Working in an urban ER: We need more moms like this one

When you work in an urban hospital, sometimes it’s difficult not to become jaded.

There are certain neighborhoods that generate a disproportionate number of patients for some emergency departments. Meth is rampant. Marriage pretty much nonexistent. More bars than there are restaurants. Domestic abuse frequent, but prosecutions rare. Police know people more by their street names than by their real names.

South Heights was one of those neighborhoods.

The emergency department frequently treats South Heights kids who are neglected by their parents. I’ve seen young South Heights kids with seizures from cocaine. Now seizing kids get drug screened as part of their workup. I’ve seen more than one young South Heights kid with a lighter burn. I’ve given a lollipop to a 2 year old South Heights kid and watched the mother take the lollipop out of the kid’s mouth when she thought no one was looking, chew on the lollipop until there was nothing left, then slap the kid for crying. Many parents from South Heights can recite the names of the family court judges from memory and quite a few have had their children taken away. Social service workers know many South Heights kids personally. Based on the history of the area, many people tend to look at the kids from South Heights with pity and look at parents from South Heights with contempt.

The next patient on the board was “finger laceration.” As I walked toward the room, the nurse mentioned “they’re from South Heights.” I was already thinking about whether I’d get attacked if I had to call Child Protective Services.

The patient was a cute little girl about 5 years old. Thin stature, great smile, polite. She was holding her arm out on the table and a gauze pad with a slowly enlarging spot of blood covered her hand. Her mom was weathered. Most of her teeth were missing. Her clothes looked like they hadn’t been washed in a while. A reusable shopping bag with newspapers, empty beer cans, and a pair of headphones sat on the chair next to her.

“So what happened to your finger?” I asked the little girl.

“I cut it with a scissor.”

The mom explained that the patient was told to wait to open a bag of cookies, but didn’t do so. Instead, she grabbed a pair of scissors from the drawer and forgot to take her finger out of the way when she cut. The result was a fairly deep laceration to the outer part of the index finger.

I went through the described mechanism in my head for a second. Scissors in one hand, holding a bag with other hand, cut to opposite index finger. OK. Injuries seem to fit the explanation.

Then I went about describing what I was going to do next.

“I’m going to put some medicine into your finger to make it stop hurting. Then we have to clean it out to get rid of all the germs. Then I’ll fix it up for you. The medicine to make it stop hurting burns a little bit. Once the burn is gone, it won’t hurt any more. OK?”

The little girl looked from me to her mother and her eyes began to tear up.

She cried and whimpered, but she held completely still while I injected lidocaine into her finger. Her mom leaned over next to her, gently cupped her head and wiped away her tears.

After the wound was clean, I got everything ready to fix the wound. But the patient was a little hesitant because the lidocaine injection had hurt. Despite me showing her how her finger was numb, she cried and didn’t want me to touch her hand.

Then mom came up with an idea.

She ruffled through her shopping bag and pulled out an old iPod. She started playing a country song on the iPod.

“Do you know what this song is?” mom asked.

“My ‘I love you’ song,” the little girl said back.

While I worked fixing the little girl’s finger, I watched as her mom caressed her daughter’s face and as they softly sang the words of the “I love you” song back and forth to each other.

I finished the last suture about 15 seconds before the song ended. The little girl didn’t move a bit until the end of the song. Then she used her uninjured arm to hug her mom around the neck and tell her one more time “I love you, mommy.”

As I wrapped up the little girl’s finger, I thought how difficult it can sometimes be not to form premature impressions about people.

And as the young patient blew me a kiss with her bandaged hand while being carried out the door by her mother, I thought how desperately South Heights needs a few more moms like this one.

“WhiteCoat” is an emergency physician who blogs at WhiteCoat’s Call Room at Emergency Physicians Monthly.

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