A Tale of Two ER Visits (pediatric physical illness vs mental illness)

This guest post is from my friend Elizabeth Curry, a mamma of 12, who writes the blog, Ordinary Time. Last fall we had some discussion about the disparity in treatment of children with physical illness versus mental illness. Elizabeth generously agreed to share some of her thoughts and experiences with you.

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There is a world of difference between how physical illness and emotional/mental illness are viewed and treated by society.

Before I became an adoptive parent, I gave lip service to the fact that people with mental and emotional illness had an actual physical problem inside of them, but I will admit that there was always a part of me that thought, “But maybe if they just tried harder, things would be better.”

This little voice continued in my head even years after adopting my son who has significant past trauma and the effects that come along with that. “If only he could just try a little harder.”

It took me a long and humbling time to realize that he was trying his best. It was just that the chaos that the trauma wreaked inside his head never made his best good enough for me. I had to change before I could expect my child to change. It wasn’t easy to change, but I am now much closer to the parent he needs me to be than I was at the beginning of this journey.

And while I’ve been changing, I have also become more and more aware of the attitude that I at first internalized, but now have left behind. That attitude that at its core does not really believe that individuals are doing their best when they are suffering from mental and emotional illness.

Let me give you an example by telling the tale of two emergency room visits.

The children in question share the same gender, the same ethnicity, they happened at the same hospital with the same parents. The only difference was the reason they were each there. One visit was with a medically sick child, the other visit was with a child suffering inside the prison of developmental trauma.

The first child went through triage and was immediately placed in a private room. Evidently a young child with a 105+ degree fever means you don’t wait in the waiting room. There was extreme concern all around, and there was immediate action.

For the second child, arriving via ambulance, there was no waiting either, but that was due to the ambulance arrival. Instead of a private room, though, this traumatized child received a gurney in the hall, complete with guard standing nearby (for a NINE year old).

For the first child, the doctors could not find a source of the fever. As a result, he was emergency evacuated downtown to the children’s hospital for more extensive testing and treatment.

The second, even though his feelings and actions were equally mysterious, remained in the hallway with strangers, while we faced a vaguely scary and shameful feeling meeting with a social worker. This meeting was all about us, the parents. What did we think caused this? What was our plan? What were we going to do?

After that meeting, where we, the parents, were asked to self-diagnose and treat our son, he was immediately discharged and sent home for dinner.

 I have several children with significant physical conditions. I have a son with significant trauma issues. There is so much more outpouring of support and appreciation for parenting a child with a visible condition than an invisible one.

We are wonderful and amazing for the former and opinion veers between parenting that is too lax and too controlling for the latter.

Everyone knows that our parenting was not the cause of our children’s physical conditions, but very few people can wrap their heads around the fact that our parenting was also not the cause of our son’s emotional one.

I understand why people draw these conclusions: we all evaluate the world around us based on what we can observe. When we can see no visible condition that might explain behaviors, we must manufacture some explanation, which may lead us to assume that an individual, the child or the parent, is voluntarily responsible for the observed behavior.

Notice that this tendency can cause us not only to assign blame to a child or parent for behavior that results from unseen trauma, but it can also cause us to excuse behavior in a child with visible special needs that has nothing to do with the child’s condition.

My experience teaches me, whether I am dealing with my own family or another family, that I must continually pause and remind myself that this child and this parent are probably doing the best that they can under the circumstances, visible or invisible, in which they find themselves.

Elizabeth
[You can also find Elizabeth on Facebook.]

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Elizabeth Curry is mother to 12 children, five of whom were adopted: two from Vietnam and three from China. She hopes that by sharing her family’s experiences she can encourage others in the trenches. When she is not taking care of children, Elizabeth writes, homeschools, sews, teaches piano, and loves reading. You can follow along with her loud and crazy life at her blog, Ordinary Time.

This post may contain Amazon Affiliate links. As an Amazon Associate I earn from qualifying purchases.

Let me introduce myself. Russ and I are the parents of twelve children by birth and adoption, and sometimes more through foster care. I'm the creator of One Thankful Mom which has been as much of a gift to me as to my readers. In 2011 I became a TBRI® Pracitioner* and have lived and breathed connected parenting ever since. I'm deeply honored to be the co-author, together with the late Dr. Karyn Purvis, of The Connected Parent; it is her final written work. I love speaking at events for adoptive and foster parents. I'm also the co-founder of The Adoption Connection, a podcast and resource site for adoptive moms. I mentor and encourage adoptive moms so you can find courage and hope in your journeys of loving your children well.

