This wasn’t my patient, because if it was my patient I would have spent the whole shift looking for people videotaping me to catch the looks on my face and the phrases coming out of my mouth.
A pediatric patient is brought in by ambulance for evaluation of suicidal and homicidal ideations. Great.
The kid is already seeing a psychiatrist and is taking Strattera and Clonidine. Fine. I have issues with kids being started on psych meds, but what do I know? I’m just a dumb emergency physician.
The social worker met the ambulance at the hospital and called the children’s psych facility immediately upon her arrival. She kept saying “He’s gotta go. This is it. This time he’s really gotta go.”
The parents had the patient brought in by ambulance and wanted him transferred to the children’s psych facility by ambulance because they didn’t know if they could control him in the car.
Did I mention that the child was THREE YEARS OLD?
The parents and social worker became concerned when he bit his sister on the leg and punched her a couple of times.
In the ED, he was drinking his bottle, then intermittently holding the bottle between his teeth while climbing on and off the bed.
One of the nurses called me at home to tell me about the patient. I had to talk to the other nurse, the secretary, and the EMT that was there to do the transport just to confirm that they weren’t BS’ing me. I still have my doubts.
The kid can’t even put together a sentence and the parents and social worker are saying he has suicidal ideations.
Maybe it’s me. Maybe he’s half Tasmanian Devil and can kick his parents’ collective asses with nary more than the sharp edges of the buckles from his car seat. Maybe was told that he’s got multidrug resistant peptostreptococcus on the six teeth that have managed to rupture through his gums and, with that knowledge, told his sister in baby language “Now you DIE!” before he bit her. Right after that he told his parents in some variant of non-Mandarin Chinese baby talk that his Similac was really insecticide and that he was going to drink it so he could die of a cholinergic toxidrome. The parents must have called the AT&T Language Line to confirm before calling the social worker and 911, but by that time the child was faking as if he couldn’t really speak. Oh yeah, and to finish the plan, after he would drink the hidden insecticide but before he vomited, salivated, urinated, and defecated all over himself, he ga-ga goo-gooed his intent to beat the family chihuahua to death with his sister’s Hannah Montana microphone.
Back when I was a kid, punishment for hitting your sibling used to be a butt-whoopin from your parents. If you got in trouble at school, it was nothing compared to the trouble you got in when you got home. These days, school teachers are afraid to discipline kids because of lawsuits. Now proper punishment when kids get home is a time out – maybe some dish soap or Tabasco sauce in the mouth for biting or swearing.
Apparently now the paradigm is changing yet again. Soon we’ll be seeing papers on how the most effective form of punishment is a three day stint in the children’s psych ward. BYOD – bring your own diapers. Maybe they’ll start him on some kiddie Haldol just for good measure.
That’ll teach ’em.
Because I have already received several comments questioning my abilities as a physician because of my incorrect assertions of developmental milestones in a three year old, let me clarify that the paragraph starting “Maybe it’s me …” was intended as hyperbole.
I am fully aware of the developmental milestones of a three year old. I witness them in my three year old child every day. I have yet to witness a three year old with sufficient abstract thought to grasp the notion of death, much less the notion of killing oneself. The fact that we imbue these qualities on children that I believe are incapable of having these qualities was the point of this post.
If children need inpatient psychiatric care for biting and hitting their siblings, then our society is in worse shape than I thought … and I need to find inpatient psych beds for all of my children.