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Case Studies

Language: English
Context: Ambulatory
Title of document: Today at school I had a problem
Name of compiler: Sabrina Grigolo
Actors involved: Healthcare professional
Description of the experience:
"Today at school I had a problem". If S. begins the physiotherapy session this way, it means that something that's really important has happened. S. is a positive, clever and sensitive kid of 12 years old, and he attends the second year of secondary school. He started to use a wheelchair a few months ago.
S. struggles daily against a dystrophy that is slowly eroding his life.
I stop massaging the tibio-tarsal joint that I have just started and listen to him. It is not necessary to ask questions, S. continues "Today I did not manage to stand up to pee at school". I knew this moment would come, but anyway I am taken a little aback. S. understands my questioning look and then goes on to say “It’s two weeks since I started having much more difficulty in standing up, I have not said anything to anyone because I thought (that is, I hoped) that it was a temporary problem". I ask him to tell me again in details (he already told me about it in the past, when there were no particular problems) about timetables and organization of the school, as well as timetables and access to bathrooms. While we are talking, I continue to massage him, slowly, as if to make the session appear as a usual one, but we both know that we are paying attention only to what we are saying. We try to deepen the more complicated aspects of the question: daily attendance, presence of friendly mates, teachers, ATA staff. We immediately understand that we must distinguish moments and procedures: urinating and defecating require completely different approaches. S. is purposeful, he has in mind some solutions that would be fine for him; for my part, I recommend him some ideas that he immediately accepts. We try to see the pros and cons of the various possibilities. We think a lot and then we work out a path that should work, but S. says "There is a problem!" How come? Everything seemed to go on pretty smoothly, at least in theory, it seemed that we had done a good job but S. reminds me that the ATA staff of the school is made up only by women and this is an insurmountable problem for him. I think "But he is only 12 years old!" But then, immediately after, I correct myself "It’s true, he’s already 12 years old!".

An hour has passed, I has just finished to massage him (today it has been really passive). We commit ourselves to reflect on what we have said, to seek other technical and organizational solutions, to imagine things that can help us, to think of acceptable compromises. I promise to talk with the other operators who know him, to contact the School Headmaster and to arrange a meeting with his teachers. He seems to be happy and, to tell the truth, so am I. We will resume the topic several times afterwards, there is still something to be improved, but somehow we go on.


Objectives:
I knew this moment would come, but anyway I am taken a little aback. S. understands my questioning look and then goes on to say “It’s two weeks since I started having much more difficulty in standing up, I have not said anything to anyone because I thought (that is, I hoped) that it was a temporary problem". I ask him to tell me again in details (he already told me about it in the past, when there were no particular problems) about timetables and organization of the school, as well as timetables and access to bathrooms.
Means and Strategy:
An hour has passed, I has just finished to massage him (today it has been really passive). We commit ourselves to reflect on what we have said, to seek other technical and organizational solutions, to imagine things that can help us, to think of acceptable compromises. I promise to talk with the other operators who know him, to contact the School Headmaster and to arrange a meeting with his teachers.
Conclusions:
He seems to be happy and, to tell the truth, so am I. We will resume the topic several times afterwards, there is still something to be improved, but somehow we go on.
Name of Institution: Gradenigo Hospital
Role: Project Manager

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