There Should Be a License for Parenting … or Maybe a Test

April 25, 2009

If I only had a dollar for everytime I have seen people in the ER who wouldn’t be able to properly parent a goldfish, yet for some reason have 2-3 kids; I wouldn’t be working right now. Really though, I think a whole blog could be devoted to the subject of inadequate parenting. Yet, the following story really stood out in the sea of poor parenting that I see on a daily basis.

I get a call from police who tell me that they are bringing in an 11 year old. I thought it was a prank and asked them if he was a little tough for the force to handle. Then they told me no, that it was serious. They had been called out to a home by a mother who stated that her son had gone crazy and started to beat her. They came out the first time and settled things down and left. Then they were called out again for the same issue. This 11 year old clearly wanted to put a serious hurt on his mother. The second time police came though, he started to scuffle with them as well. And so now, he was coming to the ER for what sounded like a transfer to a psych facility for adolescents.

When I get around to seeing this young hellion, I am surprised by how small he is sitting in the psych room chair. The very experienced nurse who had triaged him told me that he wasn’t telling her anything. No comments whatsoever. So before going in, I did a quick check on adolescent psychiatric beds in the state. The closest available bed was 4 hours away. I use that technique a lto because it is amazing how cooperative a person can get when they realize how far away they are going to be sent. I have often wished I could transfer to another country – that should really get them to cooperate.

So now it’s time to talk. I make it straightforward and simple for this young man. I spoke to him in a stern, no nonsense manner. If you don’t want to talk to me, that’s fine. I already have a place for you to go and it won’t be quite as comfy as home. If, on the other hand, you want to plead your case and explore other options, then you had better talk. And so he opened up to me with great reluctance. What he said though, I didn’t at all expect.

Doc: So, why were you beating on your mom?

William: Why shouldn’t I? Everyone else does?

Doc (shocked): What do mean everyone else does?

William: All her boyfriends hit her before when she didn’t listen. So I told her to do something and she wouldn’t listen, so I hit her.

Doc: And you don’t think that its wrong to hit her.

William: No.

For me, that was totally unexpected. Obviously, this boy’s mother had been in more than one relationship where she was domestically abused. We put a lot of focus on the women in these cases, but sometimes we underestimate the effect this has on the children. Children learn so much from watching what we do – the main reason why in parenting we always encourage parents to do what they say. You can say whatever you want, because children are going to learn more from your behavior and actions than from your words. Your words will have the most impact when they are backed up by supporting actions.

So, now I was stuck. It wouldn’t be entirely right to penalize this boy now, since he was only doing what he had been taught. I’m sure he was very confused since he had not only never been taught that this was wrong, but was actually shown that it was right. So, mom and I had a little conference to discuss this matter.

I explained to her that clearly, she had been part of the wrong message to this boy. She totally agreed with me and said that she had made some poor decisions and that she had furthermore always given this little boy decision making capacity in the home. He was, for lack of a better term, the man of the house and the head of the household. She errantly thought that allowing him to make decisions would be a good step in helping him mature, but what it had done, in this particular environment, was give him the idea that he was in charge. He was the boss, at least in his own mind, and no one had yet challenged that concept. That explains why he even scuffled with police. He was probably asking himself why they were getting involved in his private domain.

At the end, I got through to him that he should be his mother’s protector. He doesn’t want someone to slap him around, why would he allow someone else to do that to the mother he loves so much? Worse yet, why would he do it himself? I told him that he had one chance to make me a believer and that I would give him his golden opportunity to convince his mother to take him back home. When his mother went back to give him the chance to apologize, I saw the behavior of a true 11 year old child. He wept and went down on his knees telling her how sorry he was for hurting her and how he should have protected her. They both cried and I felt as if we had made an impact. We had changed the course maybe before it was too late. Only time will tell.

We get a user’s manual with every product, no matter how trivial. We are required to have a license to drive a car, to undergo safety training when it comes to firearms, to attend job orientation when we get our first job bagging groceries. Yet for the most important job in the world, most people think they need no training at all. If we want a brighter future, me thinks we need to make a bigger effort in this issue today.

For your consideration:

But really, on a more serious note:


Pro-Life/Pro-Choice? The Day When It Didn’t Matter

April 6, 2009

In the medical field, we are just like everyone else in that we have our own religious, political and social views. We all have our own set of moral values just like anyone else. But at the same time, you have to know when to put them aside. There is a time for intellectual debate and then there is the time for understanding, even if it goes against your deepest moral fibers. Today was a day that tested many of us in the ER.

Heather came into my ER today with her husband seeking help for a severe pain she was having in her abdomen. She tells me that this pain started today and has been constant for the past few hours. She describes the pain as a dull feeling across the whole abdomen, but hasn’t had any nausea, vomiting or diarrhea. She hasn’t had any fever either, no shortness of breath and no back pain. She has never felt anything quite like this before in fact. She is otherwise a healthy young woman in her mid-20’s who has just given birth to their second child about 6 months ago.

During the course of testing in the ER, it became obvious that she would benefit from having a CT scan (CAT scan). As a woman, it would be necessary to first be sure that she wasn’t pregnant because of the extreme harm that could come to a developing fetus if exposed to all that radiation.  I had asked her if she could be pregnant and she said it was very unlikely. She seemed a little sad when she answered that question, but not to the point that I felt the need to ask. We still checked a pregnancy test to be sure though.

And … it was positive. Hmm, interesting I thought. I guess that might help explain the stomach ache, but not in the way that I initially expected it turned out. I went in to the room to deliver what I hoped would be good news (you can never be sure) and received my next surprise. Heather had undergone an abortion this morning. Just a small detail that she forgot to mention I suppose.

Heather was 8 weeks pregnant this morning when she and her husband went to an inner city clinic to have this pregnancy erased. She didn’t want to bring it up because it was a very private and extremely difficult decision that she and her husband had to make. It certainly explained why they were so quiet and reserved. She cried when she told me about the procedure and her husband looked to be grieving as well.

As difficult as it was for them, I had to understand what exactly was done because abortions, even when done in appropriate clinics, still have some serious risks associated with them. She cried when she told me how after they had numbed her private area that they hooked her up to a vacuum suction and that it was over in seconds.

I held her hand feeling the remorse and sadness in her heart. Although it wasn’t necessary, she tried to explain why she felt they had to do it, “We just had a baby 6 months ago and I just wouldn’t be able to handle having another one so soon. I know I should have been more careful, I know … I just couldn’t.” I tried my best to reassure her without judging her, without criticizing her.  Then her pain started to get better, almost all on its own.

Before long it was time for them to go home. I went into their room one last time to go over things that would indicate an emergency requiring her to return.  She took me by surprise and gave me a hug. They both then told me how much anguish they had been in and how much fear they had of being judged. They appreciated how we had all treated them with compassion, with empathy and without prejudice.

Sometimes the pain in our hearts expresses itself in strange ways. Was it the grief she had over losing her child, over making a decision she would possibly regret for the rest of her life, was that the reason behind her pain? Incidentally, all of her tests came back normal and when I called them the next day to check on her condition, her husband told me they were both getting better.

We all do things that we regret because we are all human with a limited perspective, with the potential to be weak in the face of great trials or overwhelming circumstances. I was grateful not to have been in her circumstances and that I didn’t have to make that decision. I just wonder if the rest of the world has the heart to step back the next time they meet someone who has made a choice with which they disagree. They won’t have to live with the pain the rest of their lives the way others do.

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