Why Did you Break my Heart

I heard the saddest words today. I spend one afternoon each week working in an adult/peds medical clinic where I see mostly infants and toddlers for their well-child visits. I talk with mom about the baby's diet, ask about sleeping behavior, feeding habits, etc. I advise on things the parents should be doing, things they should not be doing, and things to expect in the upcoming weeks/months as far as their child's development goes. Sometimes there is crying involved, sometimes I end up with a little slobber on my tie, and sometimes I open the diaper to find a little surprise waiting for me; but all in all, these visits are pretty low stress.

There is however, at least one visit each week where everything with the patient (the child) is going very well, but the child's environment is crumbling. My first week on the job, the mom just flat out said she doesn't like her one year old girl. Forget love, we are just working for a "like." Another week, after ten minutes of conversation, the mom shared with me the fact that she was going to be kicked out of her apartment by the end of the week. She wanted to know where the nearest shelter was that she and her baby could stay. For some reason, I like those moments of the visit the best—second favorite is the moment I take the baby from mom to do the physical exam, twisted, huh. I think that I like the moments when the visit takes a turn for the worse because I see it as a challenge. What the challenge is exactly is not clear. Maybe for me to connect with this mom and really communicate, really understand what is going on in her and her baby's world. This is the part of the visit that no algorithm can handle. That is why this is my favorite part of the visit.

Today, my last appointment of the day was the special visit where the algorithm got tossed —That is only considering the well-child checks, because I did see a latino man paralyzed by a gun shot to his 4^th lumbar and now dealing with a giant flesh eating pressure ulcer on his right foot. He also was my first patient where I got to use my Spanish. Back to the special visit, the patient was a five yr old male accompanied by mom. The child had been performing poorly this year (compared to last) in school. The teacher called frequently to report behavior and overall performance problems in class. The mom had noticed similar behavior at home, etc. The mom came to a stop in her story, then, it was my turn to figure out why the abrupt change in behavior. My face contorted to a pensive shape and I think the mom realized the game I was about to begin. She cut me off before a question could be asked and just said straight up, "I know what the problem is, he wants his father around but his father don't wanna be around."

Punch to the stomach. The part of my brain working on the first round of questions shut down and I started to focus all of my thoughts on the father, or lack thereof. Images of all those Salvador Dali paintings with the father/son shadows started to fill my mind, no, just kidding.

Actually, what struck my mind, and I report for some reason with some chagrin, a news clip I saw on CNBC or something last week about the epidemic in America of fatherless school children. I also thought of a case I read earlier this morning where the resident suspected child abuse and totally lost his cool with the mom's boyfriend right there in the examination room. Could you imagine me pinning the dad against the wall in a fit of anger? Me neither. Besides, dad or ex-boyfriend wasn't even there to pin against the wall.

The frustrating thing about this visit is that there was little I could do outside of the algorithm routine. I talked about mom spending extra one-on-one with the little guy. I gave him a sticker and a book and talked to mom about reading with him; but aside from that I had to consult the social worker about availability for family counseling. Social workers, I love you!

Should I have asked more about the parents' relationship? The mom wanted the father around; that much was obvious by her body language; but he didn't want to be there, and he obviously didn't want to be at the doctor's appt. What could I do? What could she do? This episode reminded me of when I was in Ecuador. So, so, so often, many, many, problems stemmed from a bad relationship between mother/father, boyfriend/girlfriend. If things were OK between the two, everything else seemed to fix itself. I probably failed to appreciate the complexity of those situations, but I often wished people would just change their heart, like that Beck song. The way I saw it, everything else would be fine. In today's case, I wasn't hoping for any change of heart. I just wanted a wand to wave over the situation and put the father back in the home. So I'm barely into this medicine thing and I'm already looking for magic solutions. Hmm, that isn't the best of signs.

Moral of the story: Don't be making kids UNLESS you're gonna be together (child-makers) to do the entire child development part. For serious!