PHYSICIAN-IN-TRAINING/
MEDICAL STUDENT CATEGORY
WINNER
2015 RICHARD SPEAR, MD,
MEMORIAL ESSAY CONTEST
HOLD THE PHONE
T
Sarah Khayat
he child spoke Spanish and English. He was alone with a sitter
as his parents were barred from
visitation during the period of
Child Protective Services (CPS)
investigation. He appeared frail and had a stubbornly wary demeanor. Etch and Sketch® was
propped up on his lap as he vigorously turned
the knobs, making an unconvincing show of indifference. The
hospital-issued stark white blanket was pulled up to his belly and
the head of his bed elevated; he was dwarfed by his surroundings.
Everything seemed too big, just like I’d imagined Alice in Wonderland felt after drinking from the bottle down the rabbit hole. We
were gowned, gloved, and masked, only enhancing the depth of
his suspicion. The attending’s attempts at rapport- “What are you
drawing? What grade are you in? How old are you?” - were met
with tenuous defiance. The attending jokingly listened to his knee
and then his elbow with the stethoscope, trying to render it, and by
extension himself, harmless. Then came the point of actual physical
contact. His tough exterior rapidly crumbled as the stethoscope
approached. Finally, he abandoned all defenses and became a child
again, crying inconsolably.
This was a 6-year-old child with Chronic Granulomatous Disease,
a congenital primary immunodeficiency, on appropriate prophylaxis
being treated for a lung abscess. He had a history of treatment for
liver abscesses and poor adherence to the medications meant to
preclude those complications. Upon inspection, he had what were
considered potential cigarette burns- one on the face and the other
on the back. I would be remiss in not mentioning a background of
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LOUISVILLE MEDICINE
poverty and an exclusively Spanish speaking family. This was the
situation in which I uncomfortably found myself while on my inpatient pediatrics rotation. It was problematic from many different
vantage points. Aside from the obvious need for involvement of CPS,
there was the quite practical issue of communication. The child could
not serve as interpreter to his family, for obvious reasons. At least
for this, we felt we had a practical solution: the interpreter phone.
Two days later, mom was granted visitation, but only under supervision of a hospital appointed sitter. She had the same expression
of wary defiance that we had witnessed in her son two days prior,
but she was generally pleasant and participatory. We noticed her
child was much more interactive in her presence; he giggled at the
corny jokes meant to make him feel at ease and was no longer as
apprehensive come time for the physical exam. Each day, we used
the interpreter phone to help clue mom in to what was happening
medically and the results of the various cultures that were sent to
the lab. I was intrigued by his behavior during this whole exchange.
Rather than distract himself with a toy or watch television while
the adults were talking shop as most well-adjusted six-year-olds are
wont to do, he took a radically different approach. His precocity
would peek through his prepubescent exterior as he would very
astutely look from the doctor to his mom, and back again, rapidly
processing what was being discussed utilizing his familiarity with
both English and Spanish. He never visibly reacted; not a flinch,
grimace, or groan. His composure was not for us to rescind.
Eventually, discharge day was upon us. Child Protective Services
had decided that the child’s home was not fit for return. The need
for foster care was also likely informed by the questionable burns