Saturday, May 31, 2008

One patient, five minutes, I'll never forget

Even though we only had about six hours a week during which we saw actual patients in our first two years, we’ve seen enough by now that the details of individual patients start to blend into each other and fade away.

As for some patients I’ve met, though, I won’t forget them as long as I live.

It was during one of our many small-group clinical skills sessions that I met one of those patients. The goal of this particular session was to apply some of our neurology physical exam skills by practising them with some chronic paediatric patients who displayed neurological symptoms.

Memorizing a set of symptoms suggestive of a lower motor neuron disease (as opposed to an upper motor neuron disease) can be mundane when you read it in a library (or on a blog), but it can be life-saving in an emergency room – learning the intricate connections between the brain and the muscles is one way a doctor can tell if a patient’s sudden-onset drooping face could be because of a harmless palsy that will settle back to normal in a couple days, or if it might instead suggest a life-threatening blood clot cutting off the oxygen supply to the patient’s brain.

On the paediatrics ward, we went from room to room, playing with the cute kids, meeting their parents, and checking reflexes, feeling for stiffness, and looking for other neurological symptoms. At the same time, my efforts to keep my eyes open competed with my efforts to remember the relevant physiology. It was sad to see a number of children who are bedridden and have severe cognitive deficits…but everyone has seen a child in a wheelchair at some time or another, and the pre-exam study blitz was starting to take its toll on my sleeping habits.

Then we entered her room.

As he had done in all the rooms before, the doctor asked us to check for reflexes and stiffness as he started to tell us about the reason the girl was in the hospital. “Chloe came to us about six months ago after a non-accidental injury, suffering from cigarette burns, broken limbs and a fractured skull.”

I suddenly wasn’t sleepy anymore at all.

“What did he say?!” I thought to myself. “Non-accidental injury??!”

The doctor had already moved on and was talking about the clinical signs. “Notice the hyperreflexia, and positive Babinski sign on her feet,” he continued, but I couldn’t get past what I thought he had said.

“Non-accidental injury?? What, like abuse?” I thought.

That’s exactly what the doctor meant. After going over some more of her symptoms, we asked for more details about what the doctor meant by “non-accidental injury.” I regretted asking that. The doctor went on to explain the atrocious abuse this poor, beautiful young girl had suffered at the hands of her stepfather.

I was shattered. She was about nine years old, in a purple dress, with her blonde hair tied up in cute piglets, sitting in a tiny wheelchair just the right size for her small figure. I looked into her big, blue, eyes… they didn’t work quite in unison after being struck in the head so many times, but every so often she would look right at me, and smile so big, and I actually felt like crying. I was looking at a beautiful young girl who will never be able to live up to her full potential, because some utter idiot could find no better way to take out his rage than to use her tiny head as a punching bag. Honestly… can someone sink any lower?

It was then I realized I could probably never work in a chronic care paediatrics ward. I don’t have what it takes. I based that on my sudden urge to want to find out who the person was that did this to Chloe, hunt him down, and beat him utterly senseless. Nothing so far in my medical training has made me so angry as seeing the effects of the abuse on this poor girl.

Apparently Chloe had recovered immensely since she first came in to the hospital. She had been in a coma then, and here she was four months later sitting up, making noises, responding to people calling her name – much more than any of the doctors thought she would be able to do by now.

I hope she continues to recover beyond expectations, and that her life’s potential isn’t completely obliterated because of the useless sack of dirt who abused her. And I have high hopes for her, because despite the fact that she cannot talk, or walk around her own, she’s already making a life-changing impact…in those few minutes, without so much as a word, she left an impression on me more unforgettable than any conversation I’ve ever had.


Anonymous said...

I would love to hear of a follow-up of this monster that did this terrible thing to a little girl. Like maybe he was found tortured to death by very slow body part dismemberment. That would be appropriate punishment in my book.

Anonymous said...

Congrats on finishing your pre-clinical years. I look forward to following your blog as you move into your clinical years.

Anonymous said...

wow.. that must have been a very sad and frustrating experience.. knowing that you can´t do anything to make the stupid bastard pay for what he did to Chloe..
i love your blog.. love how it is funny and everything.. but this post is one of a kind..
i think i am your biggest fan.. if you published a book i would definetely buy it!

Rachel said...

I made the same decision after a similar experience.
As a med student here in the UK I met a little lad who'd been admitted with malnutrition. His mother had neglected him to the point that he looked about 1 at the age of 3, with behaviour more appropriate to a one year old. I worked on the ward for 6 weeks as a student and became very attached to J, he improved every day and was a bright lovely child who thrived on any attention.
Then his mother arrived to pick him up. She hadn't visited for four months but the law said she got to take him home because she had made efforts to improve her home circumstances and been to a class.
I wanted so badly to hit her and instead had to let her take him away, the nurses and junior doctors and I were distressed but poor J was heartbroken. At the sight of his mother he wept and wept and wept.
I still think about it and it is the number one reason I am an adult physician and do no paediatrics.

Anonymous said...

So, no chronic care peds. I don't blame you. Any idea what you will eventually go into?

Dragonfly said...

Personally I think paediatrics is pretty darn depressing, and sometimes would like to slap the idiots who think that it involves playing with cute, happy children all day.