When you work as an emergency physician in an urban setting, you find that certain neighborhoods tend to generate disproportionately high numbers of emergency department patients. In those neighborhoods, drugs fuel the economy, people are known by their street names rather than their real names, and street cred is much more valuable than bank cred. The East Village was one of those neighborhoods.
Growing up was tough in the East Village. Violent crime was a way of life and there was a steady stream of “Village People” (as they called themselves) who frequented the emergency department. Some were active members of the “Knife and Gun Club.” Others were victims of domestic abuse. Unfortunately, it wasn’t unusual to see Village kids brought in for injuries inflicted by adults. We saw several shaken baby cases. One kid came in with seizures from accidental meth ingestion. I never thought about doing drug screens on kids until EMTs told me about all the coffee tables covered with drug paraphernalia they saw during their ambulance runs. Those odd-looking circular scars on the kids arms and foreheads weren’t from scratching bug bites, they were from someone putting out a cigarette on their skin. Waiting room cameras even caught parents slapping their kids around. Calling Child Protective Services and the police in a crowded waiting room makes for an interesting few hours.
Social service workers at the hospital knew the history and family trees of many Village parents on sight. Village parents, in turn, knew which social workers they could and could not manipulate. Many Village parents had older children removed from their home only to give birth to more children and have those children taken away as well. The emergency department performed so many “well child checks” when State agencies took custody of potentially abused children that we kept a chart template in the computer to make completing the paperwork less time consuming. Many people tend to look at the kids from Village with pity and look at parents from the Village with contempt.
The next patient to be seen was a little girl with a hand laceration. As I walked into the room, the nurse nudged me and mentioned that she was a Village Peep. It was a busy night already and the nurse’s comment made me hope that we wouldn’t have to make a call to Child Protective Services. The patient was a cute little 5 year old girl. Pony tail, dimples, polite, deep blue eyes. A bloody gauze pad covered her hand. The patient’s mom was weathered. She was in her thirties but already had dentures. Her jacket and her clothing had matching holes. A plastic shopping bag with some magazines, a few cans of soda, an open bag of chips and a pair of wired earbud headphones were sitting on the chair next to them.
“How did you hurt your hand?” I asked the young patient.
“I cut it with scissors.”
The mother explained that she told her daughter not use scissors to open a bag of cookies, but she did so anyway. While cutting open the bag, the scissors went through the bag and cut into the web space between the patient’s thumb and index finger. I thought about the mechanism of injury for a second. Scissors in one hand, holding a bag with other hand, cut to web space. OK. Makes sense.
I then described how I was going to fix her laceration.
“I’m going to put some medicine into your hand to make it stop hurting. The medicine burns a little but once the burning is gone, you won’t feel anything. After that, we’ll wash it out with soap and water to get rid of all the germs. Then I’ll fix it up.”
The little girl looked to her mother and her eyes began to tear up.
The patient whimpered, but she held completely still while I injected lidocaine into her hand. Her mom leaned over, gently cupped her head, and wiped away her tears.
After the wound was cleaned, I prepared to stitch it up. The patient was still a little hesitant because the lidocaine injection had hurt. Despite me showing her how the area was numb, she cried and didn’t want me to touch her hand.
Then mom came up with an idea. She ruffled through her shopping bag and pulled out an old iPod. She plugged the ear buds into the iPod, put one ear bud in the patient’s ear and one in her own ear, then started playing a song.
“Do you know what this song is?” mom asked.
The patient smiled. It’s my ‘I love you’ song.”
While I sewed up the patient’s hand, I watched the mom caress her daughter’s face and as they softly sang the words of the “I love you” song back and forth to each other.
I finished the last suture about 15 seconds before the song ended. The little girl had hardly moved at all. When the song finished, she used her uninjured arm to hug her mom around the neck and tell her one more time “I love you, mommy.”
As I wrapped up the little girl’s hand, I thought how difficult it can sometimes be not to form premature impressions about people.
And as the young patient blew me a kiss with her bandaged hand while being carried out the door by her mother, I thought how desperately the East Village needs a few more moms like this one.
For more patient stories, visit the Creative Writing section of this blog.