Attempted

Last week a 38 year old woman was convicted of attempted murder for withholding medications from her 9 year old son. The full details of the story I am about to discuss are found here: http://www.boston.com/news/local/breaking_news/2011/04/jury_in_kristen.html?p1=News_links . I am fascinated by this story for several reasons. First, while this may seem an obvious question, in truth it is not: Is it up to a parent to decide on medications for their children? There have been several famous cases in the past 30 years of Jehovah's witnesses withholding blood products from their children. And more often than not, courts have had difficulty deciding for the parents if a bad outcome resulted. The thought is generally that a child can not make a sound, informed decision for him or herself. And usually I agree with this. But Kristen LaBrie had an interesting twist to her story: Her son had cancer and was suffering. There have been many times, in my young career, when a patient with a terminal illness, sickened by medications and treatments, has decided that enough was enough. I have helped many people make the difficult decision to stop treatments when I felt they were doing more harm than good. And most patients have felt happy with their decisions and died with dignity, often in the comforts of their own homes with family nearby. Jeremy Fraser, LaBrie's son was only 9 years old when he died. The courts decided, in the end, that he could not have made a decision for himself to terminate treatment, and that his mother was remiss in making a decision to withhold treatment for him. And perhaps both are so. Or, perhaps, as the prosecutors argued, her ulterior motives of fatigue or even selfishness led her to consciously decide to end his life prematurely. But there is another option: maybe this woman and her son communicated and decided together to stop his suffering from the affects of chemotherapy including constant nausea, vomiting, pain, infections, etc. Of note, according to the article, "LaBrie was also convicted of assault and battery on a disabled person with injury, assault and battery on a child with substantial injury, and reckless endangerment of a child". This is a case with no answers. Only this woman and her now dead son really know the circumstances. But as a dad, I know one thing: we greatly underestimate the decision-making ability of children and their ability to know what they need. The defense lawyers in this case spent a lot of time painting LaBrie as an emotionally weak woman, fatigued by responsibility. Instead they might have focused on her relationship with her son, and maybe even noted that he told her clearly several times that he himself did not want the medications. You can argue with her judgement, but it's hard to argue with a sad boy, asking repeatedly to be left alone. As a juror, I would have found it difficult to charge a woman with assault and battery for withholding medications no mater what the argument. Just because he was a boy, the same rules of humanity apply. Chemotherapy is hell, anyone who has endured it knows that. Doctors know that. Kristen LaBrie knows that. And I cannot think of a more difficult circumstance than having to make your child suffer- even to save their life. In the day to day of administering those medications, it may have been easy to lost track of the long-term goal. Watching him whither, vomit, keel over, weaken- that may have played a role. And no matter what, I am appalled that the outcome of the decision in this case is prison. What Kristen LaBrie needs more than anything is psychiatric help. Regardless of the motive for her decision, she'll have to live with it for the rest of her life. That might be punishment enough.

Just like that

This evening a seventeen year old young woman was on the highway a few blocks from the hospital when, in the glare of the sunset, she hit a man walking beside his car at 60 miles an hour. He had stopped his truck and drove into the breakdown lane. He was heading back to his side of the car to get back in when she hit him. She stopped her car and got out. What she then saw will give her nightmares, therapy and bad memories for a long time. He was missing a hole in his body from where the car made impact. His arm, half of his chest, his abdomen on his right side were literally missing. He wasn't pronounced until after the parametics arrived and was still breathing for a few minutes which means that the experience of his suffering lasted 15 minutes or more in front of the girl who killed him.

This is not a horror story meant to make you nauseous or to scare you away from driving (although I'm going to think twice about the "breakdown" lane.) Instead I am thinking about the girl. Even the firemen who brought him in were distraught by what they had just seen. She had no training for this- no preparation of any kind. She was not texting or distracted by anything except the sun, and she was wearing sunglasses. She did nothing wrong. They even determined that he was in the road based on his trajectory and how the blood tracked. So what about this poor girl?

Trauma happens in an instant. One day a phone call comes and you find out some bad news. One moment everything is ok, and then it isn't. The brain handles this in many ways. Memory storage and processing is different in trauma. And the permanent connections made in reference to an event like the one described above are the type that haunt someone. Post traumatic stress disorder (PTSD) is the official name of the disease coming for our young friend. Amazingly, there has been some good progress in the field lately. New treatments, including one used tonight in the emergency room, use medications to break the connections neurologically which bind us to bad memories associated with trauma. These medications are starting to work in the field, (she received some tonight including Inderal, a Beta blocker and steroids), as soldiers returning from war are being treated with good results to-date. We tend to pity those who suffer a trauma, but make light of that suffering at the same time. After enough time, a homeless vet is seen as "crazy." But if you found out that a homeless person, in 10 years, was girl I met tonight, would it change your opinion of her "craziness?"

The best advice about trauma, is that the only preparation is a recognition that it is real and lasting. Medicine may improve techniques or medications to treat this horrible condition, but in the meantime, compassion from friends, family and the medical community will help.

A seventeen year old girl, with a boyfriend, a letter of college acceptance kept in the car so she could read it over and over with pride, good parents, siblings, means- may or may not ever recover from what she saw this evening. Life is tricky that way. Here I am with 10 years of training under my belt, and the site of this man would still shake me to the core. Imagine her. She wasn't ready for that.

Once, outside of Las Vegas, I was first upon a car crash. A truck had spun out and hit almost 10 cars. Most people were ok but one car had three corpses in it. I remember seeing three of the four family members dead and feeling awestruck and almost embarassed at the intimacy of being in a moment where I had no place. The trauma of that day still haunts me from time to time. I was early in my training, and not quite accustomed to death as a normal part of life as I am now. Besides, there was very little normal about the fact that the only survivor was a 75 year old grandmother. But it was that day that I learned my first lesson about trauma: These moments stay with you as vividly as the most vivid dream.

Now I am going to my day job, and then I go home to my children, both under 4 years old and my wife. I will try to enjoy the weekend, maybe bar-b-q. I will put some of the images I saw this week aside and carry on. I am trained to do that and I have gotten better at it over time. Meanwhile, a seventeen year old girl will be seen by teams of psychiatrists who have a short window to change her mental trajectory, and avoid a life of suffering from PTSD. Medications aside, I think the chances are slim to none. This was one of the most greusome sites one could see. And I am afraid for how she will feel when she finds out that he is a father and loving husband. Time will tell. She will have a court date to get through, a funeral to attend. She will have to apologize to his family, to come to terms with this- in light of the fact that it probably would have happened to the next driver in her lane. It's the extreme example of wrong time, wrong place.

Just like that, in the blinding shadow of sunset, many lives are changed forever.