|Year : 2023 | Volume
| Issue : 1 | Page : 66
Handle with care
Sharmila Banerjee Mukherjee
Department of Pediatrics, Lady Hardinge Medical College and Associated Kalawati Saran Children's Hospital, New Delhi, India
|Date of Submission||24-Jan-2023|
|Date of Decision||26-Jan-2023|
|Date of Acceptance||27-Jan-2023|
|Date of Web Publication||27-Feb-2023|
Dr. Prof. Sharmila Banerjee Mukherjee
Department of Pediatrics, Lady Hardinge Medical College and Associated Kalawati Saran Children's Hospital, Bangla Sahib Marg, New Delhi - 110 001
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Mukherjee SB. Handle with care. Indian Pediatr Case Rep 2023;3:66
"Handle with care" by Jodi Picoult is more than a book about a girl born with osteogenesis imperfecta (OI) type 3, a form that although not lethal has the propensity to fracture at the slightest provocation. It is a diary of the family of a child with special needs, and others whose lives get touched by theirs.
The story starts from before she was born and primarily revolves around a lawsuit that her mother initiates against her obstetrician for "wrongful birth" when the child is around 6 year old. This is the legal term used for a medical malpractice claim brought by parents of a child born with birth defects, alleging that negligent treatment or advice deprived them of the opportunity to terminate a pregnancy. With reference to OI, it was failure to identify "very clear" indicators (a fetal brain that was too well visualized due to a poorly mineralized calvarium) in the 18th-week ultrasonogram (USG). The plot is presented as individual perspectives of several protagonists. The storyline focuses on the lives and interpersonal dynamics of the following characters.
Her first breaks were picked up in the 28th week USG (when the OI was initially detected). She suffered her first postnatal fracture when the nurse picked her up to hand over to her mother after birth. A few more followed during resuscitation leading to pneumothorax and the need for ventilation. By the time the court proceedings start, the toll has reached 68. Willow is a smart kid (nicknamed "Wiki" due to her penchant for memorizing trivia) with an expansive vocabulary and reading level of Grade 4, books being the only solace for her when she becomes nonambulatory due to casts, spicas, or orthopedic procedures. Enrolled in a clinical drug trial and despite being in and out of hospitals, she is uninhibited, resilient, funny, and has dreams of her own. This changes drastically when she starts to think that her mother no longer loves or wants her.
A pastry chef by profession with aspirations of opening her own bakery, her career comes to a standstill when she becomes pregnant with Willow. Dedicated to looking after the needs of her vulnerable child, she can go to any extent to protect her. She believes that the ends justify the means and that by winning the lawsuit, they will get enough money for Willow to avail those services that her medical insurance does not cover and a promise of a secure future.
Willow's father, a police officer, is always struggling to meet the ongoing financial drain. Extra duties are at the cost of family time. When Willow turns six, they go for their first vacation to Disneyland, where she gets injured. After emergency hospitalization, Sean gets imprisoned for suspected child abuse. Later, when the couple approach a law firm with the intent to sue, they learn about wrongful birth. Finding the idea abhorrent, Sean is against the idea from the start, and even files for divorce when his wife insists on pursuing this line of action.
The hidden tribulations that a sibling of a vulnerable child faces are portrayed by the challenges that Willow's teenage sister encounters. She starts to feel invisible to her family, completely worthless, and becomes a loner at school. Bulimia and self-mutilation ensue as her silent screams for attention go unnoticed till dire circumstances prevail.
The obstetrician in question also happens to be Charlotte's best friend. After their falling out, she loses confidence, is torn by moral dilemmas regarding her professional accountability, and stops practicing. Her marriage and social standing also suffers.
Incidentally, "Handle with care" is also a cookbook of sorts. Each chapter is preceded by a recipe with a cryptic message that links some process of baking with the contents. I believe clinicians will benefit from reading this book. Not only does it portray a moving story, delve into an extremely controversial issue with sensitivity, but it also reveals the hidden struggles that a family of a child with special needs has to face, which we generally fail to recognize.