A sharing by Ann Toh
Childhood should be carefree, playing in the sun; not living in a nightmare in the darkness of the soul.
—-Dave Pelzer, A Child Called “It”
A Child Called “It”
The three-month-old boy was admitted to hospital for a respiratory illness. The senior physician picked up some hint that something was not quite right and ordered imaging. Behind his back, some of us laughed at him for being paranoid and for over-investigating. As a junior doctor, I did as I was told and organised the investigations.
We were shocked by the radiological findings. Not only did this boy have a possible leg fracture, he had also sustained a skull fracture. I scrambled to organise further cranial imaging.
The reasons the x-rays were done were so subtle that today I cannot recall exactly why we ordered them. Many of the other senior doctors at that time had questioned the need to do them.
I have now seen other such cases, many of which were picked up by school teachers. I worry that I may miss the non-accidental injury when I see a child for unrelated illness. Yet I have also seen families torn apart by accusation when there is no real threat.
To pursue or not to pursue? This is a true conundrum.
Commentary
When I was working in the home care services, we sometimes visited to investigate the home situation. There was a time we visited a woman’s home to assess her coping, as she was caring for an impaired child.
On my first visit, I was truly horrified. History taking revealed that her fourteen-year-old daughter was having seizures almost every hour, was not on medication, and had not seen a doctor for many years. Was this neglect?
The girl herself was wearing a pretty, floral dress. The apartment was neatly kept. In fact, it was a welcoming, homey place, testifying to mum’s efforts to create a refuge.
I probed very gently. Had there been difficulty in bringing the girl to a doctor? The woman’s eyes welled with tears. Her child care leave had been used up to bring another child for visits; taking more time off would leave her jobless. She was a single parent trying to bring up six children, and she needed the job to support them all. How about extended family and relatives? Her facial expression and body language told me that this was not an available option.
It was clear through subsequent visits that there was no exploitation. She loved all her children, was trying her best, and was unaware that help was obtainable.
How many more of such families exist? Families struggling with the care of children with complex needs are sometimes barely afloat, and those with more than one ill child and facing economic hardship struggle the most.
Dr Ann Toh is a Family Medicine resident who enjoys the privilege of caring for patients in the context of their real lives from cradle to grave, and feels that she is currently passionately pursuing the heart of medicine.
The commentary and vignette were reproduced with permission from the book “Being Human, Stories from Family Medicine” edited by Cheong Pak Yean and Ong Chooi Peng and published in 2021 by the College of Family Physicians Singapore. Pictures of illness experiences were drawn by NUS medical students in workshops conducted from 2012-2017 by A/Prof Cheong Pak Yean. Senior family physicians subsequently shared vignettes and commentaries based on the pictures.
