Peaks and Valleys b Mandy O’Hara, MD, MPH
House staff lecture today covers child maltreatment, and I compare and contrast cases of child neglect. Although reluctant, I feel obligated to include the reality of fatal neglect, with a slide of an intubated girl pictured from the bottom of her dirty feet up. The overriding message I hope is prevention—a chance to reflect on all of our efforts before neglect and abuse happen.
The day goes on, and I shift into my nighttime responsibility on call. It is a quiet evening until the morning at 4am, the beeper awakens me, and I make the call. The history is of 6 and 2 year old siblings awaiting transfer to critical care after a parent’s confession to police led the way to discovery of multiple slash wounds to their necks and abdomen. OR exploration was life-saving. Both are surviving. With my ear to the receiver, I flashback 7 years, when, as a fellow, I found myself at the autopsy table of two siblings ages 6 and 2 with fatal stabbings –neck in the one, abdomen in the other. The same wounds as tonight’s call, but to a deeper degree resulting in death, on a date that happened to be my own daughter’s 6th birthday. Tonight’s siblings arriving shortly, will live under our care.
Finally, I manage to fall back asleep after the startling page, and dream a dream of hope. In this state of mind, I dream I am scrubbing the bottoms of everyone’s feet—patients, law enforcement officers, attorneys, and my own.
Once the children stabilize, 6 year old Sky is forensically interviewed promptly by the prosecutor. In what becomes an extended interview on the inpatient unit with the support of child life and hospitalist staff, he discloses thinking he was going to die (when his throat was slashed), but he didn’t. “I survived!” he added and energetically high-fived the staff, in a manner that only a 6 year old can.
Sky became a vision of resiliency that resonated with my decision to first enter this field. In the beginning of medical school, when asked to select community outreach work, I picked the pediatric option—volunteering in a therapeutic preschool for abused and neglected children. I read my very first patient medical records there, detailing child witness to fatal domestic violence and severe intrafamilial chronic sexual abuse, among others. After sifting through the paper charts stored upstairs, I went downstairs to meet the children. In the caring therapeutic multidisciplinary environment of this specialized preschool, the children found security, joy, and comfort. With an “I survived” attitude, I was struck by their ability to bounce back into childhood after living through unthinkable abuse. I witnessed not only their ability to play but to connect in warm loving ways, despite great adversity, and these first pediatric patients remain a guiding light for the work I do today.
The resilient potential of children like Sky, who, though traumatized and in need of professional care, persevere with a “survival” force, are the greatest hope in this field. Though Sky and his sibling were separated in foster placement, it was a joy to see them reunite at my follow-up visit. A moment of joy in the child abuse clinic is not so common, so this one felt truly celebratory. After they joyfully embraced, Sky lovingly helped “Baby O” with her fear of the approaching exam.
Weeks later, while taking a break from work to recharge, checking emails sitting at the base of a mountain retreat, I receive news of Sky’s collapse, failed resuscitative efforts, and his death. The cause unclear, I am left with an aching pain that lingers when we face such loss in the medical field. I can only honor the bright resilient nature that he exuded after surviving life-threatening abuse..
I ascend the mountain, and sit in nature, at a high altitude with an elevated view of peaks and valleys. As physicians and child abuse pediatricians, we all sit in nature—the nature of birth and death, peaks and valleys, and paths of life that we hope to sway toward less suffering and “survival attitudes” for all.
The day transitions to night, and I light the candle I save for those kinds of days like today. Yoga begins to flow through me, preparing me to sit in complete silence, still. All that I am and all that I do is supported in this moment, as I release the suffering of others I have been witness to in this day. Shavasana follows, my own corpse pose, and next a restful night’s sleep, all replenishing the energy drained from me, and enabling me to be ready for the next patient I will encounter with resilient potential like Sky.