How a child's shattered life changed my career

The emotional trauma this doctor suffered over ayoung patient's brutal death made her reassess her goals in medicine.

How a child's shattered life changed my career

The emotional trauma this doctor suffered over a youngpatient's brutal death made her reassess her goals in medicine.

By Susan H. Hayes, MD / Pediatrician, Chattanooga, TN

Despite our illusion of control over our lives, sometimes our paths areprofoundly altered by a chance meeting with a stranger. In my case, thedeaths of two little children--both strangers to me--changed things. Onesolidified my decision to become a pediatrician; the other caused me tochange direction in midstream.

During my third year of medical school, I realized with growing dismaythat I hadn't found a specialty that was a good fit for me. The stroke patientsin comas that I saw in internal medicine distressed me because I couldn'tinteract with them, and I just didn't like psychiatry, surgery, or ob/gyn.I was about to add pediatrics to the rejection list; there was no way Icould deal with children dying, I thought.

But then I actually saw a child die--a 9-month-old boy admitted for repairof an umbilical hernia and bilateral inguinal hernias. Twenty-four hoursafter surgery, he succumbed to overwhelming sepsis. And although we allcried, I realized that I could survive the death of a child, despite feelingthat a little piece of me had died too. The death of that beautiful babyboy showed me that the joy of taking care of children who survived far outweighedthe sadness I'd feel when a young life was extinguished.

During my internship, I felt most at home in the pediatric emergencyroom. Finding a hot appendix, sewing up lacerations, and putting on castsgave me a thrill; I loved fixing things. I joined the staff of a pediatricemergency department in the Chattanooga hospital where I had done my residency.

For six years, life was good. Despite the long shifts, my work gave megreat satisfaction. That drastically changed one night in the fall of 1994.

It was a quiet night, which makes emergency physicians nervous becauseof a superstitious belief that quiet means chaos is right around the corner.A nurse and I went upstairs to grab a Coke, and as we strolled back, weheard car tires squealing at the entrance to the emergency room. At thesight of someone emerging from a private car carrying a very still child,we rushed to get a trauma room ready.

The thin, pretty girl, about 3 or 4, was in full arrest when she wasplaced on the stretcher, and the staff began CPR. On superficial inspection,the only notable findings were cyanosis and some discoloration about thepubis, which I initially attributed to pooling of blood. While another EDdoctor was inserting an intraosseous line, I intubated the child--with nodifficulty, which is always an ominous sign when the patient has not beenpremedicated. We gave her epinephrine in the endotracheal tube and throughthe intraosseous line, but we never got a heartbeat.

The little girl's name was Lindsey. The job of telling her family thatshe was dead fell to me. The other physician, the nurse, Lindsey's mother,and I all cried as I broke the news. But when the mother began to speak,I had to lock my knees to keep from fainting. "I want you to checkwhether she was molested," she said.

Although I didn't know why Lindsey had died, it had never occurred tome to consider savage sexual abuse as a cause.

The story that emerged was chilling. Lindsey's father had custody ofher, but she had come to her mother's house for a visit. The mother wentout for the evening, leaving her child in the care of a female friend. Whenthe mother returned, the friend was gone but two men were present. One waswatching TV, the other was naked and unconscious--drunk--in a locked utilitycloset next to Lindsey, who was also naked.

I went back into the exam room. Except for the cyanosis, Lindsey couldhave been peacefully sleeping on the stretcher. I lifted her legs to lookat her genitalia. "Oh my God, oh my God," I gasped. It felt asthough all the air had been sucked out of the room. Someone had assaultedher tiny rectum and genitalia; her little body had been ripped apart.

I don't know how I managed to take care of the patients I saw the restof the night. After each one, I would go off and cry. I had seen childrenwho'd been physically abused, but never a sexual molestation like this.I couldn't believe an adult could do something this heinous to a child.

A photo of Lindsey holding a lacy parasol and smiling saucily appearedon television for weeks after her death. I have a similar picture of myniece, which I could no longer look at because the pose reminded me of Lindsey.I stopped watching the news and reading the newspaper; I couldn't bear toknow anything about the alleged killer.

But I couldn't stop thinking about Lindsey. First I had nightmares, thenI had trouble getting to sleep. When I did sleep, I often awoke with myheart racing. Speaking about Lindsey brought me to tears. The more I thoughtabout her, the more miserable I became. My unhappiness was so intense thatI began crying whenever I had to go to work. I was so afraid that I'd seeanother patient like Lindsey and that I wouldn't be able to cope. The bureaucracyof working in the ED bothered me in ways it never had. Six months afterLindsey's death, I gave my notice; the job I once loved had become intolerable.

After I left, I joined three other pediatricians in a practice ownedby the hospital. In private practice, my worry about confronting anothersexual molestation abated. At the same time, my anxiety about testifyingat the upcoming trial mushroomed. What if I cried and was unable to talk?Worse, what if I said something that convinced the jury not to convict Lindsey'smurderer?

A good friend accompanied me when I went to talk to the prosecutor twoweeks before the trial. The worst part was looking at the gruesome autopsypictures--a beautiful little girl had been reduced to torn-up body parts.I cried so hard that 30 minutes passed before I could talk. I'm not sureI would have made it home without my friend's assistance. From that dayon, I prayed for help in getting through my testimony.

And just as I expected, taking the stand was the most painful thing I'vedone since the night I pronounced Lindsey dead. When I walked to the witnesschair, my knees felt like jelly. I refused to look at the accused. Instead,I focused on a juror with a wonderfully kind face. (Later I learned thathe was a pastor who often visited patients at the hospital.) As I begananswering questions, I was surprised at how scared and little my voice sounded.After I heard a woman spectator sob, the bailiff had to bring me a cup ofwater so I could regain control of my emotions. The prosecutor's looks ofencouragement helped immensely.

I wasn't as successful at controlling my anger when the defense attorneyquestioned me. The harder he tried to make me contradict myself, the angrierI became.

When I finished testifying, I went to my car and cried until my eyesached. But this time, instead of grief, I felt a release from my burden.I had done my part in telling the jurors how horrible Lindsey looked, sothey would know what a terrible crime had been committed. I finally feltfree of all those months of worry and anger.

The jury convicted Lindsey's assailant of rape and murder. He was sentencedto two 25-year terms for the rape, and to life without parole for the murder.The judge dismissed his motion for another trial.

I still grieve for Lindsey, and have bad dreams about her occasionally.But as I learned so many years ago from the death of that 9-month-old boy,I can go on living even after a part of me dies.

I'm happy again. And although I miss the instant gratification of workingin the emergency room, I don't miss victims of car accidents or house fires.Private practice is a bigger world than the emergency department--with evenlonger hours and fewer days off. But I get to watch my patients grow up,and I'm the beneficiary of lots of hugs and kisses, handwritten cards, carefullycolored pictures, and photographs.

Yet, as much as I love my practice, I realize that fate sent me here.I might never have wound up where I am were it not for the boy who succumbedto sepsis--or the terrible loss of Lindsey.

Susan Hayes. How a child's shattered life changed my career. Medical Economics 1999;18:65.

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