The door was opened by a young child. Several children of various ages stood behind him, two in diapers. It was a little after midnight and they weren’t in bed. But I had long gotten used to young children being up when they, really all of us, should have been sleeping. We were all ignoring our circadian rhythms. One of the older boys made his way to the door, to act as spokesman for the rest of the group.

“We had a problem waking up our mom. That’s why we called 911,” he said. He led us to the bedroom where the young mother was laying in bed.

“They told me I should wait here, in bed,” she said. Who had told her, the dispatcher? “No,” she said. “The children.” She apologized for ‘bothering’ us and said she was fine.

We asked what had happened and the oldest boy, who we found out later was 11, explained that the kids were watching television but there was a problem with the remote. They tried to wake up their mother to fix it but she didn’t respond right away. They were very concerned she was unconscious because it took repeated prodding to wake her up. They had never seen their mother have such a difficult time getting up and when, after a few minutes, she did wake she seemed disoriented at first.

“We kept saying ‘MommyMommyMommy’ but she kept sleeping.” said one of the smaller children.

When we asked their mother about the incident she explained that she had been up for two days straight because of a very long list of circumstances, including repeated trips to the ER with one of the younger kids who had asthma. She went into great detail as to how hectic things had been and it was exhausting just listening to her struggles. I am always in awe of single parents and the way they juggle the needs of their children with the day to day needs of daily living. She had finally been able to lay down and despite having only gotten 45 minutes of sleep she had had very intense dreams. We asked her how she felt now and she said, simply, “Tired, just very, very tired.”

We did a short exam and established that she had excellent vital signs, no medical history and took no medications. She said that she had eaten properly, despite her rigorous schedule. When asked about the ‘disorientation’ she experienced getting up she said she hadn’t been confused but that her eyes had had some difficulty adjusting to the light. Her explanation was extremely understandable and reasonable. We were completely on board with letting her get back to sleep.

When the oldest son heard that their mother was getting ready to refuse transport to the emergency room he became very upset and pleaded with her. “But mom,” he said. “You GOTTA go. What if something happens?”

The rest of the children agreed. “You got to go get checked out! We don’t want you to get sick.”

“But mommy is not sick,” I explained. “Just tired. Sometimes it’s really hard to get out of bed when you haven’t slept in awhile and get woken up. She would probably feel better if she got some rest.”

“No.” said one of the children. “Hospital.” All of the others unanimously protested as well.

“I’ll get my coat,” said the mother.

I’m never one to discourage someone from going to the hospital but in this case I felt that her needs would definitely not be served by spending several hours in a waiting room only to be told it’s normal to resist getting up when your body is craving rest. I was sure that the mother knew that too.

“I really don’t want to go but they want me to and I don’t want them to be mad,” she said. I can understand giving in to pressure as a path of least resistance but the pressure here was being exerted by very young children. But if she wanted to forgo sleep to placate her children who was I to argue?

“It’s OK,” she said. “I should go anyway. You never know what could happen.” I understood it could be the sleep deprivation talking but she elaborated. “Next week or something, I could be on the bus and just die. I better get checked out.”

The premise that getting checked at an ER with no specific complaints could somehow prevent an impending, random death is something we hear often enough. The logic of it doesn’t really pan out. A busy staff dealing with the constant influx of emergencies isn’t generally able to do the entire battery of tests that would weed out a hidden life threatening problem.

She got dressed and called her neighbor to take care of the children while she was at the hospital. The neighbor was very concerned when she rushed over and I wonder what she was thinking when she hurried over in the middle of the night just to find out that there is “nothing really going on, I’m just getting checked.” The neighbor looked at her watch but even she agreed that ‘you never know.’

The two older boys instructed their mother that she was not to return until she was better. The mom smiled and nodded and we went to the hospital.

After the triage nurse took all the patient’s information and did her vitals again she was at a loss as to which category to place her in and what part of the hospital to send her to. She called over another nurse to ask what to do and, in seeing the mini conference, a doctor came over as well. The triage nurse asked the patient to give the story of events leading up to her arrival at the ER, which she did. The doctor became increasingly exasperated. “So you are tired?” he asked. She nodded. “And why are you in an emergency department and not at home sleeping?”

“Because my kids don’t want me to die.”

The two nurses and the doctor looked at each other incredulously. It always makes me smile when novices are introduced to my world.

“I’m sorry to be the one to have to tell you this,” said the doctor. “But one day you will die. But right now, there is nothing a reasonable ER can do you for you. There is nothing to fix, there is nothing we can change, there is no reason to change anything. Why don’t you just go home and get some rest?”

“I’ll just wait.” she said. “My kids will know that I came right back and they will be upset if I didn’t at least get checked out.”

“You are the parent!” the doctor was becoming increasingly frustrated. “You were checked out! We checked your vital signs, you have no issue to investigate further. I prescribe rest for you! Is that what you need to hear? Do you want documentation for your children? I will write a note if that will give you peace of mind.”

“Maybe it’s good now, but what if I’m in a store or something next week and something happens?”

The nurse signed my paperwork as the doctor stormed out and the other nurse shook her head. She directed the woman into the waiting area and just shrugged at me as she walked away. I came back to that ER several more times that night and each time the mother was still in her seat, wide awake and waiting.