My memory of the small boy with dark eyes and curly hair comes back quickly as the medical students I am working with share what they are thinking and what they would do next. I saw him first on a busy evening shift along with a new resident rotating in the ED for the first time. I was fairly new in the ED in my first job out of training.
The boy was brought in by his mother with his older sister along for the ride. His mother was concerned about his vomiting which began earlier that day. No other symptoms. No fever. No diarrhea. No cold. No cough. No bile or blood in his vomitus. He was “just vomiting” and he wouldn’t stop.
After what I thought was a good exam including a thorough abdominal exam, I fed the infant small amounts of Pedialyte myself. He took it well and had no episodes of vomiting after watching him for about 30 minutes. I discharged him home with a supply of Pedialyte and instructions to return if not better by the next day.
He did return the next day with more vomiting along with posturing and a fixed gaze to one side. He received several doses of medications for seizures, but he continued to seize. He was intubated easily on the first attempt. His head CT revealed diffuse brain swelling, inter-hemispheric bleeding, and no evidence of fracture.
I learned of his return visit later that day when I came back for my evening shift. My colleague who cared for him that day graciously took me aside and shared the update with me. She reassured me with the words, “It could happen to any of us.”
I learned later about the state-of-the-art care he received from my mentors in the PICU. He stayed in the hospital for several months. He was discharged to his mother’s care after she learned how to use his feeding tube, care for his tracheostomy, and administer his anti-epileptic medications.
These events occurred more than 25 years ago and it truly seems like it happened yesterday. I recall a visit with one of the hospital Vice Presidents who also ended our conversation with “It could happen to any of us.” I still review what I did and didn’t do during that visit in the ED. I am not certain of much more today than I was when I discharged the boy home with his mother so many years ago.
As I have processed the care I gave that day, I have made a deliberate point to learn more about the presentation, diagnosis, and management of child physical abuse. I have found myself reaching out to others like these medical students to share what I have learned. I share about epidemiology, risk factors, and injury patterns. I am not a child abuse pediatrician and I still have a lot to learn. But, I think the one of the most important things I need to share is the fact that I still choke up and fight to get the words out when I retell the story of the boy with dark eyes and curly hair. I hope this blog spot helps others in their journey caring for children.
What do I want to share?
At the end of the day, I encourage you to consider the opportunities for earlier recognition including: