Three nights ago AJ fell off his swing in the backyard; he landed awkwardly and injured his 5th finger on his left hand. It swelled instantly and – while he was trying to put on a brave face – it was clear that he was hurting and worried when he re-entered the home.
“Why does it hurt, Daddy?”
I placed him in a chair. I sat on floor beneath him. I asked for permission before manipulating his (uninvolved) right hand and fingers while I tried to explain to him what was happening.
I explained that he has all of these little “feelers” in his finger that are sending messages to the brain all day long … he wasn’t following me yet and had no idea where I was going. Time to change tactics – quick. “Don’t lose him,” I thought to myself.
I asked him to concentrate for a moment and tell me what he could hear in the room (it was a nice distraction and refocused his attention away from the throbbing finger) – he could hear the fridge running. As we talked about how it is that he hears things, he recognized that his ears hadn’t suddenly worked to hear the fridge and the fridge had been running all along – his attention had become more pointed. I told him that the “feelers” in his finger worked all day and he usually ignored them (like the fridge) unless something caught his attention…banging his finger on the ground was sudden and alarming for those feelers, just like a loud thunder clap in his ear. His eyebrows raised … now he was with me.
[forgive the homuncular fallacy] The feelers – I told him – provide information to the brain like gauges on the dashboard of a stock car … more often than not, the driver is too busy driving to pay attention to what the gauges say until the crew chief asks him to look (just like the fridge running). But, occasionally, the gauge will start to flash colors to attract the driver’s attention, like a thunder clap. Sometimes the driver needs to worry about the flashing light (“Oh no, the car is over-heating!”) or you need to worry about lightning (“I have to get inside!”). But, sometimes the driver doesn’t need to worry (“Who cares? There’s only 2 laps left.”) and the lightning is of little concern (“Phew, I ‘m glad I’m not outside, I’d be getting soaked.”). In each example, though, the flashing light or the thunder clap is almost sure to get your attention. [/fallacy]
The pain in his finger was simply his mind’s way of getting his attention so that he could figure out if something else needed to be done. Sometimes it is clear what a driver must do, other times he may not know. Sometimes he needs to ask his crew chief for advice when the gauges are confusing or he lacks confidence. I explained to AJ that when his finger hurt like it did, it can be confusing, so he asks his crew chief (me) what is going on and what he needs to do.
[He was now agreeable to me gently assessing the finger, gently moving each little joint, finding where and when his pain was the most severe while I knew that the findings of my “assessment” were extremely unlikely to change the trajectory of his care.]
He was able to understand that that he has “feelers” everywhere in his finger – I showed him a picture of nerves in the hand and explained that the feeler’s job is to inform the rest of his body/brain what is going on down there. He appreciated that if noises are too loud, he feels compelled to place his hands over his ears to protect them – the feelers don’t tell him to cover his ears, his mind simply tries to find a way to reduce the noise.
I explained how the new messages from all the feelers started after they got banged around in a way that is not at all normal (possibly “jamming” the finger) and it is surprising for all these messages to be coming from these feelers that are usually quiet. I explained that the best thing he can do for it to feel better is to protect (splint) it initially, but occasionally to move it to tolerance – after all, the first clap of thunder can be scary, but if it is a long storm, we get accustomed to the sound of thunder before the storm completely passes.
I explained how the straps that hold his bones close together can become strained and that the feelers in the straps might be sending signals to consider that the straps may need some time for repair – “Kinda like when we fix the cracks in our driveway … if you patch and re-seal a driveway, you can’t drive a car on it for a few days. right? But you can walk on it without doing any harm to it.” Again, the best thing he can do for it is to protect (splint) it initially, but occasionally move it to tolerance.
I even explained how bones can fracture, but the same process is true for bones as it is for ligaments (straps) – the best thing he can do for it is to protect (splint) it initially, but occasionally to move it to tolerance.
No matter what was happening beneath the skin, the plan would be the same and he would likely feel a little better after splinting it with a popsicle stick. 3 days later, it is still swollen and a bit black/blue, but he is moving it more freely, going to camp, and playing with his new (unpredictable) puppy. He is not going to taekwondo tonight; he can’t yet make a fist, but he is feeling better. Perhaps it would feel the same today no matter what I had said or done that night. Maybe not. I don’t know and wouldn’t dare to guess – I know better.
What I do know, though, is how cool it is to watch the anxiety related to pain fade from my son’s face after a brief 5-10 minutes of conversation. And while I doubt the intensity of his finger pain changed, his breathing quieted and deepened, he slouched in his chair, and he even grinned a bit.
Kids get this stuff – it is intuitive. It just needs to be framed appropriately.
Thanks to Bas for inspiring this post.
Keith's Korner 