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The Art of Medicine

A child and 16 tiny sutures

Godfrey, Alexandra MMS, PA-C

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Journal of the American Academy of Physician Assistants: November 2016 - Volume 29 - Issue 11 - p 60
doi: 10.1097/01.JAA.0000502875.76126.e5
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The child was already waiting when I arrived for my morning shift in the ED. The nurses had kept her for me, shooing other providers away. The child, they said, needed someone like me to care for her; someone gentle, someone experienced, someone female. Mostly someone female.

The complaint in her chart was “sexual assault.” The girl was 8 years old. She had injuries.

The nurses were bristling, and the security guard kept reaching for his gun.

They felt upset. Angry.

In her room, I found her parents. The mother still in pink fleece pajama pants with a Snoopy print; her blue T-shirt whitened in places by toothpaste, probably from the night before. The night before. The father sat silently. His body was motionless; taut like a cat ready to pounce on its prey. I couldn't read his expression. His eyes reminded me of small black stars; distant and indeterminate.

The child was sitting up in bed covered up by a single white sheet. Her copper hair spilled in waves down her back. Her green eyes were rimmed with shadows. I thought, she is still so young. She is 8. Eight; an age when the riskiest venture should be passing notes folded into triangles in class. An age when the character on your lunch box matters. An age when the dangerous boys are those who trip you in the playground.

I looked at her vitals: heart rate, 87; respirations, 16; BP, 100/60 mm Hg.

I pulled up a stool and sat close to the edge of the bed. I started with “hello.” It seemed the simplest beginning.

“I am Alexandra,” I said. “I am here to help you. Can we talk?”

She glanced at her mom who nodded, then back at me, and said, “Yes.”

I asked her if she wanted both her parents in the room. I saw them again nod at her; her choice.

“Yes,” I said. “It is your decision; you make the choices.”

She asked for her daddy to leave. He nodded, got up, and left without a murmur. The days of shared ice-cream cones, blowing bubbles in the bathwater, and turning cartwheels in the sun stolen. A foundation of love, trust, and comfort threatened.

I asked her what happened.

She told me she had been sleeping on the couch at her aunt's house when her uncle came downstairs. She had been watching Frozen but had fallen asleep during the movie. Fallen asleep over chocolate milk and Goldfish crackers, and drifted off to visions of snowmen.

Her uncle stole her there in a lonely room on the couch. He kissed her, and touched her, and broke her.

I felt upset. Angry.

I needed to examine her. I spoke with the sexual assault nurse examiner (SANE) nurse. I wanted to be certain. Medicine first, evidence next, she said.

Her mom held her hand as I blocked the pain from her injuries, cleaned, and sutured. I was worried I would do harm. The uncle had confessed and was in custody already. Still, I imagined the evidence washed away, the uncle recanting, my being responsible for this child not receiving justice.

Justice?

I wondered where the father had gone and if he had a gun.

I thought about the uncle in custody: what drove him to this? I considered his life story. Had there been others? Why did he confess? Would he live with regret?

I placed 16 tiny sutures. We talked as I made the throws and picked up the threads. She told me she loved sweatpants, Cheerwine, and cookies with sprinkles and creamy frosting. I told her I love the smell of new cars, gel pens, and notebooks. She said she was addicted to Sour Patch Kids and loved the first snows of winter. I watched her wrinkle her forehead and sigh. I thought maybe she doesn't want to build a snowman. Maybe the first snows of winter will bring harsh memories.

I gave her acetaminophen and an icepack. I handed her mother instructions about wound care. Her mom then wrapped her in her Tinkerbell blanket and carried her out. The SANE nurse was expecting her. I wished she didn't have to go through any more. I knew she would, even when the evidence was collected and the medications given. Even when the case had been tried and the final document sealed. She would go through more as she remembered.

I felt upset. Angry.

Copyright © 2016 American Academy of Physician Assistants