Siblings of Sick Kids

This week, Wendy had four doctors appointments.  Four times we packed up and schlepped to a specialist or pediatrician.  Four times in the waiting room, four times for triage, four times in the exam room, five conversations with doctors, three with nurses, and one blood draw.

It was a tough week, a frustrating week, a week that even for us in this point in our lives is unusual.  Sure, we have more doctors’ appointments than the average family, but because it was school vacation week, we loaded up on the specialists so Wendy didn’t have to miss academic classes.  Add in a few problems and we got a few more appointments.  It was dismal.  It was awful for Wendy and was awful for me.

It could have been the worst, however, for my younger daughter, Penny.

Penny.  I got pregnant with Penny while we were waiting for a kidney transplant for Wendy.  We decided to name her Penelope after the wife of Odysseus.  In The Odyssey she is often called “Circumspect Penelope,” who is smart and shrewd, who has all of the skills of a politician, but who is known first and foremost for her patience.

We needed patience while waiting for the kidney.

There aren’t many worse times that I could have gotten pregnant.  I couldn’t handle some of Wendy’s medications because it was bad for the fetus.  I couldn’t go into the operating room when the kidney arrived because there were too many risks with anesthesia for a pregnant woman, and at the time I was in my second trimester.  We moved back to Vermont from Boston when I was in my 39th week; I gave birth three days later. Her arrival to our family was both joyful and grounding:  it served as a reminder that we couldn’t live in the past of Wendy’s medical history.   Suddenly there was another person who needed love and protection, patience and understanding.

Penny has never known a moment of her life without a sick sister.  To her it is the normal thing.  I remember when Penny was in kindergarten and she asked me when she was going to get her own kidney, when she was going to be a diabetic just like her sister whom she adores more than anyone in the world.  It was the same kind of questioning that I got when she asked when she could play soccer like her sister, run in triathlons like her sister or get her ears pierced like her sister.  The medical issues were just part of the deal.

When we go to the doctor now, Penny packs herself a bag of things that keep her occupied.  She’s reading chapter books now, so she brings one, along with an intricate coloring book and some markers.  Sometimes she will bring shopkins or stuffed animals to play with. She is exceptionally good at keeping busy.  She almost never complains she’s bored. But sometimes she wants to be on the exam table with her sister.  She often requests a snack after an appointment.  At our last appointment, she wrote me a note that said, “Mom, I love you.  And I’m Hungry.”

When I was a kid, we had dinner together as a family every night and 95% of the time my parents had cooked it.  I thought that’s what every family, everywhere did, and was shocked when I found out differently.  Sometimes I wonder if Penny will think that every family, everywhere knows exactly where to park at Massachusetts General Hospital, doesn’t need a map, knows the back door entries, walks to the science museum after a doctor’s appointment, goes to the park or picks the perfect place for lunch after an ultrasound.  That every family is comfortable in this environment, because we are.

I also wonder, and worry, whether Penny will look back on this time in all of the doctors’ offices and think it was all a colossal  waste of time.  For now, she’s too young to stay home alone, and we try to do fun things around the visits so they aren’t too onerous.  She is also too young for any support group for siblings of sick kids, and I wonder if she’ll want to go to them once she can.

The unavoidable truth is that a child’s illness doesn’t just affect the child who is sick, it affects the whole family, siblings included.

That’s one of the reasons that we moved back to the Boston metro area from Vermont.  When Penny was three years old and Wendy was post-transplant for three years, we weighed the pros and cons of moving to a town closer to Boston.  Yes, we were certainly moving to have Wendy closer to her medical home, but we were also moving so that there would be a community of support for Penny, so that we wouldn’t be four hours away from her when Wendy was in the hospital, or she wouldn’t be four hours away from her school, friends, and activities once she got older.  We were reassured that we had found the right community when numerous families offered to take Penny while Wendy went into the hospital a few months after we arrived in our new town.

Luckily, Penny is the kind of kid that just blends in with families, and even more luckily, we haven’t needed to rely on the good grace of our friends because Wendy’s been overall healthy.

