It’s a Sunday evening in a local South Texas emergency room with the expected ER traffic for a weekend evening. Lots of simple traumas: ankle sprains, abrasions, lacerations, falls, common URI symptoms, and fevers.
The EMS radios in with a call of a five-year-old male who has altered mental status. The patient is brought in around five minutes later and placed in an open emergency room. The patient is accompanied by an adult monitor and is triaged — vitals are taken and he is placed in a hospital gown. He has normal vitals and is deemed to be a Level 3 triage secondary to his chief complaint. He was subsequently seen within 10 to 15 minutes upon arrival to the ER via EMS.
Upon entering the room, I see a small, thin child lying anxiously on the bed. I begin to ask the adult monitor a series of questions trying to obtain a history of the patients presenting complaints. He advised me that the child has not been acting appropriately over the last three to four hours. He has recently been placed in this detention center secondary to being removed from his father, as both he and his father were caught entering the country illegally. The patient has refused any oral intake including water or food and has not been able to communicate with any of the caregivers at the detention facility. The monitor tells me that he is unable to tell me if he has no previous history of any significant past medical illnesses, surgeries or if the child takes any daily medications.
The boy was recently placed in the custody of this detention center by border patrol, and it is unclear as to the length of his stay. He informs me that while he will be in the detention center he will continue to be separated from his father. When questioned about possibly being able to obtain a family or past medical history from the parent, the adult monitor indicates that he is unable to contact the parent as he is unsure of the parent’s current location or where the parent is detained. I ask if there is any indication of when the parent and child will be able to see each other again or if they will be able to communicate with each other during this process. The monitor informs me that, typically, the children and parents are held in different facilities and are not able to communicate until decisions for their deportation are complete.
I proceed to examine the child and find an essentially normal physical exam. I try to engage the child and speak Spanish to him to allow him to communicate more freely. It is obvious that the child is afraid and concerned for what may begin to transpire. As I have no significant past medical history and I am unable to obtain whether or not the child may have encountered any illicit drugs or medications en route I advise the monitor that I will need to obtain some blood and urine samples from this child. He agrees and gives his consent for the appropriate lab draws. I asked the child if he has any specific food that he prefers to eat and I’m left with no response. Working at a children’s facility I am blessed with the ability to have available child life specialists that can make lab draws and hospital stays and more pleasant for young children. I ask for there help with this child’s lab draws.
Following the lab draw, I asked nursing to provide an appropriate food tray for this patient. We engage the child in appropriate life therapy with coloring materials and bubbles. He is still quite reserved, quiet and far less active than most typical five-year-olds would be at this stage. I check in on him a few times as we await his lab results, and I find that he had taken a few bits of some nuggets and sipped a small amount of juice. He is a little more active but still not speaking much to either the nursing staff or his monitor.
Just short of three hours later, his labs and studies are resulted and are thankfully normal. While his behavior is deemed not normal, he is definitely not altered nor is he medically unstable. He is traumatized and scared and alone. He is having difficulty adjusting to his new environment, one that has essentially stripped him of his parent and placed him in a totally unfathomable situation. It’s one full of strangers, strange foods, with unfamiliar places — places where they barrage you with exams and needles. While I know that the labs and studies were essential to finding if this poor child had any significant malady, I still feel torn by adding to his trauma.
There is no easy answer for this dilemma, the plight of those trying to enter the country illegally and their children can cause social angst. The United Nations weighed in this past week on this situation, deeming it “unlawful interference in family life, and is a serious violation of the rights of the child” is perhaps a step in the right direction.
Medicine and politics often do not play well together and learning to juggle your own political views and doing what’s right for the patient can often seem difficult. Yet we as physicians are held to the standard of doing what’s best for our patients — and for first doing no harm.
Maria Perez-Johnson is a pediatrician.
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