Sometimes doing what we do is so hard. We get intimately involved in our patients’ lives, and instead of maintaining a clinical distance, you get sucked into the drama that has unfolded in their lives—the very events that bring them to the ED on this day. Then there’s a great difficulty in not judging, in not letting what you learn about them affect you or distract you from doing the job that needs to be done.
Like when a child comes in coding; that means either not breathing or their heart not beating. We jump in and start chest compressions. We put in breathing tubes and start IV’s so that we can give medications in the hopes that we can save them. Pediatric codes really affect the staff. Small children are not supposed to be this sick. They should be obnoxious 2-year-olds tearing about the room and hard for their parents to handle. They shouldn’t be lying on a gurney lifeless while people rush around them trying to save them.
And then you don’t. And later in the shift, you get a visit from a detective and Child Protective Services telling you about certain allegations. And as they ask questions, you start to think about that parent. Were they appropriate during the few minutes you had to explain what was going on? Did they have the right amount of grief? How do you even begin to judge someone’s “correct response” to something so horrific as losing a child?
And now CPS wants you to examine the other children. There always seem to be other children. They want skeletal surveys, which are basically full-body X-rays to look for injuries like healing or old rib and arm or leg fractures. They want detailed physical exams looking for signs of abuse. So I have to look for bruises that shouldn’t be there. I have to examine their siblings all over to confirm no evidence of abuse.
And I get to listen to the stories of the other parent. Of dropping off their child with the alleged abusive parent and praying that their child wouldn’t be injured. Of their sadness for the death of their child’s half-sibling, but really not being surprised by it. They’re happy it wasn’t their child.
They’re the first, and only, ones to tell me how “sweet” the dead child was. How much their child adored their half-sibling, and how hard it was going to be to explain why their sibling is no longer around. They tell me of their frustrations with the court system. Their prior experiences with CPS. And how much they hate the parent who allowed this to happen.
It’s days like this that I wish I didn’t know the whole story. That I wish I could be back in surgery. Something simple like a gallbladder removal. You fix what’s wrong and you move on. But that wasn’t my calling. This is. So I’m left to ponder: Was there anything more I could have done? But I know, deep inside, the answer is no. This child’s fate was sealed long before I became involved in their care.
Veronica Bonales is an emergency physician.