5 Comments

  1. RACHEL
    January 20, 2017

    Hi;

    I understand what you are writing and your frustration on the difference in the ways that physical and emotional struggles are dealt with in the ER. I would like to suggest a different reason than the “medical personnel do not think mental illness is real” conclusion, that I myself did not come to appreciate until this week when I had to make a ER visit for myself.

    I am a medical practitioner. A few months ago I accompanied my sister to my local hospital where I hold privileges because she was in a lot of pain and I was concerned. She was triaged immediately — possibly because they were aware I am a work colleague (which is what I initially thought) or now (after my own experience) because she was seriously ill. She was given an IV immediately and a large dose of pain medications. There were tests and lots of questions. I have been to ER with my children — not because I thought they needed to go to ER but because they insisted that I was not being caring or compassionate. We did not get that kind of treatment when I go with them. But I have always attributed that to my attitude. I am sure I gave off an annoyed vibe about being there without real cause. (With my kids I waited long times to see medical professionals and would justify that to them as people who are sicker get seen first… we have to wait — and I believe that this is just). I thought with my sister we were seen quickly and treated with grave concern because that is what I displayed — great worry about her condition and preferential treatment because I work in the system. I no longer thought any more about it.

    Last week I had to go to ER for serious and strange unexplained pain. A work colleague that also has privileges accompanied me. We both were very concerned. After being triaged I was placed in a quiet room alone, rather than the waiting room and I overhead the reason being “She is one of ours, we need to find a place” But I waited there hours before being further assessed. My work colleague initially was angry that it had taken so long as she was gravely concerned. But as time passed realized that this is not OUR area of expertise – we are in the world of OB not ER and came to the conclusion — the ER personnel do not appear as concerned as me — they must have seen this before — they must know that she is not going to die. And sure enough — I am okay.

    I think that the difficulty in comparing how ER departments deal with patients entering with physical versus mental illness is that the level of concern in physical illness is directly correlated with the level of life-death situation. In mental illness — that is also a concern but not as immediate of a concern as the physical situation that could present.

    In the example you gave of your children — the child with the fever of 105 without swift treatment could have serious morbidity or it could be fatal, therefore the highly concerned medical profession. ER is a place to deal with saving people’s lives. Mental illness also has serious morbidity associated with it and also could be fatal but the difference is that a quick thinking intervention does not make a huge difference (pardon my bluntness). The road to recovery or stability with mental illness is one that is slow and has its ups and downs. Yes there are crisis that cause ER visits to become necessary (I speak from experience with my own daughter — I am there with you) but the goal in ER is to provide immediate safety and maybe link to resources… not to save a life in that moment — which is the difference I would argue.

    I do not mean to be argumentative but I think it is unfair to use ER as the measure in which how we as a society treat mental illness/trauma differently than physical illness/trauma. It to me would be the same as saying a society treats women better than men if we compare how a Labour and Delivery unit treats a man who knocks on their door in pain versus a pregnant women.

    Yes we as a society need to treat those who suffer from mental illness and their families with more dignity and respect — absolutely — you do not have argument from me there. We need more services, we need more compassion, we need more concern. No argument from me on this at all.

    Reply
  2. Ann
    January 20, 2017

    How would you have liked your child with trauma treated? What tests would you have liked performed? Did you want scans? Medications? Do you want Social Services deciding “treatments” for your child? What if the Social Service worker is a good person, but has core religious beliefs different from your own? These questions seem insensitive, but I mean them sincerely. I am a medical professional and do not work in the Emergency Department, but on a floor where young adults would be admitted. We are a med-surg floor, as our hospital does not have a dedicated psych unit. I, too, feel that we vastly underserve these children/young adults. However, the reality is that there is no one at our facility (and we are not a small rural hospital, we are a Magnet Hospital with a Trauma 3 rating) qualified to treat or prescribe medications for this population without potentially causing more trauma. Most times, the parents are far more “expert,” and far, far more educated, at caring for children from hard places. Ideally, it would be good if our hospital could staff someone with education in parenting from trauma. However, we see approximately four falls/fractures per night in our ED and perhaps one mental health/trauma admit per week. In this day and age of value/benefits/profit, no hospital can support staff unless they are financially able to do so. I see the problem clearly. Unfortunately, I do not see the solution.

    Reply
    1. Elizabeth
      January 20, 2017

      Ann —

      It’s a valid question, and truthfully, I don’t even really have an answer, because I don’t know. I don’t really know what I truly wanted in that situation. I do know we were scared. Scared about what the future held for our family and more immediately what this ER visit was going to do in terms of social services. The sad thing is, for the majority of people, social service intervention does not feel helpful or safe. Whether that is an accurate estimation or not, it’s hard to shake that feeling. I do know we called 911 that day because it felt as though it was our only choice in the situation.

