Sunday, December 21, 2008

Pediatrician vs. Christopher

So. Here we are. I'm about to write in my blog...about...hmmmm...what should I write about? The fact that I haven't wrapped any of the Christmas gifts that I have picked up? I usually bring them to work to wrap, but for some reason, this year I haven't wanted to do that. It seems like too much hassle. Nah. Not really much to write about in that.

I about my son Christopher? We got to go to the doctor AGAIN last week. He woke up with a bright red rash all over his body last week. As soon as I noticed it we were off to the doctor's. I was worried that it might be related to the Strep A that has been flying around our household this year. So we got to take another trip in to the pediatrician's office. Meh. What a pain in the butt. It's about an hour drive one way. A lot of people have asked me why I haven't found a pediatrician that is closer. Wouldn't it save me time and aggravation? My answer to them? No. A resounding no. My kids' pediatrician has known them since birth, and she really does know them. She treats them with respect, not just like pieces of furniture she must tend to. She asks them how they are doing. She talks to them about the things that she has to do in order to make sure that they are healthy, and she smiles and has a nice bedside manner. The nurses ini the office are kind too. Even when they are obviously swamped they are kind and courteous to both me and my children. We have never had to wait longer than ten or fifteen minutes in the waiting room.

My kids like their pediatrician too. I have never had to fight with them about going. They know her and are comfortable with her. That's important. That your kids are comfortable with their doctor. Some people don't think so, but I do. How will they feel free to discuss anything important with their doctor if they don't like them? My daughter Allison is starting to want privacy. She needs to be able to tell the doctor things even if she feels she cannot tell me. Thankfully we haven't hit any stage where she feels she cannot share things with me. I try to respect her need for privacy and to encourage her to talk about things with her doctor. I also try not to embarrass her by talking about her medical issues in front of friends and relatives. That's private.

My boys know that if they have to get shots it will be over quickly and that they really need the shots and the doctor wouldn't do anything to intentionally hurt them. They both knew that anyway until this last visit anyway. Now I'm not so sure. Christopher has been quite sick this past fall. There has been a lot of Strep A in our family lately. Because he keeps coming up sick, the doctor has had to test often for Strep A. He has probably had to be tested for Strep at least four times in the last month. Do you know what the test for Strep A is? It's a cotton swab in the throat. The doctor must take a tongue depressor and hold your tongue down and then swab the back of your throat to get a culture for the lab to grow out and see if there is any Strep in it. It hurts.

So we were on our way to the doctor's office. Christopher asked if he would have to get a shot. I told him that I didn't think so but that I couldn't promise that he wouldn't. I don't ever want to lie to my children. I want them to know that they can trust me. So I won't play games with them about what will happen at the doctor's office. If some unpleasantness must occur, I won't trick them into thinking it won't. I won't wait until the last second either. I am straightforward with them about this stuff. I think the direct approach is best, otherwise you have a fight on your hands.

Christopher seemed to accept what I said about the shots just fine. Then he thought a moment and asked if he would have to get the thing stuffed into the back of his throat, "I don't like that Mommy, it hurts," he told me. I refused to lie about that either. I told Christopher that he may indeed have to get that test done. I wasn't sure, we would just have to wait to see what the doctor said. "I won't let her do it, Mommy," Christopher informed me. Oh oh. Prelude to what was coming. Just great.

"Sweetheart, the doctor doesn't like giving you the test any more than you like having it, but if she feels you must have the test please cooperate because she is only trying to make sure that you are healthy," I tried the logical approach.

"I'm fine Mommy. I don't need that test. I don't have Strep, I know," Christopher informed me.

"You don't know whether you have it or not, and if you do have it, we need to make sure you get the proper medicine," says Mommy, hopeful that this will be effective in driving off any dissent.

"I do too know," Christopher responds. "Remember I had it before? The thing in my throat hurts way more than Strep does. Even if I have Strep, it's ok," he assures me. Ahhh, the logic of a five year old. It almost makes sense. The thought of not having to fight him is alluring.

"Sweetheart, you don't know if you have Strep, and if you do and it doesn't get treated you could get very very sick. Remember how Mommy was in the hospital this summer because of her leg? That was Strep. And Grandpa's eye? That was Strep too." The gloves have come off. Now I am resorting to a combination of logic and fear to gain cooperation. Dirty trick.

"Well, I don't want the thing in my throat," Christopher says petulantly.

"Well, let's just get to the doctor and see what they have to say, okay?" I postpone this argument, reasonably assuming that it may be an unnecessary fight. Until we have more information, getting all worked up doesn't make a lot of sense.

Well, our doctor is not in on Wednesdays. It's Wednesday, so we will be seeing another pediatrician in the practice. Great. She is nice, but not our pediatrician. How will this go? I wait to see. The nurse meets us in the stairwell because they don't want children with rashes waiting in the waiting room with the other sick children. We are brought the back way to our exam room to wait, and to explain to the nurse what has been going on.

The doctor finally joins us while I am reading "Green Eggs and Ham" to the boys. She is a petite woman with an Italian or Greek look about her. She smiles and is very nice to the boys, chatting and getting them to chat about themselves. She takes Christopher's temperature, looks in his ears, eyes and throat, and takes a peek at the rash that is covering his body.

