Thursday, August 20, 2009

A Doctor who misunderstands, A nurse who could have been more helpful, and my really really bratty son

Today was the second time I’ve left the pediatrician’s office in tears.

The first was when, pregnant with my daughter, I mentioned to Simon’s doctor that I was contemplating an altered immunization plan. As she laid into me – basically accusing me of accusing her and all other doctors of organizing a conspiracy to give children autism – I dissolved. Partly, I think, because I really liked her. I really liked her, and so I asked the question I’d been nervous to ask – what do you think about delaying vaccinations – and got an angry lecture. The pieces I remember are:

“If you really think that all of us in the medical profession are part of some conspiracy, and that concerned parents like you are the only ones privy to the truth….”
After that I don’t remember anything other than my desperate need for a tissue.

I switched doctors. I also, by the way, went with the traditional immunization schedule because our crazy traveling does put our kids at a higher risk for many diseases at much younger ages. In our case, I believe the risk scale tips in this direction. However, the point is that though she was right, she was not the doctor for me.

I’ve been happy with the switch. My new doctor is patient and empathetic, and she always answers my questions in two ways: what she’s supposed to say as the doctor, and what she has done as a mother.

But, today, there was just not enough empathy to pull me through the horror.

Simon. Have I mentioned that he can be a bit fearful? Doctors are on the list. Usually, it ends up fine, but he is a remarkably healthy kid. He has never in his life had to go to the doctor for illness, so it’s been well over a year since his last appointment.

He was nervous. I was nervous because his nerves often lead to coping mechanisms that are less than pleasant.

It’s always the little things. The nurse asked him to take his shoes off so she could weigh him. Sy freaked. Screamed. Refused to take his shoes off, refused to stand on the purple footprints, screaming, refusing, screaming, refusing.

Finally, we got him on the thing and the nurse asked him to put down his toy airplane. This is where I start to move from embarrassed to frustrated. She insisted she couldn’t weigh him with the plane, which sent him into another screaming/refusing cycle. So, she picked him up and held him down on the baby scale while he screamed. I think it is worth pointing out that letting him hold a 4 ounce airplane wouldn’t have skewed the results as much as a thrashing boy being forcibly held onto a scale.

Here’s the thing: I understand that his behavior is unacceptable. I also understand that she has to do her job, and she doesn’t have all day. But I am this child’s mother, and I also believe that had I been given another minute, I could have gotten him through it. I also believe that her decision to force him on the scale has now put us past the point of no return – now his anxieties have been confirmed, and he will not settle down for the rest of the appointment.

So, I just grit my teeth and restrained him while she took his temp and measured him. This is when the tears just started to flow. I knew he wasn’t being hurt, but I was just upset that I couldn’t give him the time and attention to deal with his fears. Okay, I was also pretty pissed at Simon for being such a brat.

Oh, well, I decided. We will now be put in the exam room for the eternal wait. This long, wait, which normally makes me crazy, I will use to my advantage to calm him down. Only this time there is no long wait. The doctor and some sixteen-year-old intern waltz in right away, and Simon goes ballistic again.

At this point, I am an emotional wreck.

Doctor: I’ve never seen him like this.
Me: Well, sniff, yes, sniff sniff sob, we’re usually here for his sister, not him, snort, sniff.
Doctor: But still…
Me: It all started, sniff, snot dripping embarrassingly out of my nose, when the nurse forced him on the scale. Sniff sniff, When he has all control taken from him, it can push him over the edge. I understand she was just doing her job, but it really sob freaked him out.
Doctor: He’s four and cannot be in control all the time.
Me: Sob, I realize that, I’m not saying, more snot, he needs to be in control all the time…
Doctor: See what his preschool teachers have to say about his control issues, and if it doesn’t fix itself, we’ll see what next steps we have…
Me: But, sniff, sob, choke, um, this, sniff, isn’t normal, sob for him.

With the tears and snot freely flowing, I hear the words coming out of my mouth and know how they sound: My baby is perfect, it’s your fault, etc.