      I think that is one of the problems with trying to get our children who dealing with past hurts help. There isn’t a good system in place to act as a support. I agree completely that the ED of a hospital is probably not really appropriate, but that is where the ambulance dumps you on a call such as ours. There was no physical injury, but there were other types of hurt and pain. Truthfully, by the time all the emergency workers arrived, it was enough to shake him out of the bad place he was in. Ideally, not transporting him to the hospital at all, I guess, would have been my preferred choice, but we lost that option when we picked up the phone. I still maintain the guard by the bed of the obviously calm 9yo was not needed, but I also know there are rules to follow.

      I wanted answers. I wanted someone to tell me it was all going to be OK. I wanted someone to have some sort of advice as to how we could avoid doing this another time. Heck, I wanted someone to tell me there would never be another time. I wanted someone to tell me it wasn’t my fault. I wanted someone to tell me that the parenting job I was doing wasn’t horrible. I wanted to lose the sense of shame I felt that we were in the ER for my son’s behavior. I wanted someone to be able to push a rewind button so that we could do things differently and maybe avoid this outcome. None of that could happen.

      My fantasy… some sort of calming center where cases such as ours can be brought. A place where there are a wide variety of therapeutic bells and whistles that can be used to help the distressed child regulate. The staff would be well-trained in trauma and other things of the mind and offer real, helpful advice and support to parents experiencing shock and grief. The parents would not be blamed, but instead supported and encouraged to keep on with the hard work of helping their children heal. And maybe even handed a cup of tea.

      A girl can dream…

      Reply
      1. Emily
        January 22, 2017

        I like your vision.

        As an RN in ICU, I know our medical treatment of mental health crises (including addiction behaviors) can be very inconsistent, very dependent on who is diagnosing and treating. I’ve had patients in locked 4 way restraints from the ER when a little Ativan would have gone a long ways. I’ve seen patients get intubated from getting too much Ativan. And calming? Regulating? Supporting? Maybe – maybe – a dedicated peds hospital would have child life on hand who knows something about calming kids.

        Until we can decrease stigma around mental health and increase availability of trained professionals (not to mention quality of those trained professionals), we’re a long way from any kind of adequate emergency services, especially in smaller communities.

        Reply
  3. Alice
    January 23, 2017

    Thank you for sharing your experiences. I really connected with what you were sharing. My daughter was injured in an auto accident seven years ago. Her freshmen year of college. Taken to a major trauma center and has had twenty-six surgeries. She is always given amazing care by her surgeon at the trauma center. He seems to be blessed with amazing emotional skills in addition to surgical skills.

    My daughter is not an easy patient. She also has a seizure disorder. Her medication affects her personality and she developed an addiction to her pain medications. What I learned early on even the first day of the accident was that her medical team was not going to include good social work care. We her family had to provide everything. A social worker placing a trauma pamphlet down on a sleeping patients night table was woefully inadequate. It has been seven years since the accident and she is still recovering from the trauma of it. However, amazing our surgeon is his job is to operate and the hospital did not have the resources in place to provide strong social work care.

    In between reconstruction surgeries and bedrest she has had some serious behavior and emotional issues that resulted in treatment at our local county hospital. I have had the county hospital send her out of the hospital with blood streaming down her forehead after a seizure because she is an adult. During psych. assessments her care was similar to the gurney in the hallway assessment that you described. She is always released within a few hours. She’s not always aware cognitively after a seizure. If she is released from a hospital before we get there we’ve had to drive around looking for her. This is after the county er doctor has determined she can refuse treatment for her seizures. We usually end up taking her to our local urgent care facility where she get’s better treatment than the er.

    Our county hospital has limited beds and limited resources and the help just isn’t out there. We have provided all of the therapy she needs privately at great cost to us. I’ve learned to provide my own cup of warm tea which I am drinking now but I agree with you some comfort for the parents would be wonderful.

    Another emergency room visit in our family happened when my husband had a stroke eight months ago. I previously had thought that the county hospital was just horrible with mental health care and addiction care but the doctor misdiagnosed my husband’s stroke. I called in family in the medical field who helped get my husband transferred to a major hospital center. The emergency room doctor at the county hospital told me he didn’t agree with me. Turns out I was right. Some county hospital’s are just poorly equipped to deal with many situations. However, the lack of mental health care in our country is disgraceful. I don’t see it improving any time soon.

    Reply

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