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21 April 2012

Compromise.... Negotiate?

I get it - Life often requires compromise or negotiation.  If I have a kid who doesn't want to sit on the disk but will sit on a large exercise ball --- do I fight him?  Do I demand he sit on the disk?  Why?  Sitting on the ball will accomplish the same goal.  One kid likes hockey another likes bowling... either works for me as long as we are in high kneeling working on motor control and strength.  Yet to some people this is me being pushed around or having no backbone.  Interesting.

I learned a long time ago that when dealing with children there is one requirement and then you expect the unexpected.  That one requirement? FLEXIBILITY.  It pains me each day to have details of my treatment plan analyzed, terrorized, and criticized.  Kids are not the same as adults and for those of you who think so --- you obviously have not worked with a lot of kids.  Last summer I would plan  each treatment in my head --- it looked something like this:

  1. moist hot pack
  2. stretching
  3. pendulums (10x2)
  4. wall crawls (10x2)
  5. isometrics in doorway 
  6. pully (15x2)
  7. ER/IR with theraband (15x1)
  8. AROM with bar (10x1)
  9. PROM with manual assist
For an adult -- this works ---they will go in each day and do what you ask just how you ask it.  Some get annoyed when things change.  The flexibility required is in progressing the patient --- whether in pushing AROM more, increasing weight, progressing an exercise.  You progress and they do it.

With kids --- It's different.  Each day finds the child wanting to play something different.  Oh there are some things that remain constant -- like my little man's love of hockey or my little girl's love of anything with princesses.  But everything is fluid.  The plans I'm required to give sound something like this:
  1. supine stretching of knee flexors (15sec x3 B) <-- I won't even go there...
  2. sitting on yellow egg for 8min working on sitting balance, equilibrium responses, and sitting posture.
  3. high kneel at high mat working on puzzles for 8min with assist for anterior pelvic tilt to work on posture, endurance, and strength of hip region
  4. Skin Check
  5. Don BAFOs
  6. standing at high mat with Sponge Bob connect four 10min with assist for ant pelvic tilt and knee ext to work on standing posture, endurance, and strength.
  7. Ambulation --- walking with pacer with BAFOs 100'x2.  Will require min-mod A at BLEs and modVCs for flat foot during stance and knee extension.
  8. Either doff BAFOs and skin check or advise parents of AFO schedule and check back later.
Stupid--- you know why?  Because I know why I am doing the things and because today she wants to sit on the giant purple therapy ball and paint by number.  She no longer wants to be a doctor and play operation she wants to play ant in your pants.  Sponge Bob Connect Four is being used by another child and standing today  requires more assist at the knees and no assist at the pelvis.  After 80'x1 pt is complaining that her feet are killing her and AFOs are removed and skin check performed.  We are now going back to paint more while we wait on the redness to subside and calm my crying patient.  This is what I do every day.  SO... In my head it is like this:
  1. Stretch
  2. Sitting Balance - egg'ish
  3. High Kneel with activity
  4. Standing with activity
  5. Walking
So much easier......

This week is an interesting negotiation.  I finally have my darlin' girl out of bed and walking but it's a struggle after being in bed for so long.  It's exhausting, it's painful, and mentally taxing.  And so.... the negotiation comes into play.  She works really hard this week and we really push it to make as many gains as possible and....... She gets to give me a makeover and make up lessons at the end of the week. Part of the negotiation is that I go out for drinks or dinner after work with my make up intact.  This could be interesting.  She tends toward the blue or purple hair, roller derby side of things..... but apparently is a whiz with eye make up.  I don't have much room to complain.  When I do my make up (yes - i do it---- approx 2x/year :) )  It either looks like I have nothing on or I appear to have two black eyes.  So we'll see how this goes.

I love what I do.  I wish I could start studying now for my boards and graduate soon so I can find a inpatient pedi (pediatric) job.  It is exhausting.  It is emotionally taxing on the best days and the worst.  But it's what I know I am meant to do.

This week a doctor said this "You have an amazing way with children.  I came into children through medicine and I love them.  But it is obvious that you came into medicine with an amazing love for children.  I'm look forward to learning a lot from you during your time here."  She now observes some of my sessions and asks me questions on dealing with kids.  I am a true believer that everyone has something to teach.  The student learns from the teacher and the teacher learns from the student.... as long as all involved are willing participants.

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