And that is NOT what I mean.

What I mean is this: I am angry with my son for his unacceptable behavior. But, I also realize that his behavior is rooted in fear. When he refuses to put away his toys, I force him to do it. When he refuses to stop whining, I punish him. Even when he is acting out of fear, there will be a punishment (bye-bye ice cream) but the kid is afraid.

When he is afraid of a large, friendly dog who I know will not hurt him (his fear is unfounded), I do not force him to let the big dog lick him. I give him space and time.

My emotion today stemmed from the fact that I couldn’t give him those things (no one’s fault, just the situation), and then I felt as though he and I were being unfairly judged as a result.

The thing that really stinks is I still have to take him to the allergist and the dentist. How acceptable is it to wait until the big teeth come in?

Leave your comments, and please - at least one of you tell me I'm not crazy.


Kirsten said...

Darn it. That kind of sucks.

One of my twin girls is terribly afraid of dogs. Every time she gets asked on a play date, she asks me if the family has a dog, and if they do, she won't go. A fear is a very irrational thing and you really can't rationalize it away. It drives me nuts when we pass a dog on the street, she crawls up my leg into my arms and the dog owner insists that it's a friendly dog. I realize that, it could be Benji and she's still be afraid.

I have a friend who had her daughter hypnotized to get over their fear of dogs. It only marginally helped.

You know you son best and I don't think letting him hold the airplane would have made that much of a difference. Seriously. She shouldn't work in a pediatrician's office if she is not willing to work with kid's and their quirks. Simon cannot be the only kid to be fearful of the doctor's office. My four year old son HATES it by the way. Why couldn't she make a game out of it and weigh him with the plane, then weigh the plane and subtract the difference?

Ugh. You're not crazy. Just a mom who's instincts are usually right no matter what a doctor tells you. You are the only one with a phd in Simon.

Sorry this is more like my own post, but you touched a nerve. :-)

Kristin said...

I am so sorry that you had an experience like that today! People working with children really should learn to be a little patient...

I think Wyatt and Sy would get along wonderfully. Wyatt starts screaming the second we round the corner near the scale. It takes a lot of work to get him to stand on the Snoopy sticker, and you should hear the screams the second the doctor walks in the door.

Suzanne said...

That stinks, big time. I know I don't have any kids of my own yet, but our experiences with Zack have taught us to be patient with him when he's honestly afraid or needs more help, and to push him to do the right thing when he's just being Zack. Sounds like you're doing the same with Simon. Not easy, but I think you're doing the right thing.

And doctors. Doctors are not high on my list most of the time based on family experiences and my work with special needs kiddos. True, there are some amazing docs out there, but they are few and far between.

We've learned that you're the expert on yourself and your kids. The doctors are trained to look at the symptoms and make assumptions, until those are proven wrong. If you feel like a doctor is not listening to you, or taking your situation seriously, feel completely in your right to get another opinion.

Hopefully Simon will grow out of it in time. Until then, keep doing what you're doing.

Rachael said...

Poor you and poor Simon! That sounds so demoralizing - especially b/c the nurse doesn't understand how her one action has cascading consequences for the rest of the doctor visit (and future doctor visits).

Do you think It would help him if you retold the story with him, but he got to change parts of how it happened or be a different role (like maybe the nurse was crying b/c she didn't want to get on the scale while Simon weighed her) - that gives him some control and a way of processing it (if he likes that sort of thing). I use social stories like that with David sometimes and it's been helpful - though it's usually not until a few days afterward that he's ready to talk about it, before that he tends to shut down. (Like with our wonderful ER visit last month).

Amy Troxell said...

Susie... I was faced with similiar situation. Nicholas went to a 3 year old birthday party at a park and all of the sudden it got windy! He screamed, freaked out, cried at teh top of his lungs, flew under the picnic table held on to the center bar, and sat there the whole time while the party went on. Everyone at the party I could tell was judging me and saying "what is wrong with your son?" Well, somethings take a while to get used to especially if you are scared or fearful. The only thing I can suggest is getting books, videos, play doctor, draw pictures, etc. before he goes so he know what to expect and that you will be with him the whole time. Best of luck and believe me, I would have cried, too. I did in fact the other day when both boys were in the car in the front of the grocery cart at the store at check out screaming and all I could do was yell and say "Be Quiet!" in front of everyone.

