Jamie was a 7-year-old girl with bright blue eyes and a winsome smile. Sarah, the admitting intern, carefully pulled up a chair beside Jamie, complimented her on her colorful shirt, and then asked, “Do you know why you are in the hospital today, Jamie?”

Jamie looked up, her blue eyes flickering as often happens when children try to recall their pets’ names or siblings’ ages. She then bashfully said, “I tried to kill myself with scissors.”

Her answer, so discordant with her innocent countenance, hardly caused Sarah to bat an eye. As Sarah asked Jamie and her mother more questions, she drew out a story of behavioral health issues against the backdrop of family discord, substance abuse, and sexual assault. Jamie was admitted to our hospitalist service while awaiting inpatient psychiatric placement, to be cared for by our pediatric residents and hospitalist attending. She would remain there for 4 days...

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