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Partnering with a parent

Maurer, Brian T. PA-C

Journal of the American Academy of PAs: August 2019 - Volume 32 - Issue 8 - p 58
doi: 10.1097/01.JAA.0000569812.31411.de
The Art of Medicine
Free

Brian T. Maurer has practiced general pediatrics for more than 30 years. He is the author of Patients Are a Virtue and blogs at http://briantmaurer.wordpress.com. The author has disclosed no potential conflicts of interest, financial or otherwise.

Tanya Gregory, PhD, department editor

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“You're all set in Room 9,” the nurse informs me. “It's a follow up MVA. They were in the ED last night. Make sure you read the last couple of lines on the final page of the report.”

I glance at the chart, review the ED encounter document, and step into the examination room.

Immediately, I recognize the parents. I've met them before. Their infant daughter is now 4 months old. The father stands in the middle of the room next to the examination table with the child in his arms. The mother is seated in one of the chairs by the far wall. Brief smiles fade from their faces as the conversation moves quickly to the reason for the visit.

“I see that you were in the emergency room last night,” I say. “Motor vehicle accident? What happened?”

The woman clears her throat; the man holds the child close, tucks the little girl's head under his chin and stares at the floor.

“I was coming home from my girlfriend's place,” the mother says. “It was early afternoon. There was one of those landscape trailers parked by the curb up ahead. The back ramp was still down. I guess I misjudged it,” she sighed. “Before I knew what was happening, the wheels on the passenger side of my car rolled right up the ramp, and the whole car flipped over on its side.”

“My goodness! Was the baby buckled in to her car seat? Where was she riding?”

“In the middle of the back seat. She was buckled in tight. Someone called the fire department. The landscapers helped pull the door open to get the baby out. The police came. They took the baby to the hospital in an ambulance.”

“So it was just you and the baby in the car?”

The mother nods her head.

“When were you notified?” I asked the father.

“I got a call from the hospital,” he said. “I left work right away.”

“And you, Mom? Did you ride with your daughter in the ambulance?”

She shakes her head. “No, I stayed behind—to talk to the police.”

“I take it that the baby was okay?” I ask the father.

“Yeah, the doctor said she checked out fine; although she cried bloody murder as we were leaving when I put her down to get my coat.”

I ask how the baby slept overnight. “Has she been eating? Any vomiting? Giving you wet diapers? Last bowel movement?”

The child appears comfortable in the father's arms. My examination produces no new findings. Physically, the baby appears well.

“And the vehicle?”

“Totaled,” the mother says.

“Well, a vehicle can be replaced,” I say. “It's a lot harder to replace a mother, and impossible to replace a baby.”

The mother's eyes begin to water. She opens her mouth as if to say something, but the words don't come.

“How are you doing?” I ask her.

“Okay,” she sobs.

I glance down at the chart and take a deep breath. “I notice that the record indicates that the police detected alcohol on your breath,” I say.

The mother nods her head. “I was over at my girlfriend's place. It was a nice day. We were sitting in the back yard. I just had one drink—that was it—just one drink.”

“I see,” I say. “Have you ever thought that you might have a problem with alcohol?”

The mother shrugs her shoulders. “I know I use it to soothe myself when I get upset.”

“And how often is that?”

“Pretty often,” she says. “Nearly every day. It was a hard pregnancy. I had some postpartum blues. My obstetrician put me on some medicine, but it didn't help much.”

“Has anyone suggested that you see a counselor?”

She nods her head. “Our insurance plan is out of state. There aren't any in-network counselors in our area. I'd have to drive quite a ways to see somebody, and now I haven't got a car....” Her voice trails off.

I wait in silence. She has no further words. The father continues to cuddle his daughter and looks at the floor.

“I'm sure you can get the help you need,” I say. “You just have to make the decision to take the next step. Your husband is here to help. Your daughter needs a sober mother.”

Slowly, the mother nods her head. The father takes a step toward her, then hesitates, still holding the child closely to his chest.

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