I have been clinically retired as a practicing PA for several years now after a 42-year career as a PA, mostly in emergency medicine. During that time, a number of patient experiences have remained with me, mostly for the life lessons they taught me. There is one, though, which has haunted me for over 10 years, and I’ve finally decided to banish those demons by sharing the story.

In emergency medicine, the practice environment is a closed system. There are no windows and the doors lead to other areas of the ED or the hospital. In wintertime, while working a day shift, it was dark when I left for work and dark when I finished my shift to drive home. The florescent lights on the ceilings are our synthetic sunshine.

One winter’s shift I arrived to discover that the Spanish interpreter we usually used to help us with our Hispanic patients had called in sick, and there was not a backup interpreter available. My first patient was a 12-year-old Hispanic girl who was presenting with 2 weeks of nausea. She spoke English fluently, but her mother did not speak English. I had a dilemma since there were no staff in the ED who spoke Spanish that day.

I decided to speak to the 12 year old since she was intelligent and appeared mature for her age. I did ask her to share my questions with her mother, and her answers with her mother—English to Spanish to English. A history of present illness revealed no associated symptoms—just intermittent nausea throughout the day for 2 weeks. She also told me she had not started having menstrual periods yet and had no boyfriends.

Her physical examination was normal—no signs of dehydration, no icterus, no abdominal discomfort. The decision was then made to obtain some laboratory studies (blood and urine) as a screening assessment. Just before sending these to the lab for analysis, my “6th sense” told me to add a urine pregnancy test. All the labs came back normal except for one—a positive pregnancy test.

I returned to the room to speak to my patient about her lab results. She swore to me, quite adamantly, that the test had to be a mistake as she had no boyfriend and had never had sex. I was determined to uncover the truth, and we continued our discussion for over an hour—her denials and my persistent assertions that it was important to face the truth for her health. Ultimately, she started to cry, then told me that her stepfather had been sexually abusing her for several years, finally progressing to penetration in the past few months. She begged me not to tell her mother, saying that he was the only one who worked in the family and that she, her younger brother and her mother would have no place to live if he was arrested. I convinced her to tell her mother what she had told me. And, I told both of them I had to report this to the police and to the social worker as what the stepfather was doing was harmful to both of them, as well as a crime.

The mother had difficulty accepting the diagnosis and the facts behind the pregnancy. The police arrived as well as a social worker, and the stepfather was arrested in the waiting room. All I could think to say to the 12 year old girl that she would come to realize later this was the only way to heal and move toward a healthy life.

I then returned to seeing other patients after being tied up with one patient for over 2 hours. As is common in emergency medicine, her follow-up was lost to me. At the end of my shift, I drove home in darkness, thinking about this child and the terrible events bringing her to the emergency department, wondering what would happen to her and her pregnancy, wondering if she and her family would survive the betrayal of trust from her step-father and his path through the criminal justice system, wondering if she would grow wiser in the coming years. It was then I had an epiphany. The emergency department may have no windows, but it is truly a room with a view. It allows us to see people in their worst times, caused by events not of their choosing in most cases, and it allows us as PAs to be part of their lives for a sliver of time when dealing with the results of those events. I’m happy to settle for that.