Query

doi:10.1503/cmaj.1031971

My daughter slid down the stairs last week in a cardboard box. She'd been using it as a sailboat, sitting inside and propelling herself across the hardwood floor with her hands. My wife and I thought the activity cute — until we heard the scream. And there she was, crying at the bottom of the stairwell, her right arm at an unnatural angle.

Figure. Photo by: Anson Liaw

We put her arm in a makeshift sling and took her to Emergency. We were seen first by an intern, who carefully examined the arm and checked for a pulse. He tried to move the elbow through its range of motion as my daughter, apprehensive, began to cry. I was about to intervene, to snap, The bone's broken, she needs a film done, what's torturing her going to tell you? when he stopped. Once he asked, I told him what had happened. He agreed an x-ray was necessary.

On our way to Radiology my daughter pleaded for no needle, no needle! — a slogan she'd picked up from an older child in the waiting room. She continued to moan about needles as I removed the sling and sat her on the x-ray table. I figured it would be relatively painless, compared with the actual bone-breaking and the physical exam — which wouldn't be the last, I thought. I began to resent the medicine's apprenticeship system, which would require trainees to serially manipulate my daughter's limb for educational benefit. By my reckoning, the emergency staff physician would have to examine the arm regardless of what the x-ray showed. And, if a significant fracture was present, the orthopedics resident would first look at the arm before staff took their turn.

But I recall an earlier kind of resentment. I remember being a student and dealing with parents who demanded immediate tests for their children no matter what the supervising doctor thought. I remember parents who assumed incompetence in the Emergency staff and requested consultation while still in triage. I remember loathing those who wanted to limit the number of times their child served as guinea pig for student physicians like me.

I knew better, yet I met every criterion on this bad-parent checklist after just ten minutes in Emergency.

The technicians soothed my daughter. One handed me a lead apron and asked me to hold her as the pictures were taken. They mentioned that the last picture would require full extension of my daughter's arm. Remembering her pain at the earlier attempt, I asked: Aren't you going to do it?

No, we get Mom or Dad to. Kids like it better when a parent does it.

After the first two pictures I gradually straightened the arm and my daughter forgot all about needles. She looked up at my face and half-gasped, half-shrieked my name, begging me to stop hurting her. I felt the crunch of bone against bone; I couldn't look at her, knowing that this was the worst pain she had felt in her young life and that I was causing it.

The technicians took the picture. I lowered my daughter's arm. My wife picked her up and started to comfort her.

If it hadn't been the policy for parents to do the dirty work, I'd have harassed the technicians for doing their job. I'd have been one of those unreasonable parents I used to criticize.

I like to think I'll be more gentle and forgiving now when I work with families. My daughter enjoys her long-arm cast and allows me to colour it with markers. — Dr. Ursus