My Asthma Education
By Ashley Lucke, MD, District VII Assistant Coordinator
(Reprinted with permission from Resident Report, American Academy of Pediatrics, Fall 2012, Vol. 22, No. 2)
Purple whale pajama pants sit crisscross applesauce on the bed while I ask the girl’s mom when she was first diagnosed with asthma. She’s 4 years old. It’s a run-of-the-mill asthma admission; the seventh today, though it feels like the 107th. A little touch of upper respiratory discomfort, then wheezing, and now here we are together in room 216.
I continue to take the history, asking about medications, allergies, family history, birth history, surgeries, vaccines—you know the drill. Then a complete physical examination, her bright green eyes watching every move I make. She’s stable, already spaced to every-2-hour albuterol treatments.
Mom seems overly worried, but I can’t figure out why, considering she’s had multiple previous asthma exacerbations. We’re wrapping up when I tell mom that asthma education for parents is at 8:00 am tomorrow. Her facial expression changes and then her eyes well up with tears that she tries to blink away. Suddenly it’s as if the entire room went into bronchospasm and the air is tight. I ask and she says, “Something happened,” then suddenly she can’t hold it in any longer. I step toward her and wonder how long has she been holding this in, whatever it is? She’s apologizing over and over and whispers, “I can’t go to asthma class because I have to go to court.” One week prior there was an argument at home and dad pulled out a gun. He pressed it against her face, threatening to kill her. He turned the barrel to the side away from her and shot it, rupturing her tympanic membrane.
I try to blink away my tears while we hug. She looks at her daughter and shamefully mumbles, “She watched the whole thing happen.” The little girl’s big green eyes are watching us closely. She’s quiet and still; I gather this isn’t the first time she’s seen her mother hurting. “Mommy’s OK, she’s just crying because she loves you sooo much,” her mom says. Then looks at me and asks, “Did I do this to her? I’ve been told if kids with asthma get very upset, they get sick. This is my fault.” Her voice cracks and my heart breaks.
Social work was called and child protective services opened a case. The father is now incarcerated and mom has found a shelter for victims of domestic violence. I can’t help but feel lucky that this mother was brave enough to say something to me. So many victims of domestic violence live in silence. I think about how many other asthmatics I’ve admitted today, this week, this year—and can’t remember the last time I asked one of them about domestic violence. Unless there are bruises or suspicious chief complaints, the questions are not asked. On that day, I made a commitment to screen every child for domestic violence regardless of the chief complaint.
As physicians, we have a distinct opportunity and responsibility to take care of the entire patient. This encounter was a dark reminder of how important it is to do just that.
Ashley Lucke, MD, is a second-year resident in pediatrics at the Children’s Medical Center, University of Texas Southwestern Medical Center in Dallas. Write to her at email@example.com.