One of the best pieces of advice I was ever given was, “As a mother, you are only as happy as your least happy child.”  We have to pay attention to the needs of both kids, as much as we can, and help them to be good, strong, empathetic, resilient adults, whether they have special health care needs or not.

 

 

 

 

Dear Doctor S—-

Dear Doctor S—-

I want to thank you.  Really.   Even though you gave us bad news, I want to thank you for your approach, courtesy, and helpfulness.

Truthfully, we don’t know you well.  Wendy goes to see you once a year, to get new glasses.  We were just there a few months ago.  But in the last month or so, she was having a hard time seeing again, and I thought maybe it was growth or puberty or whatever, and I took her back to you.  I had Penny in tow as it was school vacation week.

You remembered all of us and asked us each questions about work, school, sports, and our town.  You spoke about people we knew in common.  You were ok with Penny playing on the floor of the room while you conducted your exam.  You don’t know how much I appreciated that, most of the time doctors find the extra child to be tiresome at best and a nuisance at worst.  You totally went with the flow of our chaotic life.

You examined Wendy and realized that it wasn’t really her vision that was off, that her prescription didn’t need to change that much, so you looked for more problems.  It turned out that Wendy was seeing double.  You examined her and you asked her good questions.  She had a hard time explaining some things, and you encouraged her by telling her that you know these things are hard to explain, but she was doing a good job and she should keep going and he would ask questions for clarification.  Doctors don’t do this often enough, not only did you engage Wendy, but you encouraged her, and when she didn’t have the right words, you asked thoughtful, non-threatening questions to help her.  Then you let her and Penny go out to pick glasses.

And this is a small thing, but I need to mention it.  Your staff was totally fine with both girls trying on as many glasses as they wanted to, and Penny didn’t even need them.  They let them try on a hundred glasses, or what seemed like it.  They were patient when the girls wanted to try on the crazy cat eye glasses or the pointy square glasses.  Eventually they narrowed Wendy down to five pairs, then three, then two, but they let the girls explore and have fun in the process of finding just the right pair.  No one judged them, no one told them no, no one worried they were going to break something (except perhaps me.)

While the girls tried on their fashion accessories, you told me about your concerns.  Based upon Wendy’s medical history, her medications, and her symptoms,  that I should speak to her specialists immediately, and that I should contact her pediatrician and make an appointment. You answered all my questions.  You continued that I should ask about a neurology consult and that this likely will lead to more tests.  All of these things you did firmly but not in a way to try to scare me.  You just let me know that something was wrong, it was serious, and we needed to look into it.  Then, and this is important, you helped me by telling me EXACTLY how to look into it.

I’ve been doing this a long time now doctor, almost nine years.  I pretty much consider myself a professional hospital parent, and I have to tell you that you did everything right.  Your exam was thorough, you were ok with the extra kid, you validated Wendy and her explanations, you explained your concerns to me, and you helped show me the way to the next step.

I don’t know what the outcome will be, this is a new needle in the haystack of Wendy’s medical conditions, but I want to tell you how much I appreciated our encounter yesterday.

Yours truly,

Darcy Daniels

New Faces At Grand Rounds

One day while Wendy was in the hospital in late 2007, an endocrine fellow came in to ask us if we had any pictures of her that we would be willing to share.  The fellow was presenting Wendy’s medical case at Grand Rounds and she wanted to add a few pictures to  the slide show.

At the time, we didn’t know what Grand Rounds was.  Grand Rounds is an opportunity for doctors to present challenging or unusual medical conditions to their colleagues, along with what the course of treatment was, and allows a venue for the presenter to be challenged by his or her  peers.  It is a way to educate doctors both whom are going to the presentation and for the presenters themselves.  It was a novel approach to have pictures of Wendy in the slide show, because for the most part Wendy is just supposed to be a “case” to be discussed, not attached to a face.

I remember thinking that like other parents, someday I wanted Wendy to be famous, but I never thought it would be like that.