Beth said...

What an awful experience, Susie! I'm so sorry. You're not crazy. You're his mom. Sounds like you did well, considering the circumstances. I would have probably put a tight-lipped, fake smile on my face and said something to the doctor like "your nurse could probably benefit from further training" and then made some comment to my sniveling son about people who just don't understand kids. Didn't she think about weighing Simon with the airplane, and then weighing the airplane itself? Maybe she didn't know how to subtract.

As for a doctor who doesn't understand a little boy's fears....don't know what to say about that. A minute more to let him (and you!) calm down would have been helpful, as well as simply acknowledging that for a 4 year old, control is what they're about! He-ll-o!! If I had a dollar for every time I've seen a control issue, I'd be sitting in the Carribbean somewhere, using my Blackberry, instead of in my hot humid basement on a desktop! In fact, I was just at the mall and saw a little kid standing immobile in the doorway, sobbing, because HE wanted to open the door (that opened automatically!). The mother just stood there and said "he wants to control it." That's what they do, that's who they are, and thank God they're not growing up to be doormats.

So my dear, you're not nutz, the doctor was probably trying to be an "example of medical knowledge" for the intern, instead of being an example of human compassion, and that nurse..Well, I won't say anything about her.

Hope you found some tissues, know you're not alone, and that I, as well as others I know, would have reacted the same way.

Kristy M said...

Wow, it looks like this story hit a nerve with a lot of moms and I understand why. I am so glad that you did not go back to the first doctor. Part of their job is addressing health news in the media and they should never ever make a person feel afraid of asking questions.
Sometimes doctors forget that even though they are medical professionals they are still people who form their own opinions about what is right and who also make mistakes. I am feeling very compelled to drill that into my students heads before they go to medical school since it seems that many of them don't receive that training there.
Simon does not have control issues - he's 4!!! He is still learning so much - for heaven's sake his brain isn't even done developing yet. You are such an amazing mom and have had some harder issues to deal with - I am amazed at how well you and Ben have handled things.

By the way, I have one daughter and two dogs that are afraid of the scale. I usually end up holding the dogs while I step on the scale and letting the whole clinic know how much I weigh. For Ellie, our previous nurse has just ignored the weight in the beginning and after she warms up to her we come back to the scale. There are people out there who will do it right, just keep looking.

Anonymous said...

Oh my goodness, I have been there! Elliott is much like Simon (from what I read on your blog). I get it. What else can I say. You are NOT crazy. Your son's love of control will both thrill and exasperate you the older he gets. (I swear, once Elliott turned 5....well, let's just leave it at that.) Unfortunatly, the world doesn't seem to have much tolerance for a kid who is acting out AND is fearful. (seems like one of the other is more "acceptable".) And mommy wants to calm his fear, hates to discipline the behavoir knowing its root, but know she must...for his sake. And, that mommy can do both if she can just GET A MINUTE! :)


Anonymous said...

OK, So I don't normally do this, but being a RN I think I should put in my 2 cents. If that person who weighed your son is really a nurse and not a med tech, she should be reprimanded. It's not ok - what she did. The weight could have waited. It was the wrong thing to do, and we nurses are taught that!! Furthermore, I want to empower you. You are his parent and you know him best. You have the right to tell us( the medical community) to stop. If you don't find a Doc who understands, keep trying, they are out there. HTH


DrMommy said...

I also feel the need to weigh in, being a mom AND a doctor who sees kids.

First of all, I agree with RN above. Nurse was WAY out of line.

