Back to Basics (February 2016): Dr. James Mooney, M.D.

 “An ounce of prevention is worth a pound of cure.”

                                                             -Benjamin Franklin

 Society spends considerable time and resource attempting to increase awareness of medical emergencies. We frequently hear about the importance of addressing chest pain in order to prevent a heart attack. Emergency departments all across the United States are filled with patients responding to the alarm of this life and death situation (it is the top diagnosis for all visits and approaches nearly 5 million visits a year with a cost of 4.7 billion dollars).  The point of the educational attempts carries validity. Early detection saves lives. However, the heart attack represents the outcome of multiple factors. Many of these factors have been overlooked by patients for many years and for many reasons. True early detection of medical emergencies should begin in childhood. What would our healthcare delivery system look like if we began addressing early detection of trauma and neglect in relation to chronic medical problems? Would we have any change in the healthcare costs for individuals and society? Would we have better outcomes for patients? Is there such a thing as a “trauma attack”?

 A story told to me by my daughter may shed some light on the subject. It involves the openness of a child expressing herself in a genuinely naïve way. My daughter was volunteering her time with a group of friends at a community gathering. She was interacting with a six year old girl in an attempt to engage her in play. She told the young child that she liked how her hair was done. The girl responded, “My dad did it this morning. “ My daughter expressed excitement in order to affirm the girl’s joy. However, with little hesitation, the child continued. She said, “I was sad the other day. My dad can’t pick me up from school anymore. My mom and dad got into a fight and my mom won so my dad can’t pick me up anymore.” Needless to say, my daughter was stopped in her tracks. Like most of us would, she struggled through an expression of sorrow but the moment passed quickly. The child had already moved on to the next activity and seemingly left the memory behind. Or had she? What was going on in the child’s limbic system (particularly the emotional center of the amygdala and the memory about past experiences churning through the hippocampus)? Why did the child express that to my daughter at that moment? Was the safety of the situation an opportunity to share her innermost thoughts and feelings? Was she simply expressing herself or calling out for help? Was she experiencing the symptoms of a trauma attack? What are the telltale signs of such an attack? Is there something we can teach my daughter to say at that moment (or others in a similar situation) which would have given the child hope? How do we tell the parents of that child about their daughter’s feelings? Would society be as interested in addressing the trauma attack as the heart attack?

 My daughter told me the story with a sadness and helplessness created by the situation. I couldn’t help but imagine that event in the context of our healthcare delivery system. If that same child’s father had chest pain because of his marital strife, he would have been hospitalized overnight for heart monitoring, blood tests, and a stress test. He would likely start new medications and arrange follow up care with a physician and possibly even a cardiologist depending on his risk factors. What do we do with the child’s symptoms? Why do we not escalate the importance of her statements? What if we attended to the correlation of childhood trauma and chronic health issues? After all, wouldn’t a childhood Trauma Intensive Care Unit ultimately lessen the number of admissions to an adult Cardiac Intensive Care Unit?

About the author:

Dr. James H. Mooney, M.D. is a Hospitalist physician in central Ohio who explores the connection between a person's emotional and physical health.

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