The boy has only gone a broken his collar bone! It was after a tackle during a football match at school. He heard the bone crack. We waited in casualty to have the news that he had fractured his clavicle, he would need to wear a sling, he would need to come back to fracture clinic in a week, he would need regular pain killers. All the usual stuff.
For a day or so he was dutiful patient. Wearing his sling as symbol of his heroism. Then the pain got more manageable. The sling has become an irritant. Maybe he was cured already. Maybe they were wrong. Maybe his bone could change the whole of medical science and heal itself in under four days.
He takes his sling off. He swings his arms around. He is falling out with people. His mood swings from placid and loveable, to hostile and aggressive. He is a teenager remember, off course he is invincible, he is immortal. But when he was younger, he was neglected. He was left alone. He went without food. His needs were not met. His body coped. His brain wired itself to survive in the most hostile environment.
When he hurt himself no one would come. Once he was left in the sun as a toddler until he burnt and was admitted to hospital. The adults didn’t help or care. They didn’t keep him safe. So now, years later, despite being safe, nurtured and secure, his brain is fighting to keep himself safe. How can he trust anyone? Why would anyone look after him? When he was helpless, he was neglected.
Now he is older he is able to look after himself, and to defend himself. He was found with a whole packet of 12 paracetamols in his pocket. I do believe they were for his pain, nothing else. He needed to take control of managing his pain, in case he was let down again. He takes his sling off because he has to be better, he can’t be injured. In the same way the lion will go after the weakest antelope in the herd, he has to be strong. He makes a scene while taking his sling off, he says “look I am better!”, inside he is shouting “I am frightened! I don’t know what to do!”. He turns against those nearest to him, pushing them away, he might as well, because they will reject him anyway. His rugby team were all his mates, now they will forget him and move on. The most diligent meerkat is soon rejected and forgotten after the smallest misdemeanour.
So we go back to basics. We have to be safe. We wonder why he won’t keep his sling on. We find compromises, but stick to the rules to keep safe. We take the control back – when to give pain killers, not waiting until they are needed, but when they are due. We make sure the sling is comfortable. We empathise and sympathise. It is the first time he has ever really hurt himself. We don’t patronise, we listen. We build the scaffolding back up – it’s just a short time. We think think how quick the time is going – the first week is nearly over already. We look forward to the fracture clinic to see things how things are going. We find ways to do things together – easier to put the affected arm in his shirt first when getting dressed. We allow him to be independent as much as possible, but then “let me do that for you, to help you”. We do the running commentary on progress – he can do this or that now. We find new responsibilities, to replace the ones not able to do for the time being. We have time together. We have played board games every night since the accident. I am taking him to school instead of the school bus. He said this morning “I like having this time together on a morning, just you and me”.
We are rebuilding, mending the broken ties….