A few months later, I was approached to speak at Grand Rounds myself.  The Family Advisory Council at MGHfC spoke at one Grand Rounds a year surrounding the topic of family centered care, the idea that it is not just a child that the hospital is treating, but the family of the child as well. This Grand Rounds was designed to ask parents and patients if they had anything they felt was important to share with doctors of their children.  Michael helped me prepare as to what I was going to say, and I have to say I was nervous, but it was a really positive experience. The doctors asked good questions and it was all together well received.  The Family Advisory Council has sponsored Grand Rounds around conversations and communications between providers and parents, as well as asking doctors to speak as to how they have changed their medical practice as the result of having a sick child.  These are unique opportunities for doctors and parents to arrive at the same goal:  understanding each other in the quest to give the best possible care to children.  It has been an incredibly successful  endeavor.

Now, a new approach: having the pediatric patients speak directly to the doctors at Grand Rounds. This was the first time that an entire panel of speakers was all pediatric patients, at least at Massachusetts General Hospital, but I suspect that this is new territory for a lot of children’s hospitals across the country.

Wendy spoke yesterday with three other patients about their experiences.  All four patients were teenagers, (well, Wendy was twelve and the youngest), and they were all what we would call “frequent flyers” in the medical world:  they were patients who had been there a lot.  One teen had cancer of the jaw, one teen broke a vertebrae while playing football, and two teens had undergone kidney transplants.

The themes were rather universal and centered around anxiety and communication.  The teens asked to be listened to fully, have procedures explained to them, be addressed by their names and really be a full partner at the table.  Isn’t that what we all want in medical care?  What’s funny is that doctors know this, and I would be willing to wager that they think they are doing a good job at communication, especially those who work in pediatrics.  Yet the gap in communication remains.

Here’s why I think yesterday was most beneficial.  One:  people connect to stories, and these kids had stories to tell.  They are survivors in the medical world.  They have grit. And they are vulnerable enough, willing enough, courageous enough to tell their stories, to tell what could be improved upon, to their doctors.  Doctors don’t often get the opportunity outside of inpatient setting or the clinic to hear how they can improve.  Two:  a lot of these teens really made an impact on their doctors just by returning. They had been so sick and had such a positive outlook nonetheless, and they were succeeding in the world, not just as patients, but as people.  They were inspiring.  I don’t think that doctors often get to see their success stories years later, when patients leave they don’t come back, much like students and their teachers.  Both medicine and education have a long term return that you don’t often get to see:  the success of the child due to the efforts of the doctor/teacher.  After grand rounds, so many doctors came up to me to tell me how wonderful Wendy looked and how grateful they were to see her.

Pediatrics is a tough field, but one of the things that a doctor said yesterday is that it also garners hope, which is a powerful motivator. Those teens yesterday might not know how incredible they are, they just know that they have an extra burden of medical issues.  It’s the adults in the room who are affected by their tenacity in the face of adversity. Not just their tenacity, but their optimism and sense of self.  They are not patients, they are people.  They are success stories.  They have a voice.

This is the new face of medicine, partnerships in success through communication.  Yesterday was just one of the steps in the process.

A very welcome step.

 

The Magnitude of Small Choices

We’ve tried really hard to let Wendy help to steer her medical road, but it hasn’t always been easy.

She got sick when she was three, so in the beginning, we did most of the steering.  But even still, we tried to give her as many choices as we could.  We would let her choose which finger she wanted to get her blood stick for her diabetes.  We would let her choose her 15 carb snack if she was low.  After a doctor’s appointment, we would let her choose where she wanted to go for lunch. You get the idea, little choices, but ones that gave her a stake in her own care, which we felt was important.

As she got older, she started to take more control.  She liked to negotiate with the phelbotomist or the IV nurse where she thought the best place for her IV site should be.  She liked to help flush the lines with the nurse.  She would ask for warm packs for her IV site or warm blankets if she was in the Emergency Room.

