Beyond office walls

January 20, 2006

An emotional experience with one family taught this physician the importance of trust, instinct, and compassion.

When my husband and I married and went to medical school, we both dreamed of doing exactly what we've ended up doing. Now three years out of residency, we're both family physicians practicing in a rural farming community in southeastern Washington. We're also busy raising our three small children, balancing the demands of family with those of the clinic, hospital, ED, and call.

Not long ago, a deeply emotional experience reminded me of why I wanted to go into medicine:

I was on call one weekend when I had to evaluate a patient at the ED. While I was filling out paperwork there, my good friend Sherry rushed in holding her 10-month-old son Chad in her arms. (All names have been changed.) Seeing him lying there limp and lifeless, I thought of my own son, the same age.

I stayed in touch with Sherry almost daily over the next two weeks as her nightmare unfolded. Chad remained in the PICU while several pediatric specialists evaluated him. Fortunately, the hematoma was stable, and surgical intervention wasn't necessary. However, ophthalmologic evaluation revealed severe retinal hemorrhages. Luckily, the macula wasn't affected, and vision was intact.

Because of the nature of Chad's injury, the hospital's pediatric abuse specialist was called in. As she told me by phone, retinal hemorrhages of this severity "never" occur unless someone has forcefully shaken the baby. As a result, the case was referred to the police and Child Protective Services. When their questions made Sherry realize that she was under suspicion, she contacted a Seattle lawyer who advised her to say nothing. But her refusal to respond to their questions apparently made the police and CPS assume she was guilty. So when Chad was released from the hospital, he was placed in foster care-fortunately with a family member.

Sherry and her husband were distraught. She told me that Chad had fallen backward several times in previous weeks as he was learning to walk. Until that weekend, however, someone or something had always been able to break his fall. Convinced that Sherry and her husband were ideal parents and incapable of child abuse, I defended them when I was interviewed by the police, CPS case workers, and others involved in Chad's case. I explained that I had been Chad's doctor since his birth, and had never seen any red flags signaling abuse.

Over the next two months, I coordinated Chad's care with various specialists in Seattle. His hematoma diminished, the retinal hemorrhages resolved, and pediatric neurologists ruled out any seizure disorder. Since CPS had recommended evaluation by a physical therapist, I arranged that also. After that exam, Sherry, nearly crying, called to report that the physical therapist had finally diagnosed Chad's problem.

Apparently, Chad had developed tight extensor muscles in his back and legs from sitting for extended periods in his exerciser/play seat, one possible risk with such products. That condition had caused his repeated backward falls. Within a few visits, the therapist had solved Chad's problem. A few weeks later, the police and CPS concluded that there was no evidence of abuse. Chad was finally reunited with his parents, and has continued to thrive.

At the time, I'd felt nervous about managing such a clinically complex case. Looking back now, however, I'm relieved that my confidence in Sherry and her husband was justified. By trusting my own instincts, I gave them the emotional support they badly needed during that difficult time. I've learned that a compassionate physician can help patients survive life's heart-wrenching experiences-which makes me glad I chose a career in medicine.