An Unexpected Gift
BY: JENN D'MELLO
I’m on call, the last of 8 days in a row.
Not many people want to be a child maltreatment pediatrician- called to evaluate children when a health care provider has concerns of abuse, but I actually enjoy it for the most part. It’s not something I could do full time so I balance it with my shifts in the pediatric emergency department- another job that can be stressful and hard but that I love most of the time.
Thankfully being on call for suspected child abuse isn’t as busy as being on call for many other areas of medicine. Most of the time it’s just answering phone calls from my colleagues who need a little help or encouragement with the often difficult next steps they need to take to protect a child. Less frequently there are consults on children that have severe enough injuries they are admitted to hospital. These consults require a meticulous, thorough and empathetic approach- not surprisingly they are time consuming and can be emotionally draining.
So back to my last day of call. It’s a day I otherwise have off and knowing that call isn’t typically busy I’ve told my 3 sons I’ll take them to the amusement park that day. We hit the road at 10:30am and 5 minutes later I pull over to answer a call from the PICU. They have a baby with a head injury they’d like my opinion on. I look at the 3 kids in the back seat and ask how urgently they need me to see the patient. Not urgent they say, the patient is stable. I tell them I’ll come in at the end of the day and we carry on to the amusement park. The boys have a blast and mostly so do I, other than the nagging feeling in the back of my mind that there’s work waiting to be done when I get home instead of a glass of wine.
Around noon I get a call from a family physician about a child who’s been sexually abused. I can guide the physician regarding the next steps over the phone, and they are kind enough to wait for my guidance while I order my kids some slurpees.
We get home at 4pm and as I’m quickly changing to go to work I get another call from the hospital. Surely an update on the patient they asked me to see earlier. Nope- it’s a new consult. A toddler with a burn.
I arrive at the hospital and see the first patient in PICU. It goes as smoothly as these types of scenarios can and I move on to the second patient. The parent has stepped out of the room and should return soon. I try and patiently wait for them to return as the minutes tick by and I think of my family having dinner at home.
While I’m loitering around the inpatient unit waiting, I see someone I recognize. It takes a second to click and then I realize it’s the father of Blake. A 3-year-old boy I saw in the emergency department a week earlier and diagnosed with the largest brain tumor I’d ever seen. I told him and his wife what I can only imagine is the worst news they’ve ever heard while they’re beautiful son sat on their laps oblivious to why I was making his parents cry. Surprisingly Blake’s dad gives me a big smile and says “Hi, do you remember me?” (Of course I do!!).
“Yes, how is Blake?” I ask, shocked that this dad is smiling at me- the person who delivered such devastating news to him.
“Do you want to come and see him for yourself?” he asks.
This is an unusual circumstance for me. Once I deliver bad news like this in the emergency department another team takes over and provides the ongoing care. I rarely get to know what happens to my patient after that, and I almost never get to see them again.
I’m taken to Blake’s room. He’s smiling and playing with his mom and looks perfect albeit with the addition of a large C shaped scar circling the right side of his head. He had his surgery 4 days earlier where they removed as much as they could of the grapefruit sized tumor that was taking up space that should have been reserved for the right half of Blake’s brain. He lost a lot of blood during the surgery and the parents were told to expect a prolonged post op recovery period, likely at least 2 weeks.
But Blake surprised everyone. He bounced back right away. He was out of PICU 2 days post op and now the family was packing up to go home.
It was such a gift that this family invited me to share in their joy after a roller coaster week that I felt like I’d set in motion. I had thought of them and Blake every day since, still stuck in the mud of wondering why these things happen. Their ability to focus on the good things right in front of them and take a break from worrying about the future pulled me out of that mud.
I left them and returned to my consult. It wasn’t quick or straightforward, but that’s ok. Ironically one of the reasons I like this job is because it’s the opposite of the emergency department, where I have to gather information and make decisions quickly. That initial information gathering quite appropriately identified cause for concern with this child- too young to describe themselves what happened, a serious burn in a pattern not typically seen from an accident, and a delay of over 24 hours in bringing him to the hospital. This young mother already knows people are questioning her story and ability to care for her child. I worry she won’t be willing to talk to me, but my fears are unfounded. She opens up and describes not just what happened to her child, but her own struggles, most of which were set in motion by things outside her control. Having this greater context allows me to see how much she cares for her child and how hard she’s trying to fight an uphill battle. She herself recognizes that she needs help to be the parent her son deserves. It was important to take the time to understand all the complexities that led up to this little one’s injury. This way I can help those that will need to make important decisions for his future do so with the best possible information.
I head home. I feel like I’ve been pulled in so many different directions in one day. Not an uncommon feeling in this life I’ve built. Fortunately, at least so far, I can usually focus on the good things right in front of me.
I missed dinner, but made it home in time to tuck the kids in bed.