Each semester I ask students to share about a patient situation that impacted them emotionally that semester. Typically this is a situation that, for whatever reason, resonated with them in a way that has been difficult to let go of. This past semester, the following story was shared: “I was in the neonatal intensive care unit (NICU) for a clinical shadowing experience. A young father entered the unit, looking disheveled and reeking of cigarettes. The nurse lifted his premature newborn daughter out of the incubator to let the father hold her. The nurse asked the man if he wanted to change the child’s diaper and he said yes. He proceeded to remove the dirty diaper and carelessly place it right near the small child’s head. It was as if he didn’t even care about her. I just wanted to scream, what’s wrong with you??”
When I asked the student what feelings came up for her she began to cry and said, “I was so angry and afraid. How could someone treat a child so unlovingly? How can we let this child go home with this man? I just wanted to sweep the baby into my arms and run.”
This student’s experience reminded me of a similar situation in which I was caring for an elderly bed-bound woman who was living with her adult daughter and the daughter’s two small children, a four year old boy and a three year old girl. As I was assessing the patient in the bedroom, I could hear the mother scream at the little boy and say, “Santa’s bringing you nothing this year!” I then heard the boy whimper to which she yelled, “stop your stupid crying” and I heard a loud ‘crack,’ as if she slapped the child. I became paralyzed with fear and filled with rage and I just kept thinking, “I need to save this child.” *
The lesson I learned from that experience came 20 years later. I was watching the local news when a story appeared about a 24 year old man who was arrested for armed robbery. The name sounded familiar. I cannot be sure, but I believe this young man was that same child I had met all those years ago. I immediately thought, “of course he ended up in trouble with the law, he had no love as a child.”
Every human being has a story and none of those stories begin with the person being some kind of monster. Though I had only spent a matter of minutes with that boy many years ago, I witnessed a glimpse into his story and I understood that he suffered great trauma. Though it is never ok to excuse inappropriate, illegal or abusive behavior, it is important to try and understand the why behind it.
I asked my student what feelings she had toward the infant in her clinical experience. She stated, “I felt love and compassion for that little girl.” To which I responded, “please remember that, when she shows up 20 years from now, disheveled, and smelling of cigarettes, asking to hold her own newborn baby.”
One of the most important shifts we can make as health care professionals, and as human beings, is to move from asking, “what’s wrong with you?” to the deeper question, “what happened to you?” Though we should not accept inappropriate behavior, we would all benefit to seek to more deeply understand each other by learning about our stories.**
*If you are ever in a situation where you suspect abuse, speak out. Please refer to your state’s child welfare policies for further guidance: child welfare.
**For further information regarding how adverse childhood experiences impact health, please refer to the Centers for Disease Control and Kaiser-Permanente Health Care’s landmark study commonly known as the ACE study (Felitti, Anda, Nordenberg, Williamson, Spitz, Edwards, Koss, & Marks, 1998).
This study paved the way for a new approach to caring for and relating to others, known as trauma-informed care. Trauma-informed care challenges us to move from asking, “what’s wrong with you?” to the deeper question, “what happened to you?” (National Council for Behavioral Health, 2019). That shift moves us from a place of judgment to a place of compassion.
Felitti, V.J., Anda, Nordenberg, D., Williamson, D.F., Spitz, A.M., Edwards, E., Koss, M.P., & Marks, J.S. (1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. American Journal of Preventative Medicine 14(4), 245- 258.
National Council for Behavioral Health (2019). Trauma Informed Services. Retrieved from, https://www.thenationalcouncil.org/consulting-services/trauma-informed-services/