Nahva Follman

                                                         בס"ד

סיון, תשפ"א

The Katz’s nine-year-old daughter, Fraidy required a blood test.  Bad news for the Katz’s, because Fraidy was not about to allow a masked nurse to come anywhere near her, let alone to insert a needle into her arm.  Fraidy was quite vocal about her resistance too, “No way!” She shrieked as her mother tried to cajole her in the public clinic.  “Leave me alone!  Don’t touch me!  I’m leaving right now!”  Mrs. Katz looked like she was also about to cry, as she physically held a struggling Fraidy, and firmly informed her that she was going to have this blood test come what may.

But the mother was no match for her wriggling daughter, so she called in the cavalry- Mr. Katz.  Together they simply picked up their screaming charge, walked into the blood-taking room, and while Mr. Katz gripped his daughter tightly, the nurse did her ‘dirty work.

But Fraidy had the last word, and white as a sheet, she began retching and heaving, again and again.  While the nurse and Mr. Katz ran to clean the floor and walls, Mrs. Katz led a limp and defeated Fraidy to a clinic bed where she could lie down.

Does this story make you critical of Mr. and Mrs. Katz?  Or are you thinking sympathetically about what a difficult child they have to contend with?

Are you feeling sorry for poor Fraidy – an innocent child in a cruel world?  Or do you agree with one of the people in the waiting room who was certain that the parents ought to give two ringing slaps to this kid and put her in her place?

In all truth, the parents are both wonderful people; a caring, united and devoted couple who try to do what’s best for their child.  And Fraidy? - She’s mostly a robust, sociable, well-adjusted child.

So what went wrong in this scenario?

1. What’s happening?

1. Is it a problem?

1. How to re-focus?

1 A child requires a
medical test.  This is a non-negotiable need.

  Maybe the child’s doctor and the parents think this is non-negotiable, but the child does not.  There is a basic difference in beliefs.  Are there alternatives?

  Find the common ground.  This part is on the cognitive and less emotional level. For example, “Fraidy, don’t we all agree that you need to be healthy?”

2 The responsible parents are the ones charged with carrying out this dangerous mission.

  Does the child see the parents as kind and trying to help despite the unpleasantness, or as the enemy?  And if she has a negative take now, could it have a negative impact on the future parent/child relationship?  Are there other situations where she sees the parents as the enemy?  

  This needs to be checked.  The child must be convinced by our tone, actions, and body language that we are friends and not foes.  Even if the child disagrees with our insistent stand, if they are convinced that we love and care for them deeply, then they will not see us as betraying their trust.  They must feel secure about our commitment.

3 The child vehemently disagrees with 1a and 2a above and is not about to give in.

  This is one of the most important points.  We see the child’s resistance, but where is the resistance coming from?  Is the source of her contrariness expressed?  Is it understood?  And most important, is it addressed?

  The child is not resistant simply to be contrary – there is a reason.  And when in an emotional state, the child is unlikely to know the cause of her agitation, and even if she did may lack the vocabulary to describe it.  She needs your help to recognize her emotional turmoil. 

   What is at the root of her reaction?  Is she lacking information or is the source emotional? Help her zero in by asking pertinent questions, and considering multiple possibilities.

   For example, you’ll want to check the levels of fear, distrust, previous trauma, body association, general nerves, and anxiety.

4 The child is forced against her will.

  The parents are the ones with the power.  Besides, they’re two against one with the nurse for backup – how does this affect the child?

  Although you do want your child to learn to reverently submit to your authority, how can you ensure that your child will not be distanced by seeing you as too forceful a tyrant?  Are you allowing your child to express her feelings, doubts, concerns safely? Does she feel that you truly care about the real her, or that she is an object that needs to be maintained much as the car needs to be kept in working order?

5 Mission accomplished for the blood test, but the child suffers a significant physiological reaction.

  How do we define success in any given scenario?  How do we measure failure?

  In any relationship people sometimes gauge success by getting the other to do/perform/say/ think what they desire.  That might really be a success for one’s agenda, but is it at the expense of success in the integral relationship?  No relationship can endure successfully if one party feels discounted, discredited, disrespected or not really cared for.  The parents may have gotten the blood test done, but they want to have a daughter who feels connected to them at the end of the exercise.  Did that happen?  

Let’s consider an alternative scenario; one in which Fraidy’s emotions are addressed…

 Mrs. Katz approached her daughter.

“Fraidy, Dr. Heal is concerned about your lack of energy since you had that flu last month.  He’s not sure if you have a lingering infection or whether your iron is low.  Do you know why iron is important, Honey?”

Fraidy shook her head.

“Iron is one of the ingredients that helps your blood bring oxygen to your whole body.  Iron is a mineral that must be in the correct amount in order for you to feel energized.”

“Oh.” Fraidy accepted her mother’s explanation.

“In order for Dr. Heal to measure your iron level, he’s sending you for a blood test.  Tomorrow I’ll be taking you for a blood test at the local health clinic.”

Fraidy’s body went tense, her eyes opened wide.

“What do you mean a blood test?” Fraidy asked cautiously. “Is it the same as a shot?”

Mrs. Katz remembered the times that Fraidy tensed up when needing to receive her booster vaccine shots.  She had shut her eyes tightly, clenched her fists, and with a pale face and trembling arm, she girded herself for the torturous needle, while someone gripped her arm.

Fraidy shuddered at the thought of the three times she was vaccinated, each time being absolutely sure that she would faint.

