What would you do, how would you react?

Working in Emergency Medicine, we have all sorts of days. We have amazing days, good days, bad days, and days that, for whatever reason, are far beyond bad. I recently had one of the latter. I rather knew it was going to be a bad from the beginning. The ER was already busy when I arrived at 8:00am with a backlog of patients waiting to be seen. Given the day of the week, the  next provider would not be in for 3 more hours which had us behind the curve for most of the morning. The day in general was an All-Star roster of the crazy, manipulative, and opportunistic. One patient trying to use the ER to get her outpatient ultrasound, one convinced that the conscious sedation he received a month prior gave him brain damage because the vein in his arm is moving, one for a refill of his hypertension medication because it was the clinic’s fault (when in reality he didn’t show up for his last appointment), plus the usual compliment of patient’s wanting narcotic refills were just a small sampling of the day. Alone or in small numbers, these are pretty par for the course and easy to handle. However, when one faces these in larger numbers, on a busy day, combined with an equally large number of critically ill patients, the potential for the perfect storm is there. Those of yousisyphus who work in Emergency Medicine I’m sure know the feeling. Overwhelmed by the shear volume, frustrated by the time taken away from the critically ill, it’s hard not to feel like Sisyphus and his boulder. And then it got worse…

While examining a patient for a minor illness, I witnessed in my periphery another person stand up, walker over to a child, and strike them in the side of the face and head. If I may digress for a moment, we as health care providers are well aware of child abuse and domestic violence, many of us unfortunately have seen victims after the fact, some of us may have even been working when it happened in the ER but not actually witness the incident. To actually witness an incident when a child is struck by an adult is another thing altogether. It also brings up two distinct issues. How do you handle it professionally and how do you handle it personally.

Fortunately, what to do professionally is straightforward. While the laws may differ state to state, where I practice if a health care provider even suspects child abuse, let alone witness it, it is mandatory that we report it the Division of Youth and Family Services (DYFS). Regardless of whether one agrees or disagrees with hitting a child as a form of punishment, it does not matter. You have to report it. As I went to evaluate the situation further, it turned out the two involved were actually the next two patients I was to see. The person and her grandchild were both there for mild viral symptoms with the grandparent also requesting a refill of her narcotics, something I did my best to not let cloud my judgement. It was quite evident the child was very guarded of even me when attempting to evaluate the situation and injuries, shielding their eye and saying very little. Fortunately there was no serious injury and at the same time I thought, if this happens in public, what could be happening at home. I advised the nurse of what happened and then we both pulled the grandparent aside for evaluation and advise that DYFS had to be called. Obviously irritated with us, we explained that we had no choice in the matter. That legally we were obligated to report any suspected or witnessed abuse. DYFS was contacted and security stood by in the interim. Being the busy day it was, I had to continue seeing other patients, all the while with the grandparent on the phone making assumptions out loud about my sexual preferences (which oddly enough I took more as a compliment).

That is a very cold and calculated description of what was done from a professional stand point. We as clinicians are not stone, we are not robots, even though I’ve seen some do their best to act that way. At the end of the day, we are still human beings with feelings. So how did I handle it personally? I cried. I pulled the nurse working that section in the office and I lost it. I cried. It was the proverbial straw breaking the camel’s back. After the long day I had already endured, to witness an adult strike a 10 year old was just too much to handle. I cried after work while with my girlfriend. I’m sure there are those of you who like me got hit when we were punished as children. Some of you  may think “He did something to deserve it”. For me that’s neither here nor there. If you can, or think you can, witness a child getting hit in the face/head and not have some kind of emotional response then I say there is something very wrong with you. If you can witness such an act and repress your emotions entirely, then I say you are not handling yourself in a healthy way. If you sit there and read this and think that I am unprofessional for letting this affect me emotionally, then please email so I can explain to you why you need to leave medicine or retire.

While we do need to remain calm and professional during any time of crisis with our patients, we are still human and we still need to find other time to address our emotions, let ourselves feel our emotions. We cannot bottle them up or ignore them. We can’t hide behind bravado and hubris saying to ourselves, “I’m a professional, I’m a man, I don’t cry”. When the kettle boils over, we need to find a healthy way to experience our emotions, whether it be leaning on a co-worker/colleague, friend, or partner, writing about it, or meditation. Finally, we need to find ways to minimize  when the kettle boils over which is something I will try to work on from here on out.


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