The Walls Came Tumbling Down

The day started just like any other busy day in clinic. Lots of coughs and runny noses that needed parental reassurance. Diaper rashes needing Nystatin. Ear infections needing Amoxicillin. Speech delays needing therapy referrals.

An ordinary day until my second to last patient of the day. I had a premonition that something might be amiss by just looking at the chief complaint and the age of the child. My office visit with the patient and parent confirmed my suspicions. This was no ordinary case. This was a potential child abuse case. My attending and I ensured the patient was going to a safe place and would not be around the alleged perpetrator. The patient left after being informed of that authorities would be in touch, and thus began my first experience as a mandatory reporter.

My attending informed me who to call, so I did. That person gave me the number for the Child Abuse Hotline, so I called the number. When they needed more information then I had on hand, I told them I'd call them back. With the attending's blessing, I quickly saw my last two patients of the day, and called the number again.

After being on hold for quite a while, I was finally able to file my report. I was then informed by DHS I needed to call the police to make a report with them. I called the clinic social worker, who was nice enough to come back after hours to continue to help me navigate the system.

The social worker got in touch with a child abuse pediatrician. Meanwhile, I was busy calling two different police departments because two different counties were involved in the story. Each county's police department tried to pass the buck to the other police department.

I was starting to get frustrated. It was well after 6 pm at this point, and all I wanted to do was do my duty to my patient by making my report to authorities, go gather Julia from my parents' house, and go home.

Finally, one of the police departments said they would take my report and that they might call and get it over the phone, or they might come to get it in person. They weren't sure yet, of course, though, so they just told me to wait until they called me back.

So more waiting. More getting inpatient and calling back myself. Finally, they decided an officer needed to come get my report in person. Finally, though, it was too late to stay any longer at the deserted clinic.

However, the police sergeant on speaker phone was wanting an address where he could find me to give my report.

"Just give him your home address," the attending prodded me. "The clinic is closed. We can't wait here any longer. The officer can just come to your house."

So I did, as hot wet tears finally overcame my steely determination to keep them in and began streaming down my face.

"It's okay!" he said. "I'll come with you."

I wiped my face off, apologizing to the social worker, the nurse, and the attending for crying.

"I'm sorry," I stammered. "I didn't mean to cry. I'm just tired and emotional about the situation and I was supposed to pick up my daughter hours ago and I just wasn't expecting all this."

"Don't apologize," the attending insisted, kindly. "You're crying because you're human."

After I wiped my face and apologized for crying, I went to the bathroom to see why I was itchy. My torso was completely broken out in hives. It's been longer than I can remember since my body has decided to manifest stress in that way.

I tried to convince my attending to go home, that I'd be okay, that he should go and be with his family, but he insisted on coming to my house. As an attending, it was his responsibility, he said, to be there. I realized I couldn't deny him that.

So, he followed me to my house where we sipped on ice water and made polite conversation. And waited. And waited some more. And finally, after 9 pm, the attending had me call the police department back and they still couldn't tell me if an officer was even yet en route to get my report, so he had me cancel the call and said we'd just try calling again in the morning, which we did.

I've been trying to sort out my feelings about the experience.

Of course, first and foremost, quite glaringly, there's the potential abuse of a child. And that makes my heart break. I can't help but think about if Julia were to go through something like that and it makes me cry.

Second of all, I think I began crying in clinic this evening because the experience was beginning to make me feel violated.

Of the two, the former is quite obviously the tragedy. There's so much I could say about the horrors some children have to go through, but I want to focus in on the latter, more subtle feeling I had this evening. My feeling of violation.

I didn't want this already hours long process to steal more of my precious time that was supposed to be free.

I didn't want to give up the little time I had left in my day to spend with my daughter, my daughter whom I wanted more than anything to hug tight after a long, emotional day of work.

I didn't want to have a police officer calling my personal cell phone.

I didn't want a police officer showing up at my house and interviewing me about a patient in my own home.

I didn't want my attending to come over uninvited to my messy house, with embarrassing piles of underwear and socks being sorted on the living room floor and toys strewn haphazardly about and  unvacuumed floors since our vacuum belt is broken and the bathroom and kitchen looking like goodness knows what.

I didn't ask for any of this, yet I wasn't really given a choice. No one was invited, yet in they came.

I'd tried to build up some walls, flimsy as they were, around my free time, around my family, around my home. I'd tried to make sure my home was a sanctuary of sorts where we could have respite from work, with its not infrequent frustrations, sadness, and even tragedy.

I felt frustrated, overwhelmed, and uncomfortable to be asked to give so much. And, in an ideal world, this situation would have been handled differently for me. In an ideal world, I wouldn't be asked to work until after 9 pm. I wouldn't have to make arrangements for my daughter to spend the night at her grandparents' house. I wouldn't be asked to have an attending sitting in my living room late at night, surrounded by our family's undergarments. I wouldn't be asked to entertain police officers at my home.

In an ideal world, though, we would not have been put in this situation in the first place by the potential tragedy preceding it.

Sometimes, doing the right thing for patients hurts. It pulls us out of our comfort zones, our sanctuaries. Sometimes, it pulls us into our sanctuaries, embarrassing undergarments and all. We can try to partition off our lives with paper walls, but they will get blown over, or ripped and crumpled.

Life is messy, and to love sometimes means being okay with a lack of walls to hide behind or protect.

In medicine, our patients are so often vulnerable. They sit there on the exam tables, shivering in their paper dresses that crinkles and don't offer warmth. They walk the halls in their thin gowns, clutching the back to try to keep their rears from being exposed. We see their bedside commodes or urinals full of waste, waiting to be cleaned out by overextended techs. We ask them questions about their families, their digestion, their sex lives.  We weigh them and talk to them about how high the number is. We probe with questions, searching for depression, menstrual problems, bloody stools.

But how often are we asked to be vulnerable? How often do we feel naked and exposed?

We ask our patients to be vulnerable because we love and care for them, but are we willing to be vulnerable ourselves because we love our patients?

I'm reminded of one of my favorite quotes from C. S. Lewis:

“To love at all is to be vulnerable. Love anything and your heart will be wrung and possibly broken. If you want to make sure of keeping it intact you must give it to no one, not even an animal. Wrap it carefully round with hobbies and little luxuries; avoid all entanglements. Lock it up safe in the casket or coffin of your selfishness. But in that casket, safe, dark, motionless, airless, it will change. It will not be broken; it will become unbreakable, impenetrable, irredeemable. To love is to be vulnerable.”

It was embarrassing to cry at work. It was frustrating to be asked to give what I maybe should have not been asked to give in the midst of a difficult situation.

But you know what? 

I may cry because I'm human. But, I also give because I'm human. And I love because I'm human.

And that is a gift. I pray I will always hold onto my humanity as a physician, even when it hurts to let the walls come tumbling down.