As a parent, I realize what a difficult job parenting is. Yet, at the hospital, I often see people who are clearly making bad parenting choices. Here are a couple of recent examples:
Twelve-Year-Old Girl with Discharge
The mother brought her twelve-year-old daughter in with a foul smelling vaginal discharge. There is really no way for a girl to have such a discharge other than from a sexually transmitted disease. This fact directs our evaluation of a girl with this complaint.
As I asked questions, the girl wouldn’t give any details and the mother seemed offended that we would ask her daughter such “personal questions.” When we tried to get the mother out of the room to give the girl a chance to open up a bit, the mother got upset and refused to leave. It seemed she was paranoid that we were going to do something to her daughter, something she felt determined to protect her daughter from.
The female nurse and I tried repeatedly to help the mother understand that we were there to help them, that her daughter probably had something that needed treatment and we really needed to find out what was going on. Still, the mother refused to let the girl be examined or tested.
At times like this, my fallback response goes something like this: “You brought your daughter here because you are worried about her. We are offering to help, yet you are refusing to let us do that. When you decided to come here today, what were you hoping we would be able to do for you?” In this case, the mother had no answer to my question. Rather than prompting some positive reflection, as I hoped, it just seemed to frustrate her. She left, saying she would take her daughter to their pediatrician.
As they walked out, I was presented with a dilemma. Did this mother’s refusal to allow us to diagnose and treat what was almost certainly a sexually transmitted disease constitute child endangerment? Should I call the police or send a report to Child Protective Services?
In the end, I decided to send an email to their pediatrician and let her try to help. I felt this would be better in dealing with this mother than having authorities come down on her. Who knows if I made the right decision or not.
First, let me say that I don’t like tattoos. I am not morally opposed to them, I just don’t find them appealing. I have also talked to too many older people who express some remorse at having been tattooed in youthful exuberance. With time, both the images and their meanings blur. The permanent nature of tattoos would keep me from deciding to have one myself.
With that background, you can imagine my thoughts when I cared for a fifteen-year-old girl with abdominal pain who was COVERED with tattoos: hands, arms, chest, back, abdomen, and legs. Her face was about the only part of her body that I looked at that didn’t have tattoos on it.
First of all, it is amazing a mother would let a kid tattoo herself so extensively. What is the chance a fifteen-year-old is not going to have buyer’s remorse some day when she looks at her body tattooed with images she thought were cool when she was so young?
Another issue is money. I work in a public hospital. Most of our patients are poor and unable to pay for their medical care. It is amazing to wonder where people get money to pay for all the tattooing.
I think it is sad that a mother would spend money on tattoos, money she might not be able to afford. I think it is crazy that the child be allowed to make irreversible decisions, which she might one day regret. I also think it is a sad comment on a tattoo artist who would, even with parental consent, tattoo such a young person.
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On the first case, obviously I don’t know the extent to which the girl smelled, but sometimes even yeast infections can smell pretty badly. Any chance it could have just been a bad one? I’d just hate to think such a young girl could have such a disease. 🙁
You are so right but it is unusual for a girl this age to get a yeast infection without having been on antibiotics or something that would cause it. Besides, in the emergency department, I have a “worst thing first” mentality. If someone has a yeast infection and I don’t figure that out, it is no big deal. If a girl has a sexually transmitted vaginal infection that is not treated, it can be passed on to someone else and it can spread up into her pelvis, really make her sick and impair her future fertility. So, if you remember “worse first,” you will better understand how I think in the ED.