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The Toll of Caring

Maybe I can adopt her?

This thought awakened me from my sleep. Earlier in the day, I had treated a little girl, Carla, who was brave enough to tell me about the horrible abuse and neglect she’d suffered, and whose skin and bones were ravaged with injuries that silently told the same traumatic story. Recalling these details, which I had carefully documented, I understood that I’d fulfilled my professional role, but wondered if I could do more.

My thoughts were intercepted by memories of the countless other children I have cared for whose words and bodies told painful stories of trauma and abuse. I can’t take them all. As my heart breaks for them, what do I do with the burden of their suffering that I now carry with me? My worldview is altered, and the idealistic perspective of my younger self has given way to the harsh realities of my patients’ experiences and the indelible impact their trauma has had on me.

Carla came to me with a Child Protective Services worker as an acute case. A first grader perched on the exam table and dressed in a hospital gown, she sat there, expressionless. She didn’t know why she was there, but when I placed my stethoscope under her gown and onto her back, I discovered the answer. Her beautiful brown skin was overshadowed by so many bruises–covering her back, extending under her arms, wrapping around her chest and waist.

Memories flooded my mind of the scene from the TV miniseries Roots in which Kunta Kinte, bound to a post, was savagely whipped for disobedience. I was just about Carla’s age when I first saw that scene. Now I was doctoring the wounds of a little girl who bravely told me how her mother beat her unclothed body for reasons she did not understand. As I diagrammed every bruised loop and line, my heart broke with each stroke of my pen. 

What could enrage a mother so much that she would beat her young daughter the same way that overseers and masters beat slaves?

The cumulative weight of my own ancestors’ intergenerational trauma and pain was embodied in this little girl, along with my childhood memory of the movie that opened my eyes to the horrors of slavery. I felt acutely aware of how powerfully a patient’s condition can affect my emotions. I suppose this is why Carla’s image remains so vivid in my mind.

Child-abuse pediatricians like me regularly come face to face with physically and emotionally injured children. We listen as they bravely disclose the unthinkable experiences they have survived. While we wrestle with grief and distress for the children who have endured these experiences, in the moment we have to place our emotional reactions on hold as we care for them.

I now realize that these experiences aren’t confined to hospitals or doctor’s offices. One of my colleagues, a child psychologist, shared a story about hearing a child crying inconsolably in Walmart. Although such a scenario might strike others as a routine part of any shopping experience, to this psychologist it was a child’s signal of distress. Giving in to the need to “investigate,” she turned down the aisle, only to witness a seemingly attentive mother managing a child’s temper tantrum over a toy the mother had insisted the child could not have.

Relieved, my colleague sank into the awareness that caring for victims of child abuse is not the type of job you can leave at the office. Although she and I practice different disciplines, the impact of caring for traumatized patients is the same.

How does this affect us? At times, it fuels our sense of purpose and mission and compels us to strive for near-perfection in caring for our patients. At other times, it leaves us cynical or numb. Most times, it’s a combination of these forces, compounded by the altered worldview that seeps into our personal lives.

I often think of Carla. After our office visit, she was placed into foster care. She bravely testified in court about her experiences and was ultimately adopted. My initial impulse to adopt her collided with the reality that I cannot adopt every patient who has been denied a stable, safe and nurturing home. Instead, I must do my best for my patients by striving to acknowledge their profound emotional impact on me while bringing my utmost skill and compassion to their care.

I’m keenly aware that countless other health professionals struggle, like me, to bear the emotional toll of caring for abused children. Secondary or vicarious trauma is inherent in this work, whether it stems from seeing one patient, like Carla, whose injuries ignite feelings of sorrow, outrage and common humanity, or from treating a series of patients whose collective injuries induce a state of heavy exhaustion. We cannot unsee what we’ve seen or unhear the stories we’ve heard.

These memories create emotional and spiritual wounds—wounds that may be invisible to others. My colleagues and I are helpers, trained to put others’ needs first; and asking for help is hard. So, like many patients, we wear a mask of strength and impenetrability—and our injuries, like our patients’ injuries, remain unseen.