When she neared the age to go up to the next floor at the hospital, somewhere around 6 or 7, she would state very clearly to the Emergency Room nurse that she preferred to be on Ellison 17 (which is the younger floor) because she knew and liked all the nurses there.

When she is an inpatient, we choose to have bedside rounding, so the doctors all come into the room to discuss the problem and what the plan for the day will be.  She watches us ask questions of the doctors and we always ask her if she has questions, or has anything to add to the conversation.  Most of the time, she doesn’t have any questions, but it’s important to us for her to see the exchange as this is going to be a regular part of her life and she is a part of her care team.

When she is released and we have our normal clinic visits, on the drive in I ask her if she has any concerns or if she plans on asking the doctor any questions about her care.  We also talk about the right way to address doctors and nurses and I remind her that no screens are to be on when a doctor or nurse is in the room.

When she was ten years old, she wanted to start packing her own lunch, but she didn’t have much of an idea of carbs versus protein, so I set up an appointment with a nutritionist who went through it with her.  (She didn’t want to listen to me, I was her mom.) We set up a list of things that needed to be in each lunch:  a protein, a carb, a fruit, a vegetable and a dessert.  We made a list like a Chinese food menu, pick from columns ABCD & E.  We went to the supermarket so she could pick out her favorite fruit and vegetable for the week.  And we put down each item on the chart along with the carb count.  She would choose from ABCD & E, find the carbs for each, and create her own itemized list of the food on a post-it note to give to the school nurse, just like I did every day for her.

When she was eleven, we got her a cell phone so she could more easily go over to friends’ houses without a parent present because these were no longer little kid “play dates”.  She checks her own sugar, and texts me the information about how much she is going to eat, sometimes taking a picture of the plate so that we can figure out the carbs.  When she started sleeping over at friends’ houses, she sets herself an alarm at 2 am to check her own sugar, and then texts her father the number, to make sure that she is in the normal range.

She knows she gets sicker faster than other kids because she is immune suppressed and she knows to wash her hands before each meal.  Sometimes she snacks when she’s  not supposed to, but just like the rest of us, it’s hard to pass an open bag of chips and not take a handful.  She knows that she can’t have “open food” at a buffet, and she knows to get her food first when we are at a party before other kids “double dip” or lick their fingers.

When she says she doesn’t feel good, I ask her if she thinks it’s serious enough to go to the hospital and I trust her answer.  We talk about her symptoms, call the doctor, and make the best decision based upon the information we have.

I always tell her that we are a team and we will get through her illness together.

These are all conscious, concerted efforts.   It’s not easy to plan all of these ways to empower Wendy, but both Michael and I think it’s important. She’s twelve, and she has a lot of issues to deal with, but it’s important to know that she can take care of herself, both for her self esteem and for our peace of mind.  We want to nurture in her a strong sense of self, complete with all of her aspects.  We want to show here that we are a team:  her doctors, her parents and herself.  She needs to know that she can interact well and intelligently with the medical world, because she will need them for the rest of her life.  It would be so much easier to do these things for her, but it’s important to show her how to do them herself.  Like the old adage of teaching a man to fish, we are showing Wendy  how to navigate the medical world, trust her instincts,  and be a strong self-advocate.

Probably the road will get bumpy again as we encounter the teenage years, but that’s all a part of it.  It’s just important to lay the foundation that she can do this, we can do this, we are a team, and she will have us when she needs us.  It’s all any parent wants for their child, but it is both especially challenging and especially important for the parent of a chronically ill child.  It takes planning, preparation, determination and the willingness to watch your kids safely fail.

These small choices add up to a great result:  a strong confident woman ready to commit to self care and interact with her health care providers.

At least, that is the hope.

 

 

Review: “Miracles from Heaven”

Confession:  I dreaded going to this movie, and I thought I was going to hate it.  Maybe I wanted to hate it, but that was just a product of my own fear.  It was impossible to hate it.  Be warned, there will be spoilers in this review, but if you’ve seen the trailer, then you already know everything there is to know about it.  If you would like to see the trailer, here is the link.

