On second thought...

There will be no additional entries for my child advocacy elective journal.

Child advocacy is sad, depressing and I have cried enough tears these past three weeks without reflecting and writing about it. This will be all.

But I do want to say that I have the utmost respect and appreciation for those who work in the field day in and day out.

To the 18 full time detectives in Brooklyn whose sole job it is to investigate child abuse cases (both physical and sexual), I raise my glass to you.

To the medical doctors and nurse practitioners that act as consultants, giving up their nights and weekends to review pictures, talk to the detectives and perform physical exams and complete rape kits for forensic evidence when needed, I applaud you.

To the lawyers and judges that sit in court and review the cases and sentence the perpetrators, my thanks.

To the social workers and others that visit the homes and interview the parents, my hat goes off.

It is a difficult, sad, situation when a child is abused. Sometimes these children have no one else, their parents have failed to protect them and so they require an advocate. I don't know that we always get it right, the entire field is shades of gray to me... but to those who spend their careers as advocates I am grateful.

I suppose I am glad for the opportunity to witness these dedicated individuals hard at work. It has been educational and enlightening to meet and talk with them.  And while it is heart-breaking to meet the children and hear about the cases I am glad to now know a bit more about what happens once a mandated reporter call the state registry.

It has been a good but emotionally difficult elective. I won't be sad when it ends... I've cried enough tears already. I cannot wait to go back to the hospital and the smiling happy children in clinic.

questions and answers

I am half-way through my first elective of 4th year: Inpatient Child and Adolescent Psychiatry.The following was overheard or asked of me during the week....

Q: Am I in trouble? (asked by a 10 year old new admit who we were about to interview)
A: No, you are not in trouble and no one here in is trouble. We just want to talk to you so that we can get to know you and figure out how to help you. (So that you will stop listening to the voices in your head that are telling you to cut yourself, or at least tell an adult that you are hearing these voices before you do what they suggest.)

Q: Can I have a piece of gum? (asked numerous times throughout the day by pretty much every single patient on the unit)
A: Yes, would you like mint or strawberry?
Q: Can I have one of each?
A: Yes. (Which reminds me I'm almost out of gum, better stock up before Monday.)

Q: When you were a kid did you ever stay in a the hospital like this? (asked of a new patient shortly after I introduced myself and welcomed him to the unit)
A: No. (And I'm so sorry that inpatient psychiatric stays are the norm in your life and that at age 13 you have already had three admissions. I wish I could tell you that you everyone stays in the hospital when they are young and it is normal, but I can't and so I just try to distract you with another subject. But you are too smart and you ask me again, and again until finally I tell you that I was very lucky because I was healthy growing up and my first time in a hospital was when I was working in one. And then you say, "oh" and seem a little sad so we talk about baseball and other things...)

Q: Am I enjoying my child and adolescent psychiatric elective?
A: Yes, but it is bit depressing and I remember why I decided to go to medical school instead of pursuing a PhD in psychology.

Q: If your parents are illegal (aliens) and they brought you here can you be sent to jail?
A: No.
Q: That's good because its not your fault that your parents brought you to the US so that you would have a chance at a better life, right?
A: Right.

Q: Why do I have to stay here? Why can't I go home?
A: Because we want to keep you safe and help you. (And right now you are either a danger to yourself or others.)

Q: Will you color with me?
A: Yes. Always, yes.

Needless to say I have given away a lot of gum, colored numerous pages of batman, spent hours talking about everything and nothing. After a a week I've pretty much decided that these children are simply trying to survive. Children of young, single parents and broken homes. Children that are products of domestic violence and sexual abuse. It is no wonder that they are depressed, defiant, angry, scared. I know that many will never recover but for some I hope that this is simply a respite and that ACS or a new foster family or a new counselor will finally get through or provide the needed structure. My hope is that some of these children may begin to live life and move beyond the depression, the voices, the hurt. I know that many will forever be scarred by their childhoods but I hope that some may show the resiliency that children seem to have and that often amazes us. I have to hope this for them because the alternative is too depressing to contemplate. (I just read this NYT article regarding the adult inpatient psychiatric treatment state of affairs, I think pediatric resources and options are slightly better but still, very sad.)