Any day you almost call DCFS is not a good day

I think that ranks up there with one of the most difficult discussions I’ve ever had to have in the ER. To say that emotions were raw would be an understatement.

The triage nurse rushed a young girl about 2 years old into the peds ER with her mom right behind them. The child was a little lethargic and drowsy but looked like she was starting to come around. The story from mom is that she went to take a nap and left her daughter in front of the TV after putting on Dora.

When she woke up she found 2 of her new bottles of pills (an anti-depressant and an anti-anxiety medication) open and spilled on the bathroom floor. Initially she told us that they were brand new bottles and she hadn’t taken any yet. She claimed her daughter only took one of each. We called Poison Control and talked to the toxicologists and put mom on the phone with the tox folks and then had her talk to our PharmD as well.

In the interim, the step dad showed up and introduces himself as Dr. So&So. We talk with him to see if he can add much to the story, but he wasn’t home at the time. During all of this the child continues to look better, but after talking with Poison Control and our PharmD the mom changes her story and says she’s not sure how many pills were in the bottle because she did take some and never really counted to see how many were left.

After discussing things at length with the toxicologists from Poison Control and getting initial blood work, we go to talk to the family and let them know that we need to admit the child for observation in the PICU (Pediatric Intensive Care Unit) step-down section. The mom argues that she doesn’t want her to be admitted, that her daughter is back to her normal self and they’re going to take her home. Incredibly, the father Dr. So&So agrees with her. Turns out Dr. isn’t an MD but a PhD in psychology.  He tries to argue that they can bring the child home and he can watch her because he’s a doctor, and if there are any problems they’ll bring her back.

We explain to them that this idea was not safe in the least and that their daughter ingested some very dangerous medications. Even though she’s looking well now at this point, the two medications have different pharmacokinetics (meaning they reach peak activity at different times) and she could quickly become drowsy again, possibly worse than before.

Unfortunately, it went to shit when one of the other residents stepped in to try and help convince them and something she said set the mom off. She never mentioned DCFS specifically or said “we’ll have to take your daughter away”. From what I can recall, she said something to the effect that “We need to admit your child, with or without your consent.” The (pretend) Dr. Dad says “Well, we’ll just sign out AMA (against medical advice)” which is something you can normally do unless it’s thought that your actions are going to harm another person.

The mom flipped out at this point and started screaming at the top of her lungs at everyone. She flipped off the other resident and told her that if she ever had to see her face again she would sue the hospital and then yelled over and over “GET OUT OF OUR ROOM, GET OUT OF OUR ROOM”. She then tried to convince us that she was a wonderful mother who was with her daughter “24 hours a day, 7 days a week.” Except when she’s taking a nap and her daughter is getting into her pills.

Thankfully the attending and I were able to get the situation under control and we were able to convince the family why it was important for us to just keep her overnight so we could make sure she’d be okay. We assured them they’d be able to stay with her and that no one wanted to call DCFS as this clearly wasn’t intentional and wasn’t part of a pattern of any abuse that we could see. Things went okay after that, we just kept the other resident away from the family and rushed to get them a bed in PICU step-down.

This wasn’t my first interaction with a potential DCFS scenario. I’ve had a couple others but in one, one of the parents was clearly abusing the child and in the other, another healthcare facility had called DCFS due to a misunderstanding about a child’s ongoing chronic illness that caused her to be emaciated.

But I’ve never seen so many of my colleagues actively shaken and disturbed. We’ve all dealt with angry families and volatile patients who have attempted to harm our staff. But this wasn’t different. It was a more emotional and psychological trauma… maybe more so than a death of a loved one. I imagine the death of a young child might affect a family in the same way, but I thankfully haven’t experienced that yet.

I just wanted to give some thanks to any DCFS or social workers out there. I have no idea how you get up everyday and do you job. I couldn’t do it, but I’m glad you can.