The plot is as follows:  The Beam family are a normal, everyday, God-fearing, southern family.  You like them almost immediately.  Their middle child Annabel comes down with a mysterious, incurable chronic illness that is both difficult and painful.  They go to multiple doctors to get answers, and get nowhere for a really long time.  It tests their marriage and their financial security as well as their faith.  Finally, they find a doctor at Boston Children’s Hospital who can’t cure their daughter, but can give them hope both with his knowledge and his bedside manner.  After multiple trips back and forth from home to Boston,and  lengthy hospital stays, Annabel is still in terrible pain and not much more can be done for her, so they send her home. While she is home her older sister talks her into climbing a big dead tree with her on their property, and when the branch they are sitting on is about to give way, Annabell jumps to a hole in the tree, falls through the trunk all the way down thirty feet, and is unconscious.   Rescue teams recover her and she turns out to be fine.  Better than fine.  She turns out to be cured of her terminal illness.  She tells her parents while she was unconscious that she had an out-of-body experience, met God, and he told her that she was going to have to go back, that she was healed.  The doctors can’t explain it, she is asymptomatic and does not require medication.  It’s a miracle.

There are subplots that I don’t love, like when the good meaning church ladies come to the mother Christy and ask if it was her sin or the sin of her daughter is what is keeping her daughter from getting healed by God.  This causes Christy to stop going to church, and is in fact the exact opposite of what a church community, or any good community is supposed to do:  they are supposed to support each other during the hard times, and what could be harder than having a child with an indescribable, incurable illness?  Casting judgement about a person’s spiritual guilt is a beyond petty, it is downright cruel.

But some parts are right on.  Seeing both the pain of the child, and the pain of the parents was very real.  There was one part where the parent was asked to hold down the child so that the nurse could perform an uncomfortable procedure.  I can’t tell you the amount of times Michael and I had to hold Wendy down for blood draws and IVs, participating in the needed trauma that had to happen.  Also the part about the parents being frustrated with not being able to get answers, and being stopped by hospital policy.  I’ve addressed this in my blog post Courteous Vs. Helpful, where hospital staff can be advocates for the parent or just polite.  Compassion of the staff make all the difference.

Another part that was real was how a child’s illness effects everyone.  The child, of course, to whom these horrible things are happening, but also the rest of the family, their friends, their community.  Everyone gives something up.  In the movie, the father had to sell his motorcycle to pay bills. The older sister misses her tryouts for a soccer team.  They all give up pizza because Annabel can’t eat it.  Annabel’s medicine schedule, on a whiteboard calendar, sits front and center in the dining room, a constant reminder that their lives are not the same, but they stick together and they tough it out because that’s what families do:  they support each other, they love each other.

The most powerful message, however, comes at the end, once Annabel is healed and they return to church.  Christy delivers the sermon, and though she is grateful for the miraculous healing of her daughter, she tells the congregation that miracles are everywhere.  This is the important part.  Miracles are the actions that others perform to support the people in need.  The neighbor who watches the kids.  The waitress who befriends them while they are in Boston. The receptionist who fits them in to the schedule.  The doctor who gives them hope.

This is what I can’t stress enough, because when Wendy was at her sickest, we had a whole network of people both seen and unseen who helped us.  Whether it was taking care of our house, watering our plants, feeding our cats, offering us places to stay, sending us gifts, bringing us Thanksgiving dinner, praying for us, helping us to move, calling to check in, offering up their sick days, taking the time to come up to Boston and help, all of these things are  miracles worth celebrating.  Never underestimate what your small effort can do to help a person.

The name of the movie really should be “Miracles are Everywhere.”

Ultimately, the real shame is that Christy Beam realized it once her daughter was healed, and not before.

Bring tissues if you go to see it, and let me know what you think.

Here is a link to the real Beam family, from People Magazine.

 

Sometimes You’re Not Ready

Sometimes you’re not ready to hear the bad news.

Bad news:  the news the doctors need to tell you, the diagnosis, the prognosis, the estimations, the best guesses.  Sometimes, even if you want to be, emotionally you’re just not there yet.

