“Room 18 is a 5-year-old female, a refugee from Honduras, who is here with her foster mother and has had high fevers for a week,” said the nurse in the middle of our weekend afternoon shift, her eyes puffy and tearing up. As attending physicians in a busy New York City pediatric emergency department, we’ve each spent almost a decade working to provide compassionate emergency care to hundreds of kids on a daily basis. We’ve trained for the worst of disasters, resuscitated patients, cried with parents, and broken devastating news. But it is rare that we see a 5-year-old sob as inconsolably as our new patient, whom we’ll call C.K.
Pause, think, protocol. We check her airway, her breathing, and her circulation. All are stable.
The resident physician exits the room. “It’s complicated,” she says. “Her mother is in immigration jail and her foster mother, who she only met six days ago, was not given any medical or vaccination records.”
Pediatricians rely on this critical information to help triage, accurately diagnose, and treat their patients. If there is no family to provide a medical history, and the guardian she is here with does not know anything about her, how can we do our jobs?
“She is a 5-year-old girl who recently emigrated from Honduras with high fever, cough, red eyes, and runny nose … ” the resident continues, before she is cut off. Like detectives, physicians are trained to recognize patterns and clues that, taken together, suggest a list of possible diagnoses before doing tests. With the current measles epidemic in New York City, we’ve heightened our suspicion and vigilance around this disease, given the imperative to protect patients and the community. Measles is a vaccine-preventable disease, but C.K. had no documented immunity to this disease, a disease that has been making a comeback of epidemic proportions in recent months.
We decide how to examine C.K. We congratulate ourselves for making smart diagnostic decisions and bringing safety to the emergency department with isolation protocols. One of us gears up in the personal protective equipment and enters the room to examine her. She is crying, weeping. Her fear and anxiety swirl around the room. Under her mask, tears turn into words: “Quiero a mi mama.” It translates to “I want my mama.” It is Mother’s Day.
As doctors, we have been taught how to protect our patients, to test and to treat, to accept minimal risk and ensure patient safety. We know how to test C.K. to find out what is making her sick. But how are we supposed to be good diagnosticians if there is no parent or guardian who can provide us with answers to simple questions that would help guide us? Why does this child need to suffer with the unnecessary pain of needlesticks because of a system that separated her from her family? She did not break the law.
We recognize, on a daily basis thanks to the jobs we do, that the healing process for children mandates something we, medical providers, cannot provide—the compassion of a familiar face, the love of mothers, fathers, sisters, brothers, friends, or guardians. How can it be in the best interest of this child to separate C.K. from those who can heal her? We—the doctors, nurses, child life staff, and her foster parent—all tried to calm her. But we are not a familiar face, and there is nothing we could do to change that.
We could treat her. We wish we could have reassured her.