A Country Doctor Writes:

Autumn’s 17 month old nephew from out of town had been visiting with us in the office the other day. He sat in his mother’s arms as Autumn showed her sister, April, around the clinic. We had made brief eye contact then. He had the hesitant look of quiet amazement as he looked around our busy office. I minimized the EMR on my big computer screen and showed him the picture of my white Arabian horse standing next to me, all bundled up in my thick leather jacket with a blaze orange vest over it. Dylan’s eyes locked on to the screen as the two women talked. They stayed locked on and he didn’t seem to register my attempts to make contact. After a few minutes, April signaled she had to be going. Autumn and I both waved and Dylan strained his neck, gaze still fixated on my computer screen as his mother turned around and stepped into the hallway.

Friday, Dylan was in my schedule for fever and vomiting. Both his mother and father were there and Autumn was in the room with them.

Dylan didn’t appear to be all that sick. I sat slouched on my stool while I took the history and then slowly moved closer to the exam table and began to examine Dylan in his aunt’s arms.

Autumn and April commented from the beginning on how difficult Dylan usually is to examine. I plodded along slowly without any protests. I checked his neck for enlarged lymph nodes and carefully pulled the stethoscope from the pocket of my long white lab coat.

“I don’t believe that he’s okay with you doing that”, his mother said as I listened to his heart and lungs. I squeezed his belly very gently as I told his mother that his lungs sounded nice and clear. His abdomen was absolutely soft and he didn’t seem bothered by my palpation.

Next, I slowly pulled my pocket otoscope from the holster on my belt. Dylan watched intently as I unfolded the instrument.

“See how this works”, I said in a low voice and turned the light on. I aimed it first at my left hand and wiggled the light a little. Dylan’s eyes followed my movements. When I aimed the light at the Disney figure on his shirt, he looked down, and his chin touched his chest. Slowly, I reached past the exam table and pulled an otoscope tip from the wall dispenser. “Let’s check your ears”, I said while I attached the otoscope tip.

Dylan’s eyes followed every move I made. I aimed the light at my own hand again, then I quietly reached over and looked in his ear while I very carefully pulled just a little at the tip of his outer ear. As he started to tighten his muscles I let go and pulled away. “That one looks okay”, I said as April and Autumn stood next to Dylan with wide eyes and open mouths.

His other ear looked fine, too. He didn’t tense up at all this time. I said “let’s check your mouth” and cocked my head up a little to be able to look through the lower portion of my bifocals. Dylan also looked up a bit, and his jaw muscles relaxed. Gently, I touched the sides of his mouth and opened mine a little. He opened his mouth in the same fashion and I pulled lightly on his jaw and his mouth fell wide open. I got a quick look at his tonsils and I could see that his mucous membranes were moist and normal in color.

“He looks fine. I think he just has a viral infection, so as long as he keeps taking in fluids and doesn’t develop any other symptoms, he should be okay”, I reassured his parents.

“He’s never let anyone examine him without fussing or crying”, April said. “I know”, Autumn chimed in. “He’s always been impossible to examine.” Turning directly to me, she continued: “I always knew you were good with kids, but this was truly amazing!”

“I also tame wild horses”, I said, overcome by an uncharacteristic impulse of flamboyance.

As I thought about my words, it seemed that the analogy is obvious. People talk of the “techniques” they use when dealing with mistrusting, unbroken rescue horses, sullen teenagers or toddlers with fear of doctors, but I never thought of any of it as technique. Approaching another creature requires genuine respect and connection, and it can’t be completely taught or analyzed.

After I ended up with my rescued Arabian princess and got to know her by just hanging out with her, sitting quietly in the barn cold winter evenings and sultry summer nights, she has come to trust me, and I her. When she was ill and too despondent to return from the frozen pasture during her first ice storm, I trundled out to her with halter and lead rope for the very first time, and she followed me willingly back to the barn.

Later, I have read about just this way of relating with horses, not by dominating them, but by earning their trust and respect. Carolyn Resnick calls it “The Waterhole Rituals”. The first and most crucial step is to place yourself near the horse without fixating on it, and enter a frame of mind that is peaceful and gentle. If you just do that, any horse will seek you out to make your acquaintance.

Approaching a sick child, or just a fearful one, requires the same frame of mind. There may be techniques to learn, like listening to the lungs right away, before any crying starts, and saving the throat exam for last, because if the child does start crying, you’ll see the throat anyway, and without effort. But those are superficial and secondary considerations. The kind, gentle and healing presence isn’t something you need schooling to learn. It is just a matter of having your heart in the right place. I also think it is important to connect on a level some people may refer to as “energy”; Dylan, the amazed visitor from another world, that of a gentle and curious seventeen month old, responds better to a quietly plodding softspoken “energy” or demeanor, while some older children with mischief in the back of their minds relax and connect better with a grandfatherly doctor with a twinkle in his eye and a joke up his sleeve.

As my practice has matured, I see fewer children than I used to, but I cherish the opportunities I do have to see young children. It’s like dusting off your old bicycle and going for a spin – you never forget how to do it.