Wednesday, January 6, 2010
The question that I pose to all of you is.... Can you really tell the difference between child abuse and a genetic disease? Do we that work in the ED think outside of the box when we see injuries that could be caused from abuse? Do we just become cynical and assume all suspicious injuries that we see are related to child abuse?
This might not be an entertaining or funny post, but after the news I received today, I believe that it is worth a mention.
Case: 9 year old male covered head to toe in bruises, sclera on left eye was red, shoulder dislocated.
mother reports that child just bruises easy, that child was swinging on monkey gym and fell screaming that his arm hurt.
Both mother and child wore what appeared to be older hand me down clothes. Mother might have completed 5th grade, but very doubtful that she went any higher. The child did not have any medical insurance, not even medicaid. When reviewing the chart, the child had been to our ED many times for dislocations, bloody noses, rectal bleeding, and sprains. This child had scars that looked like he had never had medical treatment, so some of his wounds turned to scars were wide and gaping.
So what would you think???? Looks like abuse, sounds like abuse, it is abuse... right????
Lucky, I work with some great doctors!!! The resident was assuming abuse and had the police on line. One of our ED doctors told him to hold on. Dr. Great came to me and asked about what I experienced with EDS as a child, and what type of injuries that my younger son had encountered. You see,Dr. Great thought there was something off about the abuse allegation because of the mother and son interaction. No, this doctor is not familiar with the disease process of EDS, but he had thought that it sounded some what similar to the injuries that my son and I suffer from.... So he asked, then he looked up the disease.
Some of the common injuries that come with Ehlers-Danlos syndrome (EDS), include dislocations, easy bruising, vessels in eyes are very fragile, the lining of the intestines can easily tear, which leads to rectal bleeding. Minor injuries heal poorly and leave wide gaping scars.
So, after the doctor found all of this out, he came up to me with a very odd request... Can I pull your skin, he asked. At first, my response was pardon me? He then proceeded to tell me what he was thinking and prior to him going into the room he wanted to see and feel how the skin reacted when pulled. Those with certain variants of EDS have very elastic skin. Anyway, long story longer.... Doctor Dx the child with EDS and sent him to a specialist for a biopsy to confirm the genetic disease. Today Dr. Great called me and told me that the child that everyone thought was abused indeed had EDS that was confirmed by the test. Social services have been set up to help this mother find the resources to help this child.
So what is my point???
1. Look at the whole story prior to calling it abuse.
2. Most cases are abuse, but for that 1 in 1,000, 1 in 10,000, or even 1 in 100,000 it is a disease.
3. If you do not understand or know something, go look it up or ask, no matter if that person is lower on the totem pole than you. Everyone knows a little something that another does not.
Ok, Done with my rant