Articles > Melt Down at the Medical Clinic


Melt Down at the Medical Clinic
by Foster Cline, MD and Lisa Greene
Isn’t life full of trials and tribulation? Life keeps throwing us difficult situations; especially those of us with children who have special healthcare needs. The secret of success is not always wishing and endlessly expecting to have fewer troubles, for the bucket of waiting tribulation is always full, but being able to expect them and have a tool kit of coping skills available.  What becomes unnerving and downright frustrating is not only being surprised by a tribulation that happens along, but in having no idea of how to respond.
A thoughtful and loving mom told us the following story as a “thank you" to us following a workshop. We immediately knew we would be massively remiss if we did not, (with her permission, of course), pass it along to others.
Her story is a gift to all parents of children with special needs (and those without, too).  We know you will be able to identify not only with this little scene as it unrolls, but that you will also take hope and learn from this mom’s responses. In life’s long course of events, it is often possible to make lemonade from lemons that life rolls into our path.
Enjoy and learn:
The melt down was entirely unexpected. And it was absolutely spectacular.
It was a bright, beautiful day as Mikayla and I walked up to the specialty medical clinic for my child's chronic illness. The sun matched my daughter's sunny eight-year-old mood. Entering the clinic, I felt the warmth of the place which is sort of like another home; a place where the professionals that we see so often are like family. The older social worker, doctors and nurses, remind me of caring aunts and uncles that take time to converse, understand our situation and give sage suggestions. And the younger nurses remind me of the sisters-in-law that I wish I knew even better.

This medical team knows me and my kid, and I’ve always felt blessed by that familiarity. Like any proud mom, I have reveled in the responsible responses that my pretty little girl gives the team. I knew my well-behaved kids would always look good for our extended family. At least that’s what I thought until I had quite a rude awakening for which I was completely unprepared.
Looking over my chart, pert Susan, our pediatric nurse, noted, “Oh, Mikayla is about due for a flu shot.”
“Great, maybe she can get it today, so we won’t have to come back,” I replied.
Mikayla, to my surprise, said, “I don’t want any shots today.” What was that all about? This kid had gone through all sorts of blood draws, shots, and other medical procedures in her short life. In the big picture, a flu shot was a piece of cake.
“Well, honey, let’s get it over with today, and mommy won’t have to drive back here.”
Mikayla's “no” became an uncharacteristic howl and she popped under the exam table. This was accompanied by a number of wails, “I don’t wanna a shot.”
Susan, morphed from pert to “I put-up-with-absolutely-no-nonsense" in the blink of an eye. Walking toward the exam table, she affirmed, “I’ll pull her out.” She radiated the definite impression that if Mikayla needed to be hog-tied, she’d be just the one to do it! 
I walked between Susan and the table, saying, “No, no.” My maternal instincts kicked in. If anyone was going to pull my snotty-nosed, wailing, now red-faced and dripping with perspiration, kid out from under the exam table it would be me. So I got down and braved what had become a full typhoon of a melt-down. To my consternation, Mikayla actually kicked, hit and bit me as I dragged her out from under the table. Unbelievable! Looking back on it, I might have been able to explore her feelings and find out what the problem was before the whole thing escalated out of control. But by this time, I simply had a horrible stew of feelings – embarrassment, anger, surprise, and frustration. This just wasn’t the way a kid of mine was supposed to be acting!
Susan had disappeared and returned with a back-up. Both nurses looked like they were ready to stretch this kid out on the exam table and let her have her shot right in the bone morrow. And I didn’t even blame them. But it could get ugly. I just couldn’t see going down that route. Then somehow, through the miasma of feelings, Love and Logic’s number one rule clawed its way into my awareness. GIVE CHOICES.
By this time, Mikayla was sitting on the table instead of under it. At least we were making some progress. I asked her if she’d like her shot in the left or right arm. She responded with more mucus and snot blowing from her nose and gagging as if she was going to heave up right then and there. This was drama queen material fit for any Hollywood venue. The nurses were growing more impatient, and Mikayla's bottom lip was sticking out in a petulant scowl.
I was on the verge of giving up, when I remembered that Love and Logic says every bad experience is a learning opportunity. With some difficulty I shoved my emotions down with a big, deep breath and started thinking. I remembered “Love and Logic says ‘choices, choices, choices’."
“Okay Mikayla, here's the deal. If you have your shot today, I’ll pay for it. But if we leave without the shot, and I have to make another trip, you’re paying for the clinic visit and my gas. It would be a bummer to spend your birthday money on a flu shot. But that’s fine with me if that’s what you want to do. You decide.”
To my surprise, Mikayla squeaked, “How much are shots?”
A break through! Nurse Susan, a quick study, jumped on it, “Well the clinic visit is $75.00, and the shot is $25.00." The second nurse with no little relish helpfully added, “My gosh, that will set you back about $100.00, Mikayla.”
Mikayla sat there with no response.
So, I said, “Oh, this is so sad. Ladies, it looks like we’ll have to come back another day.” And Mikayla pipes up, “Okay! I’ll DO it.” And she sticks out her arm. And her lip. Nice lip....
Susan was on her like a flash, and the shot was in and out in about 2 seconds flat. Mikayla calmly and nonchalantly waltzed out of the room leaving a wake of traumatized adults behind her- especially her mother. Honestly, I’m still traumatized by that little event. I don't even like walking past exam room number 102. And, in retrospect, neither does Mikayla!
Then we went to the main hospital lobby, where I collapsed and read a magazine just to compose myself. Remembering other Love and Logic tools, I told her that she had been a massive energy drain and the only way to put energy back into my system was for her to write a couple of great apology letters to both the doctor and nurses. She sat and did that, and then we delivered them together.
She marched bravely back to the clinic although by this time she was quite embarrassed by her behavior.
The doctor had a sweet, almost fatherly, talk with Mikayla about how important it is to be brave, and how nice it was to get the apology. As we left, he gave me a thumbs up and murmured, “Good follow through Mom.” I could have kissed him as I thought: “Thanks. I needed that!” I'll always be grateful to him for his encouragement and to Love and Logic for tools that bring the light through parenting storms.
In summary, let’s review what worked for this mom:
  • Filled with emotion, she remembered life is a lesson to be learned and put the emotions aside and started thinking.
  • She remembered that her daughter wanted power, so she gave her daughter choices within limits to fill her daughter’s need for control of her life, but also subtly put herself in increasingly in charge of the situation.
  • Both the mom and the staff were clear about consequences and Mikayla knew her mother’s word was gold, so consequences were viewed as a fact, not as a threat.
  • Because the mom (and staff) were factual and not angry, there was no blowback of resentment from Mikayla.
  • Wise people “get over it”.  After the event was over, Mom did not “chew" on the behavior and show continuing angst.
  • Mom remembered that undoing, apology, or restitution (depending on the situation) is almost always required when another’s feelings have been hurt or other people have been inconvenienced.

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Foster W. Cline, MD is a well-known child psychiatrist and co-founder of Love and Logic. Lisa Greene is the mom of two kids with cystic fibrosis and a parent educator. They have written the award-winning book “Parenting Children with Health Issues: Essential Tools, Tips and Tactics for Raising Kids with Chronic Illness, Medical Conditions and Special Healthcare Needs” available at www.loveandlogic.com. 

For free audio, articles and other resources, visit http://www.ParentingChildrenWithHealthIssues.com.

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