It appears that two things bring people into the ER in the winter: burns and hypothermia. On one night I had two children who had been scalded by hot soup and two that had hypothermia of the feet and hands.
1. The “Soup Kids.” Hot, steaming bowls of delicious soup define winter. They warm us up inside. They are nourishing and good not dangerous and life threatening. That is until the soup spills. The resident said a child had pulled a bowl of hot soup off the counter and it splashed all over his face and neck. Second degree burns. He wanted me to talk to the family to find out how it happened. And to suss out if there was abuse and neglect. The other soup kid spilled the hot liquid on his neck and chest. Second degree burns. It has to be a parents’ worst nightmare come true.
The whole premise of these social work consults is wrong. Children have accidents. Even the most vigilant parent can’t prevent all accidents. If the doctor talks to the parent and child and the injury is consistent with the story, don’t call me. Doctors know so much more about injuries, if they were intentional or perpetrated, it’s kind of a CSI thing. My getting involved ups the ante, the stress, the anger. Social workers are still viewed as snatching children out of homes. But Child Protective Services (CPS) rarely takes children away from parents. The goal is to keep them together and provide services. Lucky for me I got the calls so late in the shift I left it for the social worker on the next one.
2 kids out in the cold.
It’s been really cold out. Kids play outside in the snow and ice. It’s fun, until the feet and fingers get numb, attacked by frost. I went to see the first kid with hypothermia. I walked in the room and he was surrounded by 4 African American women of all generations and all dressed to the nines. They were wearing large hats. Mom, aunties and grandma were all over the kid. The love and concern radiated around the room. I asked a few questions and got out of that room fast. Second cold kid was a disaster. His clothes were dirty, he smelled, couldn’t sit still or focus, and his mom had that glazed, lost look in her eyes that is a dead ringer for mental illness. Parents with hyper-active kids need a break. Send them outside to play. But when the temperatures dip below freezing, like 20 below, that’s not an option. This kid was outside without heavy boots or gloves. The boots leaked. I saw them, the leather was water stained and ripped away in several pieces. It reminded me of Van Gogh’s painting of a pair of beat up shoes. His feet were a sickly shade of gray. His mother, upon questioning, confessed that she had no money, had lost her job a couple months ago, and had moved in with her sister. She didn’t want to be there, they didn’t get along, but she had no choice. Winter jackets, boots, hats, and gloves cost money. Mom said she was going to go to a second hand shop and purchase those items. We have clothes in the hospital for adult patients but not children. I wished that I had a $100 gift certificate to a clothing store to give to her.
It still shocks me that in this country clothes to protect against the elements are hard to come by.
The back story to almost every child neglect case is poverty. But it is the parents that get blamed, not the economic system that produces the deprivation. So what am I supposed to do? Call CPS and report mom for neglect, for not having bought sturdy winter boots, heavy mittens, and telling the kid who is driving her crazy to come in from the cold? Once again I escape the CPS dilemma. The patient was admitted and it would be the inpatient social workers problem.
distal aspect of cuboid