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When doing the right thing for a patient feels wrong

“They took her away?!?!” I didn’t even have time to set my bag down on my desk before my colleague dropped the bomb.

My beautiful little patient, all smiles all the time, was being removed from her parents and younger siblings to be placed in a medical foster home.

We all know and love this little one. Because of her chronic condition, she has been admitted to the pediatric floor often enough for the doctors and nurses to fall in love with her bright smile and bigger-than-life personality. And because her mom has three other children under the age of 5 at home, this little girl is often alone in the hospital, waiting for someone to walk by her room so she can strike up a conversation and share a laugh.

I wasn’t prepared for the devastating news. Especially because it was my fault.

Of course, it really wasn’t my fault. But after all, I was the one who initiated the call to Child Protective Services just a couple of days before. Because as much as I loved this little girl, the sad truth is, I should not get to know my patients as well as I knew her. But her parents continued to deny the realities of her chronic disease, despite numerous previous attempts to get them to understand the harsh reality of her chronic state. She was not receiving the proper care at home and as a result had been admitted to the hospital too many times to count. Her health was suffering as a direct result of her parents’ negligence.

I had hoped for increased supervision at home, maybe mandatory home nurse visits or the assurance of closer follow up with the pediatrician. But I did not intend for them to remove her from the only home she had ever known, away from her brothers and sister, away from the parents who love her but do not understand the severity and complexities of her disease.

Last month, a toddler who ingested her parents’ marijuana was sent back home to live. The month before that, a child with an unexplained femur fracture wasn’t even investigated. But my patient is being forced into the foster care system?

It’s hard to wrap my brain around the intricacies of the social service system; the complexities of why some parents are judged harshly and others get nothing more than a slap on the wrist. And what is the right answer, anyway? My patient lives in a difficult situation, with poor, uneducated parents who are struggling to get by with four young children in a tiny 1-bedroom apartment. Parents who do not understand that by ignoring their daughter’s medical condition, they are causing her great harm. Sure it qualifies for medical neglect, but is it really as simple as that?

My precious patient will have her physical needs met in a medical foster care home. So I will choose to focus on the good, instead of the nagging irrational guilt that lingers in the back of my head. And I will focus on advocating for my patients, for their physical and mental well being, even when it pulls at my heartstrings. Because I know as a physician, I have to keep reporting, to keep calling it as I see it for the child’s sake, even when the results aren’t what I would hope for.

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About Dr. Kristie Rivers, Bundoo Pediatrician

Dr. Kristie Rivers is an Attending Physician, Assistant Medical Director of the Pediatric Hospitalist Program, and Director of Pediatric Medical Education at a children’s hospital in Fort Lauderdale, Fla. She cares for hospitalized children and also teaches pediatric residents and medical students.

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