real emergencies from supposed ones?
Even now, years later, that uncomfortable confrontation still disturbs me. I never did learn what the investigation uncovered. Most of all, I hope that the little boy, who by now would be in his late 20s, survived his childhood intact.
The following is feedback received for this blog:
No child is that "clumsy" - instead of labeling my child as clumsy, I would wonder why he is falling so much at the age of three.
If he had a subclinical neuro disorder, the hospital was the place to be. If he was being abused, social service was the right one to call.
I hope the child grew up healthy and happy, but don't second guess yourself for one minute on this one.
You did the right thing; in fact, for someone so early in training, it was a great pick-up!
- Kim McAllister
Thanks for the feedback and for the reassurance. It would have been helpful to get some feedback at the time from the pediatrician or social worker.
It is funny how those formative experiences (especially the negative ones) stick with you for a long time. I spent high school and college summers and vacations as a nursing assistant ("orderly" in those days) in an ER and I probably remember more of those stories than from the last 10 years. They had an impact.
Thanks again. I enjoy your writing (and your images) very much. Keep up the good work!
You absolutely did the right thing. The fact that the mom was so vicious, and purposefully sought you out to shame you for asking for a social work consult, suggests to me that she is exactly the kind of person who could abuse a child. If you're still feeling the effects all these years later... I bet she was guilty. An innocent mom might have said, "Hey, I appreciate your concern for my child and I don't blame you for being surprised by all these recent falls. I'm happy to have someone come to my house - maybe they can help me figure out why he keeps falling?" You may have helped to get that child on a completely different path and maybe even saved his life. We physicians must learn to move beyond our comfort zones and investigate events that don't seem right - how many children remain in dangerous situations because their provider is passive or apathetic? ;)
- Val Jones