“It’s similar, Honey, but not exactly the same.  A shot is putting medicine inside your body, and a blood test is taking a very small amount of blood out so they can check it.”

“Take my blood out?” she squeaked, as tears pooled in her brown eyes.  “I’ll die!”  Fraidy could feel the blood draining from her face and her knees going weak.  “What if my blood gets finished?”

Mrs. Katz should notice some significant information about her daughter:

1.  ‘I’ll die!” –fear of death or destruction.  

2. “What if my blood gets finished?” – Distrust of the process. Lack of information and proportion.

3. A squeaky voice, turning pale and jittery – a physiological reaction is telling you that the child is experiencing overwhelming emotion, in this case, fear and anxiety.

Now is Mrs. Katz’s chance to move into action:

1. She puts her arm around Fraidy and holds her close.  This does a lot: it tells her daughter that someone nearby is supportive, caring, containing, accepting her, reassuring.  There is empathy, not a trace of criticism, and calming energy.  This alone diffuses some of Fraidy’s tension and makes her more receptive.

1. Mrs. Katz removes two one-and-half-liter bottles and a teaspoon from her kitchen.  She shows them to Fraidy.  “You see these two bottles?  That’s about how much blood you have in your body.  And you see this teaspoon?  That’s all they need to check your blood.  Your body continues to produce blood all by itself and the small amount that’s taken is not missed until it’s replaced.” Mrs. Katz is providing information, and creating proportion in Fraidy’s mind so that she can see tangibly that this is not a fatal mission.

1. “I myself have had blood tests dozens of times; do I look like I’m missing any blood?  Do I seem to be bleeding or in pain?  And I hope you noticed that I haven’t died from the experience.  The people whose job it is to take blood are very well trained, and know-how to remove the blood safely.”  Mrs. Katz is making the experience relatable. She is also creating trust.  Just as you can see that I’m telling the truth because these blood tests didn’t hurt me, so the people who will take care of you when you do the blood test will be reliable professionals.

1. “Are you afraid of the blood test?”  Mrs. Katz gets to the root and names the feeling.

Fraidy nods weakly.

“Are you still afraid you’ll die?”

Fraidy shakes her head.  “People don’t usually die, but what if something terrible happens to me?  What if I can’t manage?  What if it’ll hurt too much?”  Tears fall softly down Fraidy’s cheeks.

“I’ll tell you a secret, Fraidy,” her mother whispers, ‘sometimes I’m also afraid.”

“You are?  Of what?” Fraidy’s tears are subsiding.

“Of lots of things.  That I shouldn’t crash the car, of saying something silly and people will laugh at me, that nobody should hurt by amazing children…”  Mrs. Katz has normalized the emotion of ‘fear’.

“And what do you do when you’re afraid?”

“First I try to think what I’m afraid of.  Am I afraid of embarrassment or of pain or of bad people?  Sometimes, I might need someone to help me figure it out, but once I do, I can choose the right tool.”

“Tools?”

“That’s right – for example, if the fear is making my body feel tight, I try to take slow deep breaths to feel less uptight. Deep breathing is a tool.  It helps me calm down.  If I’m afraid for my children, I pray that G-d watches over them. Prayer is another tool. If I’m afraid that I’ll mess up, I imagine myself succeeding.  What tools do you suppose can help you to feel less afraid of pain?”

Fraidy looks at her hands as she thinks about the question.  “I can close my eyes while they take my blood, and I can imagine that there is a faucet that they’re turning on, and then off.  I can remember that it’s just for a short time, and count till a hundred.”  She suggests.

“Those are good ideas.” Fraidy’s mother compliments her.  “And also, I’ll be right alongside you, and you can squeeze my hand as hard as you want.  Shall we go get ice cream when we’re done?”

Fraidy finally smiles at her mother.  “Can we?  I’d love that!”

1. Mrs. Katz continues to be available for any other questions, trying to imagine all possible fears and concerns.  By the time Fraidy actually has the blood test the next day, her mother has addressed her fear of the unknown, fear of death, fear of losing control, fear of abandonment, fear of pain, she has received clear age-appropriate information, tangible demonstrations, and simulation, warmth, empathy, and containment.  None of this has been at the cost of performing the medical procedure, and Fraidy is still nervous, but now her anxiety has been reduced to a manageable level without causing such a severe physiological reaction, and potential long-term trauma, or distrust of her parents or authority. Instead of being her enemy, her mother is her ally.

1. After the procedure, her mother processes, “Fraidy, you were a real trooper!  Even though it was hard for you, you succeeded!  I’m proud of you!  How did it go for you?”  This is a very important step since you are not assuming anything but allowing Fraidy to share her experience.  She might say, “It hurt much more than a shot, and I’m never going to let anyone do this to me again!” or she might say, “It wasn’t as bad as I was afraid of. But, Mommy, do I have enough iron now?”, or she might give feedback, “Yes, it was so helpful that you explained it to me, Mommy.  I kept picturing the special factory inside my bones making more and more blood for me.” 

By speaking to the heart, and giving the emotions their place, we are building relationships that are sure to be healthier and more cooperative, connected, trusting, and mutually respectful. And the tools acquired from successful emotional navigation will open up vast channels of healthy function in many interactions to come.   

Miriam Miller MSc. Is the co-author of “A Boy Named 68818”, a memoir and learning tool for Holocaust study. She is a practicing family therapist, date coach, and Kallah teacher in Jerusalem.  She can be reached at likrat.nisuin@gmail.com or +972-52-760-4452.