A difficult situation a resident faced in the emergency department

As I begin my overnight pediatric emergency department shift, there is one patient waiting to be seen: “Six-year-old male with autism, alleged sexual assault.” In year one of my pediatrics residency, I have not yet managed a sexual assault case, it is time to learn. I sign up to see the patient and move to find them in the sub-waiting room.

As I come around the corner, I find a family strewn across the folding chairs attached to the walls. Mom and dad are holding each other and crying. Another woman is supervising three children, two boys and one girl as they play on the emergency room floor. Dad just got here from work, and mom is telling him what happened. Mom and dad speak only Spanish. “I will come back with an interpreter,” I tell her. The patient a 6-year-old boy with autism. He is rolling a toy train back and forth with his sister. He looks stable, not in need of urgent attention.

I return with the interpreter. We pull the family into a private consult room and begin to discuss what happened. The patient and his younger brother were being watched by an older brother, 17, during the day. When mom came home from work she was doing the patient’s laundry and found blood on the inside of his underwear.

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