It is my hope that, together, my colleagues and I can find a way to share our very real trauma with one another more openly, to acknowledge and validate it—and so begin the vital, long-overdue process of our own healing.

Allison Jackson has been practicing child-abuse pediatrics for more than twenty-two years at Children’s National Hospital in Washington, DC. She uses storytelling in her teaching and has found it to be a constructive way to reflect on her own clinical experiences with maltreated children.

Abyssinia Washington Tabron is currently vice-president of clinical engagement and diversity, equity, inclusion + belonging with KVC Health Systems. She is a clinical psychologist with more than twenty years of experience working in the areas of child maltreatment and trauma, system transformation and policy, and practice improvements, teaching and training. Her children’s book My Warrior Pose creatively translates her expertise on childhood stress and the mind-body connection.


12 thoughts on “The Toll of Caring”

  1. I can only say “Yes” in response to all of the comments above.

    Our children need protection.
    Anyone who is aware of clear child abuse should report it to the

    Though in NYC, where my daughter has been a 1st grade teacher for
    20 years, she has been told not to called NYC “Child Services” –even when she has a 6-year-old who is clearly being sexually abused.
    “Child Services”, she is told, is “overwhelmed and understaffed.”

    She still calls.
    But only once has a child been removed from the home.
    This was a 6-year-old who tried to commit suicide by running out into the
    street in front of a Truck.

    No doubt Child Services in NYC is understaffed.
    But that only means that tax-payers should demand more funding
    for the department. Any caring adult would be willing to pay for that.

  2. Kristen Montas Graves, MD

    Your reference to that harrowing scene in “Roots” is so insightful, highlighting the effects of intergenerational trauma and the legacy of our ongoing subjugation on behavior and outcomes. As physicians of color our agony for this child is compounded by the sadness for our people, so damaged by this system they are brought to the point of taking their anger and frustration out on an innocent child. It’s tough to be a sensitive soul in this cruel world.

  3. I am fortunate to work within a team of medical and mental health professionals with shared and similar experiences. I like your idea of having a trained listener, because peer support, while helpful can compound the secondary trauma of co-workers.

  4. Allison, Great article and your point about secondary trauma for the caregivers can’t be stressed enough. I think therapy for caregivers should not only be available but mandatory. We have “critical stress debriefings” after codes in the ER but this is woefully inadequate. We also need generational healing which our society does not support. So much work needs to be done to prevent child abuse in all its forms that is why I am now working to promote Conscious Parenting /Gentle Parenting. As for working in ER and Child Abuse….my cup is empty. I hope you are well and I fully support what you are saying, just want to send you more than “thoughts and prayers” and instead promote action.

    1. Thanks Julia. Like required immunizations that protect us from the risk of infectious exposures as healthcare professionals, our institutions should be required to implement measures that can mitigate the risk of exposure to trauma. Glad to know you’re still working in this space.

  5. I love this story. Thank you so much for sharing. I fostered a student of mine in high school when I was a teacher for very similar reasons – and have since realized that I can’t do that with all the children I see who need stability, love, and support.

  6. Allison, thank you for your thoughtful, heartfelt writing. I was a forensic examiner and expert witness for 20 years. Are you aware of the Balint process? It has been invaluable to me. You can learn more on the American Balint Society website. The ABS is a professional organization of physicians, psychologists, and other healthcare professionals.

  7. To be gently touched by loving hands and a kind heart is the beginning of this child’s healing journey. What you provide matters.

  8. I believe that your compassion and empathy communicated to Carla that she was lovable and comprehensible. Such a response would be a new notion, a new emotion for her. We don’t always know what it is we do that will promote healing.

  9. This essay is super powerful –thank you for giving it to Pulse readers, & thank you for the tough work you do for children every day! I’ll be lifting up children who are abused–& you also–as I meditate tonight .

  10. Dorothy Blake FNP

    Thank you for being willing to help these children plus carrying the burden of their stories in your being. I think your idea of meeting with the other equally burdened staff is right. Maybe the hospital could loan you a trained listener, and maybe those of you who meet can be the trained listeners. Thank you for what you give to the abused children. I hope there are people in your life who give to you

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