She arrived a little after 6 p.m., sitting up on the gurney, talking, vitals stable. But the four paramedics accompanying her moved with a sort deliberate gravity, and we knew there was something more going on. As she gingerly scooted herself over from the ambulance gurney, the paramedic cleared his throat and started to present. “32-year-old female, stabbed in the neck—“ I squinted at the wad of swampy red gauze she clutched to the left side of her neck, through the middle of which, jutting up at an acute angle towards her ear, protruded something small, pink, and rubber… “—with a pencil.” I flinched involuntarily, already tabulating all the vital structures in the neck that might be hit. Carotids, jugular, esophagus, trachea, and on, and on. “Non-English-speaking,” the paramedic continued, “but the neighbor at the scene translated. She said, well…” here he paused and exhaled slightly, watching me slowly unwind the bandage, “She says her 9-year-old son did it.” I glanced back at the paramedic, aghast. With the bandages down, it was plain now that the pencil was buried deep, with a vengeance. A thin trickle of blood seeped free around the eraser. This was no accident. In reply to my unspoken horror, he only shook his head. “Apparently, some type of argument with her kid? I guess he didn’t want to do his homework or something?” At this moment, her voice, suddenly alarmed, interrupted our dialogue. She grabbed my hand and pulled my eyes down towards her. Most of what she said in a rising fever pitch I couldn’t understand, but the last few words, gasped with new tears in her dark and widening eyes, were unmistakable: “Bad boy! He is very, very bad boy!” These last few words she repeated as she flailed for the hand of everyone within arm’s length: Bad boy. He is very, very bad boy. We took her to the OR to extract the pencil and explore the wound. Thankfully, the pencil turned out to be shorter than expected, and, as happens more often than I can believe, managed to avoid every single vital structure in its path. When we were satisfied that the bleeding was controlled, we washed out and re-bandaged the wound. By the time she came to in the post-anesthesia care unit, I had a translator at bedside. There was still one thing that just didn’t make sense to me. “This is very important, Mrs. H. You said your son stabbed you with the pencil?” As the translator relayed the message, Mrs. H began nodding vigorously. Then, in a frantic tone, she pleaded, “The police. They take him away?” After conferring with her for a moment, the translator added, “She wants to make sure her son is no longer in the apartment.” “Mrs. H,” I reassured her, “No one is going to hurt you while you’re here. And, of course, we will make sure that everything is safe at home before we discharge you from the hospital. But in the meantime—“ “No!” She yelled, and slammed her hands down on the bed, making the patient two curtains over jump. “No! They get him now! Now! Get him and take him away!” She was hysterical, and I worried that she’d pop a clot in her neck. I promised her I would make sure her son was in custody. I called the social worker. He called the police. But while they ironed out the whereabouts of her son, I kept wondering, Had she been sitting down? Or lying down, when she had this violent argument? That seemed unlikely. But then how else had a nine-year-old plunged a pencil, in a downward trajectory, as if from above? He hadn’t. It took many more days for her to open up and trust us, but when she finally did, we learned she was the victim of spousal abuse, and had been for many years. Her son was also viciously beaten, although she did her best to shield him as much as possible. But a pervading sense of cultural isolation left her convinced that no one under any circumstances would favor a mother’s parental rights over a father’s. Her husband would keep— and keep abusing— her son if she were to leave. That night when the neighbor heard the fight, and called the ambulance, they took her away against her protests. But being a mom, and a brilliant mom, she did the one thing she thought was sure to put her child in protective custody, and out of harm’s way, while she was hospitalized. She lied. Source