Doctor was also out of line, and I would gather either does not have kids or does not spend considerable amounts of time with them. Everyone who has a preschooler knows that once they spiral into an extreme emotional state (from fear, anger, whatever), there is nothing left to do but step back and let things calm down. I'm sure the doctor and his intern could've stepped next door and seen someone else and then come back. Sy is 4, not 10, and the doctor's expectations were not realistic.

Emma had so many ear infections in her first year that she would start fussing (and/or screaming) in the PARKING LOT of the clinic. And both her parents are doctors! We found that having a play doctor kit at home was very helpful. We'd "play doctor" with a doll or stuffed animal before the appointment and it was less stressful. You could even let him bring the toy stethoscope, etc. with him to his appointment -- then he has one too.

Also, as I doc, if I have a stressed out kid I let him examine Mommy first -- listen in the stethoscope, shine the light in her mouth, etc. You are right, they want to feel some sense of control over their environment.

Sometimes none of this works, and it's trauamatic for everyone. And that's ok, you can't always help it. BUT mom & kid should be given the space they need to comfort/console so that everyone at least LEAVES feeling better.

Just my $2. (Yes, I realized it was way more than $.02)

Dugi said...

"See what his preschool teachers have to say about his control issues, and if it doesn’t fix itself, we’ll see what next steps we have…"
what the hell?!!!
I am so shocked and disgusted.
I am so sorry u had to go through this.
I am so over RUDE medical receptionists...nurses at medical centres who think they are judges (upholding procedures and practices even if it goes against the care of the patient at the time!) and Doctors who don't listen to what the parents have to say. The last 2 times I've taken my son to a GP...I've had to walk out and take him to another one down the road JUST so that I can felt ok about the diagnosis and treatment plan. Just yesterday my son was given antibiotics and a cough syrup....he seemed to have a wheeze last night...and didnt sleep a wink...just cried all night. So i took him back to the centre to find that yesterday's doctor wasn't in. I saw another doctor and he said that the $40 worth of medication from yesterday was "all wrong". That I should get something else. When I told him I was a lawyer and I was concerned by the actions of yesterday's doctor...the whole tone changed...alot of ummm s and arrrhhhs...and "'ve exposed him to the cold and made him wasn't Dr....'s fault" blahh blahh. I got up and walked out. disgusting.
I wish people working in the medical profession weren't such ass's. :/
they deal with sick scared vulnerable people all the time. If you can't handle it...get another job.
That goes for receptionists at these centres too. :/

Susie said...

Thanks, guys. Someday Simon will be thrilled to learn you were all on his side. I know I am!

Karin said...


I don't know how I had you bookmarked but I did and read this post.

I have a needle phobia. A real, true, out of control, nothing I can do about it phobia. In pre-term labor with my first child I knew I needed an IV. I put my arm out, the nursed cleaned the area, I went out of control. The nurse was wonderful, the doctor even better. A trip to the OR and the IV was in and two other injections given at the same time. After that was done they talked to me about how to go from there as that wouldn't be my last IV during that pregnancy and they couldn't always sedate me for it.

Anyway, as an adult I have learned many things:

*there is medication to use to numb the areas I need injections/IV's

*that I cry EVERY time a lab tech / nurse doesn't read my chart or doesn't take it seriously and comes in to draw blood/insert IV without giving me notice so I could put the numbing cream on.

*that it is OK to tell them to back off, to come back and to go jump off a bridge should they persist.

*that multiple bad experiences have made me this way.

*that just because I'm an adult doesn't mean that you can talk any sense into me when I'm in this "out of control" mode

*that I am who I am and that I am 99% sure I will always be this way.

You know your son and what will work for him. Talk to his doctor BEFORE you go in the next time. Explain how you are going to work it. Arrive a bit early, let him play, maybe even go in on a non appointment day and point things out to him, show him what they do. Explain to him that you will tell him if something is going to hurt and don't mislead him.

NEVER let someone hold a child down who is afraid unless it is a true life or death emergency. The nurse who did should be removed from her position.

CRY every time you need to and don't appologize. If they can't see that they have upset you to the point of tears they have problems.

Take care!