Monday, July 7, 2008
You Can't Chose Your Parents
I always said that I could never be a pediatrician or a veterinarian because whatever happens to children and animals usually is the fault of someone else. I felt I would always be angry at someone when treating my patients, especially the injured ones. Today was a good example of when bad parents happen to children.
Patients seen in the E.D. today:
A 5 year old with a cellulitis, skin infection ("he was at his father's and I don't know what happened to him"). I wanted to give him a dose of antibiotics and then send him home with a prescription. Mom said she was tired of waiting and needed to go "check on her bicycle" which she states she didn't lock. A nurse asked me how they had gotten to the E.D. if the mom had ridden a bike. I said some questions I don't want to know the answers to. Anyway, I asked mom to wait a few minutes, and we would have the antibiotic. Well, she disappeared with her son and didn't return. Our social worker got involved, called the contact number that was for a "neighbor" that lived 1/2 mile away who said they would try to get a hold of mother. She eventually did show up... 3 hours later. We got the child the dose of antibiotics and got them their prescription. I hope she fills it.
When I walk into a room and the mother starts the conversation by saying, "I just got her back from foster care, and she's been sick ever since" I kind of start to wonder what's going on. I don't like to judge people, but this mother was the poster girl for a "Don't Do Meth" campaign and the father looked like, per the RN, something out of "Deliverance." The mom couldn't answer my questions about fevers, vomiting, wetting diapers on her 2 year old. All she could tell me was, "she hasn't really been eating or drinking and the doctor told me to bring her here." I had a nurse ask if the girl had a genetic disease because she "had a look about her." I asked the nurse to go in and look at the parents. We ended up admitting her for hypoxia (low oxygen saturation), dehydration, and hypoglycemia (54, in kids should be around 100). I think social work might be getting another phone call.
Ok, so you're married to a doctor, and you have 4 children under the age of 5. You decide to pack the kids into the car around noon and head off to your local Target and Lowe's to pick up a thing or two. It's summertime. It's midnight as I write this and my thermometer on the way home tonight read 80 degrees with high humidity, so I am sure in the bright sunlight of midday it was much warmer. You get out of the car and leave your kids for "just 10 minutes" with the car doors closed, the windows closed, the car turned off, in the middle of a parking lot. Soon people come by and notice the children in the car, yelling and crying for help. They stand and wait to see if someone shows up while they call the police. The police arrive and wait a few minutes to see if someone shows up before they break the windows and open up the car. Total elapsed time, about 30 minutes. EMS arrives and notes the infant (9 months old) is drenched in sweat and no wet diaper. All the kids get put into the cool back of the ambulance. Dad gets called, but he can't come because he's in surgery. Mom finally shows up and get promptly shown the back of the police car. Auntie, who's also a doctor, gets called and meets the children en route to Children's. All four are seen and evaluated in our ED. CPS (Child protective services) gets called. The four are discharged to the care of their father once he got out of surgery. Will have to hear later what happened to mom.
A woman walks into a bank carrying a year old child. She walks up to another woman and asks if she would please hold the child for a moment while she takes care of something. The second woman agrees. The first woman walks out of the bank and never returns. EMS and police are called and the child is brought to WCHOB for evaluation. Social work and CPS, already there, are brought in to discuss placement of the child who is otherwise healthy. About 5 hours later the mother shows up in the E.D. looking for her child. Buffalo PD is promptly called to escort the woman to a different waiting area. Will have to ask the resident involved what ended up happening with the mom.
I had to call CPS for a case of suspected abuse. A 9 year old "smacked around" by his father causing a bloody nose. I counted and took pictures of all the bruises and lesions he said were inflicted by the father and his new stepmother. He has 3 older brothers and 2 younger step-siblings who are still living in the home. He called his mother for help from an older sibling's cell phone, and she brought him to the emergency department. Seems she is "getting help" and doesn't have custody of the children, their father does. She gets to see her children bi-monthly. She asked if there was any help CPS could give in the custody dispute. I said I didn't think so but I was sure they could connect her with the appropriate resources.
We had another child who fell out of a window and came out the other side looking like they had been thrown into a cement mixer. Head injuries, broken arm, broken ribs. She was being admitted to the PICU.
I worked on a 2 year old riding a motorized ATV who fell off the back and also had a head injury to add to an earlier one suffered when he banged his head on a wooden door. He was going to be admitted as well.
I had a 4 month old that flipped over in their car seat when the transit bus they were on stopped hard. He had bruising all over his face. A head CT did not show any injury to his head. What was interesting is that while I tried to examine the child and talk to the mother, she was more interested in berating the "baby daddy" because he, "wasn't there when his son needed him, he had no interest that his son was injured, why wasn't he a good dad and arranging transportation for them, don't blame me for what happened it was the bus driver's fault, etc."
On a good note, I got to show my final patient her 16 week old baby. She was concerned that she hadn't felt the baby move, and I got to print her a lovely picture of her baby, nice heartbeat, moving all their limbs, a new life ready to enter the world. Hopefully, to a good mother. Hopefully.