A Deeper Diagnosis

It has been a little bit of a rough month.  I knew something wasn’t right, but I couldn’t quite place my finger on it.  Everything was just a little bit off.  Early in the month I had caught a cold on vacation in Cancun, but that had eventually gone away.  And yet, I still did not have my usual energy.  I wasn’t a hundred percent.  A little lethargic…a little tired…a little off.  Just not right.

I definitely wasn’t prepared for a difficult night of deep, painful chest pains that took me by surprise and also took me to urgent care the following day.  A place that I avoid whenever possible.  I joke that I would have to be hit by a bus before I will go in to see a doctor.  However, the severity of the chest pains were definitely concerning and unnerving.  So urgent care was my morning destination.

After arriving, I checked in, took a seat, and waited my turn.  After a short wait, I was called in by the nurse for a quick run over of my vitals.  While checking my blood pressure and a quick review of my paperwork, the nurse off-handedly asked if I was having chest pains?  Not thinking it was a big deal I let the nurse know that I had and was still having some chest pain.  With that, she quickly wrapped up and excused herself.  Before I could fully comprehend the level of concern that answer had caused, the head nurse was standing in front of me asking some very direct questions… Was I having chest pain now?  Did the front desk ask if I was having chest pain?  How long and how strong were the pains?  How long did I sit in the waiting room?

And topped it off with please come with me…

I was whisked down a hallway to an emergency area of urgent care.  Told to lie down  as two medical technicians hooked up an EKG monitor to my heart.  They were definitely concerned.  It was obvious that the words ‘heart pain’ set off alarms and a very concerted and systematic response.  It was obvious that they were more than slightly annoyed that protocols and procedures were not followed at the front desk level.  That any patient was allowed to remain sitting in the waiting room with chest pains.  It was very clear that the protocols and systematic procedures were to be followed and taken seriously.

Fortunately, the EKG readings came back normal and I was allowed to return to urgent care to meet with my regular doctor…who happened to be running late.  I was actually starting to feel much better, and maybe a little bit foolish.  Perhaps I overreacted to the pain.  Except about ten minutes before my doctor came in, the pain come back so quick and strong that I actually had a difficult time explaining the concerns with my doctor.

Still concerned, even with the EKG reading,  I was provided a painkiller and sent for an x-ray and blood sample.  An hour later, the reviews were in and it was definitely not heart related.  Nor did it seem to be lung related.  The best he could determine was that it was muscle related, possibly deep muscle spasms.  So, Ibruprofin was the remedy of the day and I was off for home.

However, a following day call from the doctor pinpointed the real issue.  The x-ray determined that I had pneumonia.  Most likely, it was from the cold that I had caught at the beginning of the month on vacation.  A cold that I believed gone, actually turned into something a lot worse left unattended.

And yet, pinpointing the pneumonia and a remedy of antibiotics was not the end of the story.  A CT Scan was prepared to place any doubts of other concerns off the table.  While I thought that it might be a bit much, I was informed that they wanted to be precise in their assessment or diagnosis of the problem so that they could treat it effectively and efficiently.

Still considering it a bit much…I also found it reassuring that they wanted to be completely accurate with their diagnosis and method of treatment.  Instead of taking a wide sweep at solving the first problem encountered, my doctor continued to drill down.  Drill down to pinpoint the exact issues.  He was after a deeper diagnosis…

And how often does that happen for the students in our classrooms and schools.  We take a wide, sweeping approach to their academic concerns, hoping that a general remedy will resolve the issue.  Whereas, what we really need is a deeper diagnosis.  A deeper diagnosis if we are going to have a better probability of directly providing the correct and necessary support.

Yet, very much like the attention to my vacation cold, we often wait too long before we recognize and attend to academic concerns.  As it would have been appropriate for me to visit my doctor upon my return from vacation…it too is appropriate to enact measures in our schools, such as universal screeners that serve as a check-ups.  Academic check-up that keep our struggling students from falling farther behind.  Many students often require deeper levels or intensity of interventions as their learning struggles are left unattended or unnoticed for long periods of time.  Interventions that would not have been as necessary with early detection, with immediate support and ongoing monitoring.

In their first book, Pyramid Response to Intervention, authors Buffum, Mattos and Weber refer to this as “Learning CPR”.  While I may have felt a bit foolish, I was very impressed by the intensity of action when the nurse heard ‘heart pain’.  A systematic level of protocols and procedures were enacted immediately.  Everyone had clarity in responsibilities and measures to put into place.  The question is…do we approach our students, those who are having academic ‘heart pain’ in the same systematic manner?  Do we have the same sense of urgency?  Do we raise our level of intensity immediately?  And most often, the answer is not reassuring…

Buffum, Mattos and Weber discuss it in their book as the “Appropriate Response to Learning Emergencies” and/or “Learning CPR”.  And if we are to be effective, our “Learning CPR” must be:

  • Urgent
  • Directive
  • Timely
  • Targeted
  • Administered by Trained Professionals
  • Systematic

The hospital served as a model for “Learning CPR”…their response was systematic with obvious preparation.  Their response was united.  They acted quickly and precisely.  Their response was urgent, to the point of embarrassment.  Their response  was directive…I was not invited to an EKG, it was necessary, so it was required.  Their response was timely…there wasn’t any hesitation.  ‘Chest pain’ led to immediate action.  Action taken by the appropriate personnel.  Personnel that knew how to administer and read an EKG.  All of which was done systematically.

This provides great ‘food for thought‘ for the coming year, both in our classrooms and our schools.  Are we responding appropriately and urgently for our students with academic warning signs in our classrooms?  Do we know what our protocols and actions will be?  Are those actions systematic?  Do they extend to all students?  If not, what needs to change to make that a reality?  Our PRTI authors, Buffum, Mattos and Weber remind us that our reactions must be “urgent, directive, timely, targeted, systematic, and administered by trained professionals”

Don’t wait for minor concerns to turn into major issues and then try to attend to them with wide-sweeping, non-targeted interventions and hope to remedy the problem.  We must diagnose and assess often and attend quickly to our struggling students.  Let’s take a deeper approach to diagnosing our students for their academic health and academic success.  When students struggle…everything seems a little off…everything seems a little more tiring…a little more stressful.  Just not right.

4 thoughts on “A Deeper Diagnosis

  1. Great post, David. I hope you are beginning to feel better-pneumonia is serious business and can be life threatening if not treated in time. I’ll think of this event as I work to know and serve the students well this year.

  2. Hi David,

    While I am sorry you are not feeling well, and hope you recover quickly, I do love this post! It is such a great reminder that we do need to act seriously, appropriately, and swiftly with our students who are demonstrating difficulty in school. It is not fair to wait until things are really bad. Our responsibility is huge. These studens rely on us educators. We must do it right, for them. I love the “Learning CPR” analogy and description.

    Thank you for your post and I hope you are better real soon. Take care of yourself!

  3. I like this post David. We are often told to make learning personal and attach it to what we already know. This is an excellent example of connecting real life to school life. Well done!

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