This morning my son fell down the stairs, using his eye brow to cushion the blow. The same place where he’s landed twice before, with the scars to prove it. This time wasn’t so bad though, so after a cuddle on the sofa with a bag of frozen peas on his enormous goose egg, a Motrin and a kiss, I loaded him onto the bus.
Throughout the day I heard from his school nurse, who is a wonderfully caring man. He was extremely concerned, and as the day progressed his concern didn’t lessen. Finally he suggested that I pick my son up early and take him to the doctor. The swelling should have gone down by this point, he felt.
For a variety of reasons, I hesitated to say I’d be right there. It was my son’s bus driver’s last day of work. They are great buddies and I couldn’t imagine what it would be like for either of them to end their relationship without a chance to say good-bye. More importantly, while I’m concerned for my son’s health and safety, I’m also concerned about pulling him out of school unnecessarily. He misses lots of school for doctor’s appointments and evaluations. My mother-sensor told me he’d be OK.
I told the nurse I’d get back to him in a minute. I then called the triage nurse at his pedi’s office. She thought he sounded like he’d be just fine. The swelling would take a couple of days; no amount of ice would do it.
I then had the awkward job of calling the school nurse back. I could hear the disbelief in his voice when I told him that I’m not coming. I did my best to explain my reasoning, but I sense that he doesn’t agree with the pedi office nurse’s take on the situation. I’m stuck in the middle of the two of them like a child of divorced parents who aren’t on speaking terms, tossing out phrases like “subcutaneous tissue” and giving him advice on five-minute on/25-minute off icing strategies. It’s not particularly fun or useful for our relationship.
I had asked the school nurse to send me a picture of my son’s bump. At first he told me he couldn’t, but he must have worked hard to get the school to bend it’s policy of not using personal cell phones to take pictures of students (because of course there is no school phone to do this with). I asked the pedi office nurse if I could send the picture to her. She said I couldn’t because they had no secure way of receiving it. They have an electronic messaging portal, but you can’t send images to it, only text. What goes unsaid is that in our current health care payment system, there’s no way for my pediatrician’s office to bill for looking at email, either.
In my mind, I envision the future. Here’s what it looks like:
My son’s school nurse calls me with his concern. I securely video conference in the triage nurse at his pedi’s office, who can see his injury. I let them talk through the medical issues, being present to represent what I know about my son and what’s important to him–staying with his friends in school and saying good-bye to his bus driver. My doctor’s office can bill for this time. Within minutes we have a plan and we all agree about it. We go on with our day.
Until then, we’ll hobble along with a broken system and without the right tools, missing school and work unnecessarily, losing money and time to learn, or feeling guilty and awkward because we can’t all get on the same page.
Integrated family-centered care can’t come soon enough in my book.