We've all met this type of mom before. It's 2330, her 8 year old daughter is struggling to breathe, and you know for a fact you saw them two weeks ago for the same thing. You also know for a fact you gave her a prescription for an inhaler, a follow-up appointment with a pediatrician for asthma, and got the information for applying for state aid for medical assistance. Yet, there they are, the child anxious and pale, the mother unable to make eye-contact and answering in quiet, short statements.
A little eye-rolling as you walk into the room helps you keep your tongue civil during the H&P. Definitely an asthma attack, the kind you had educated this mom about avoiding and preventing two weeks ago. You sigh in frustration (and a wee bit of anger) without realizing it, but the mother does. She shrinks a little more in the chair, stares at the floor at little harder, and tightens her hand around her daughter's hand. Her behavior sets your teeth on edge, and you hurry out of the room so you don't say anything you think will get yourself in trouble later.
As you head down the hall to let the on-call know that FF#3 is waiting for a neb, you shake your head that just about anyone can have kids nowadays, and wonder at that mom's gall to come in and be so diffident when it is clearly her fault that child is having another attack. You make sure to share your opinion with the nurses at the station. Venting helps.
Meanwhile in that room, a very anxious mother, who is struggling with an Atlas-sized load of guilt, tries to sooth her anxious child while they both wait uncomfortably for the doctor. Mom knows what you think of her. You aren't as unbiased and neutral as you thought. She can't tell you why they are here on a cold snowy night, at least not straight out, and you didn't ask.
She can't tell you that her husband has threatened to kill her and the daughter on numerous occasions if she ever thought about leaving him.
She can't tell you that he broke two ribs and tore out a chunk of her hair the size of a golf-ball when she tried saving up money for the daughter's birthday presents. He needed that money, there was beer to be bought.
She can't tell you that he disabled her car four times in the past two weeks while he was out drinking, and one of those times fell squarely on the day of the child's appointment.
She can't tell you that he routinely takes all of the money out of her purse, and she can barely feed her daughter, let alone get medication for her.
She can't tell you that he's a twice convicted felon, and because he won't leave, and won't let her leave, she can't get federal or state aid, because one of those felonies involved drugs.
She can't tell you these things, because he's out in the car, partially drunk, with a gun hidden under the seat, and if she takes what he thinks is too long, this might be the night he uses it.
So she hides. She does what she can, and tries to keep her daughter and herself alive. She takes all of your judgement and frustration and internalizes it, reinforces her belief that she is a horrible person, a horrible mother, and deserves every little bit of scorn and distaste heaped upon her. She knows all this, and yet she brought the daughter to the ER anyways, knowing that you will still care for the daughter, even if you hate the mother. She trusts in your care, your skill, and your oath to care for the ill. She pays you in nickles, dimes, and her self-esteem.
She might not have been able to tell you, and you didn't ask.