She tells me that she thinks he has Fifth's Disease, which is a fairly benign viral infection that will last about 6 weeks. I breathe a sigh of relief as this will mean that it's not Strep and he won't need "The Test."

Then she lowers the boom. "Just to be sure though, I think we should do a Strep test since the two rashes look very similar," she says. Right. Great. Try to act casual. Then it happens. The Question.

"Do I have to have the thing in the back of my throat?" Christopher asks. He is told, rather nicely, that yes, he does have to have the throat culture. "But why? I don't want to. It hurts."

The doctor does her best to explain to a five year old that it is important to make sure it isn't Strep. "If it is and we don't treat it, you could get VERY sick," she says, pulling out the specimen collection instruments (ie: the swabs and tongue depressor)

"But you said it wasn't Strep, didn't you?" Christopher tries to argue.

Our friendly doctor tries patiently to explain that Fifth's Disease and Strep look very similar and she needs to be sure. This test is the only way to be sure. Christopher asks to see pictures of both diseases so he can see for himself how similar they look.

The doctor sighs, takes off her gloves and says she will be right back with the pictures. She returns in a few moments with a medical diagnosis book with illustrations. She flips through, trying to find the appropriately similar pictures.

She needn't have bothered in my mind, as even if it was the same exact model in each of the pictures, and the rash was on the same exact spot on the body, Christopher would never agree that they looked the same. This was not about logic at this point. I sigh. I know what is coming.

While she needn't have bothered, I am touched that she did go the extra mile. She is trying to gain his cooperation and confidence and is not content to just do things to him without his consent.

Regardless of her extra efforts, Christopher still will not consent to the test. I offer to hold him in my lap and he agrees at first, but will not allow the doctor to obtain the necessary sample. She asks me to hold on to his arms and head so he cannot resist. I do as she asks and the fight ensues. He bites down on the tongue depressor and will not allow her to get the swabs into his mouth.

"Christopher, I need you to cooperate or I will have to get the nurse," the doctor warns. "I don't want to have to do that, do you want me to?" she asks. Christopher of course does not want the nurse to come in as that implies force and he really does not want that. He says that he will cooperate, but I know that this is not earnest. We try it his way a few more times anyway, as I want to give him as much latitude to cooperate as possible, but in the end, he bites through two tongue depressors and just will not allow the test to be done.

The doctor summons the nurse. She instructs me to hold Christopher's feet down and the nurse is going to hold Christopher's hands over his head and they are going to pry his mouth open. Oh my gosh! I have never had to do this with any of my children. This feels awful. He needs this test, and that is the only reason I am doing this, but it feels so wrong.

He cries. I cry. He struggles against me. He says I am hurting him. He says if we will let go he will cooperate. I hold on. He struggles harder. The doctor says she has to get yet another depressor as he has bitten through a third and a fourth one. He sobs. I cry. The doctor finally pries his mouth open and gets the culture she needs. I can let go. Thank goodness. I let go and Christopher shoots me a look of such betrayal. We are both sweaty and he is angry with me. How could I let the doctor do this to him? I try to go to him and he tells me, "No. Leave me alone!" Those words were like arrows in my heart. I understand why he says them. He has a right to be angry. I give him his space. I try to turn so he doesn't see my tears.

The doctor tells me that she got what she needed to get. Good. Somehow that doesn't comfort me. I feel like I helped her to rape my son. I know, that sounds melodramatic. It probably is a bit over the top, but that is how I feel. I don't know if I should feel good about what I just did. Is he going to be scarred by what just happened? Is this going to be one of the random memories he carries with him for always? Is this going to form his impression of me in his mind? Is he going to be afraid of the doctor the next time we go? Will he be more inclined to cooperate or less?

What about Daniel, who witnessed the whole thing? What will he take away from this experience? Is this going to damage his impression of the doctor, or me? Will he be afraid to go now? I suppose only time will tell.

So once we left the doctor's office, it was off to the golden arches. Yeah. I know. Food as a reward is not such a good idea. But the doctor said he would probably need a cold drink to soothe his throat as sometimes abrasions resulted from encounters such as what he had. I thought a chocolate shake might feel good on that throat. It might assauge my guilt too. Perhaps a Happy Meal toy would get his mind off the fact that I was a vile betrayer.

As Christopher and Daniel drank their shakes and played with their Bionicle men (the toy that came with the Happy Meal), I found myself thinking about what the doctor said as I left with the boys. She made a point to tell me that she had never found any five year old that could fight as hard or be as strong as my Christopher. I wasn't sure why she was telling me this. She said it to me as if she thought it might comfort me somehow. I don't know why either, but it did comfort me. To know that my son had not only the physical ability to fight, but the will to fight off what in his view was an injust assault did make me feel good. It meant that his sense of self as important was intact. That he cared about himself enough to struggle against what he viewed as evil forces. It makes me proud, even if I am the evil force he is struggling against. I wrap this up for tonight, I am mindful that I have not told you my five things that I am grateful for. So, here they are:

1.) I am grateful for doctors that are well educated about childhood illness
2.) I am grateful that I do not have to drive more than an hour to get to a good doctor
3.) I am grateful that I do not have to be put on a waiting list to see a doctor
4.) I am grateful that my children have a good relationship with their doctor most of the time
5.) I am grateful that my children have a strong enough sense of self to speak up for themselves to their doctor.

Take care of yourselves, and remember, I welcome input. Just be nice, I bruise easily.

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