Trying to reconcile unspeakable horrors – as a mother and as a nurse

Austin American-Statesman, May 18, 2010

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Prosecutors allege 24-year-old Emily McDonald, mother of three, was caught on camera smearing the child's feces into her IV line and that the mother admitted to repeating this act five times during a six-week hospital stay at Dell Children's Medical Center....Waking up on Mother's Day to this image is more than this mother and neonatal nurse can handle.

As a mom and a 30-year neonatal nurse, I’m tough. Or so I thought.

I can deal with kids getting infections and being born prematurely, and I can help immensely with all that. And I can deal with and help with setbacks and recurrences.

I never thought I’d be confronted with the scenario of a parent I once knew being charged with injury to a child — Dakota, the same extreme preemie I cared for three years ago.

Prosecutors allege 24-year-old Emily McDonald, mother of three, was caught on camera smearing the child’s feces into her IV line and that the mother admitted to repeating this act five times during a six-week hospital stay at Dell Children’s Medical Center.

The day before Mother’s Day, I read in the American-Statesman about the case and how a camera set up by suspicious hospital staff captured on video the mother smearing the feces. The article quoted the prosecutor saying that the girl kicked aggressively at her mother as she was doing it.

In the wee, small hours of those luxurious, no-alarm-clock mornings when I can drift naturally from deep sleep to wakefulness, dreams collide with reality. Some are pleasant. Most are anything but.

Emily McDonald, in court

That day’s predawn nonfiction horror episode was the haunting vision of the resisting, struggling little child. Even at 3, Dakota’s instincts told her, the prosecutor said, that this act, committed by her own mother, would harm her. Waking up on Mother’s Day to this image is more than this mother and neonatal nurse can handle.

The newspaper article mentioned twice that the mother was accused of smearing the daughter’s feces on the child’s feeding tube. I do not know if Dakota McDonald had a feeding tube during that six-week hospitalization at Dell Children’s Medical Center. I doubt it. If she did, and the mother was smearing feces in or on it, it would be disgusting but not dangerous. The digestive tract is not sterile and is inherently full of intestinal flora anyway.

I was part of the team that treated Dakota as a preemie and heard about the recent hospitalization. I do know that she had several central venous lines that were used for the administration of powerful antibiotics to treat fulminating and inexplicably frequent, recurring bloodstream infections in that six-week period. The bacterium repeatedly isolated was that normally found in the intestines.

Regular IV and central venous catheters are both peripherally inserted (through an extremity) into a vein. The similarity stops there. A regular IV catheter is less than an inch long and is used short-term. The sterile procedure to insert a central catheter is significant and is performed only after the child is sedated. Central catheters are very long — reaching from the extremity through a vein to just above the heart. We use these special lines for long-term therapy — weeks — as they are more secure. But because they stay in longer, they are susceptible to infection.

In neonatal intensive care, nurses treat central venous lines like the soldier defusing bombs in “The Hurt Locker.” We don’t wear armor, but we assume that the bomb could explode. Handling it, we give our full attention, treat it with care, wear gloves and give the hub a good 15-second scrub with alcohol before entering. The idea of introducing human feces anywhere near that line is an unspeakable horror to any neonatal nurse. Makes us shudder.

The neonatal staff who cared for Dakota as a preemie and the pediatric staff who cared for her during her recent hospitalization were so distressed that an expert was brought in to educate us on a mental disorder called Munchausen syndrome by proxy.

People with this serious mental disorder (typically mothers) intentionally harm or describe nonexistent symptoms in their children (usually younger than 6) to garner attention. They use hospitalizations as a way to earn praise from others for devotion to the child’s care, often using the sick child as a means for developing a relationship with the doctor or other health care provider.

They might lie about symptoms, alter diagnostic tests, falsify records or induce symptoms. The disorder can lead to death of the victim.

Treatment for the disorder is long, difficult and complex, involving mental health professionals, law enforcement, criminal justice, social workers and foster care. Treatment is difficult and not particularly hopeful, as the affected are such accomplished liars that by the time of diagnosis, they have trouble telling fact from fiction.

I applaud our community’s response to this case so far. The hospital’s installing a camera was an extraordinary measure that newly defined patient advocacy. The community continues to do the right thing — ensuring the safety and protection of little Dakota. The case could go to trial this fall.

As each of my three grown children called me one by one on Mother’s Day, the image of that struggling 3-year-old drifted farther and farther from my mind. That is, until the next no-alarm-clock morning.

Toni Inglis, MSN, RN CNS (retired), FAAN, a lifelong Austin resident and retired neonatal intensive care nurse and editor of NursingNews, writes a monthly opinion column for the Austin American-Statesman editorial page.