When Wendy was struck with her initial illness,  the doctors didn’t have a lot of positive things to say.  She was incredibly sick, and if she survived, there would be a lot of lingering health problems to contend with.  I could tell just by the looks on their faces during morning rounds that things were not going well.  Many years later, the division chair of Infectious Disease told me, “I dreaded coming into your room every day, because I never had any good news for you.”

They did their best to deliver the bad news to us slowly, and sometimes we were receptive to it, and sometimes we weren’t.  It is hard to hear from anyone that your world has been completely altered and some doctors are better at delivering bad news than others.

I remember one of the first doctors who came in to deliver bad news.  It turns out that Wendy’s pancreas was pretty much destroyed, making her an insulin dependent diabetic.  Unfortunately, that is  how the doctor opened the conversation, over Wendy’s hospital bed, in the Pediatric Intensive Care Unit.  She looked at me and said, “Don’t worry, some day in the future Wendy will come to you and want a cupcake, and you’ll know that it’s so many carbs, and you’ll give her the insulin.”

And I remember thinking,  in that moment, that she was absolutely crazy.  I would never, NEVER, be that ok with giving my daughter insulin.  I thought that she might as well be telling me that I’d never notice that hook she now has for a hand and she will eventually learn how to tie her shoe. (Just an example, Wendy’s hands are fine.)  I remember thinking that it was all too overwhelming to bear.  Blood sugar checks eight times a day?  Shots?  Carb counting?  Seriously, What the Hell?  How could this doctor be so callous in her delivery?  Didn’t she have a heart?

A few years later, when Wendy was in kindergarten, a student brought in cupcakes, and the nurse called me.  I approved the cupcake, instructed the nurse to give her insulin for sixty carbs, and hung up the phone, no problem.

Instantly I remembered that day in the hospital.

Damn. That doctor was right.  I just wasn’t ready to hear it.

While Wendy was initially in the hospital, other days were harder.  The day the doctors took us into the conference room to break the bad news about Wendy’s long term condition.  The charts we had to look at, the medicines we would be expected to give.  I remember crying so much that there was no point in trying to stop the tears with a tissue, they just silently ran down my face.  The doctors looked at me with pity and said, “We can do this another time,”  and I replied, “I’ll cry like this then too, let’s just get it over with.”

I later learned that the doctors call that particular conference room the “Room of Doom.”

Then the  the doctors told us that Wendy would need a kidney transplant.  Almost every doctor in the practice told us at different times.  The first doctor told me early on, in the parking lot, in passing.  I hoped he was joking.  Two others told us while Wendy was in the hospital.  One told us in the outpatient clinic.  It wasn’t a sit down intervention style of news breaking like in the “room of doom”, it was just giving an idea of what was coming up in the near future. No tears those times, because the news seemed so abstract.

I remember meeting with another mom whose daughter had a kidney transplant, who told me that I’d likely have to quit my job permanently to take care of all of the details of Wendy’s illness, and the tears came back in a flash. Nothing was going to be the same again.  There was no pretending that it would be like it used to be, I was the mom of a chronically ill kid and all the rules had changed.  It’s fear of the unknown combined with the crushing knowledge of what you ALREADY know that makes it so hard to bear.

Sometimes the messenger IS the problem, like the doctor who tells you bad news like ripping off a band-aid.  It stings and you wonder if they couldn’t have been just a tiny bit more gentle. An ophthalmologist once  told me that it didn’t matter how well we controlled Wendy’s blood sugar, that she would probably go blind eventually anyway.  That could have been more tactful. I still wonder why she said it that way. Some people don’t think about the consequences of their words on a patient or her parents.

Even if the doctors do the best they can to tell you, even if they explain it clearly, even if what they says makes sense.  Sometimes you’re just not ready.

But you will be.

With time. With Healing.  With understanding.  With education.    With support.  With love.

Be gentle with yourself and this journey.

You will be ready to hear the bad news, and move forward.

 

Confessions of the Alpha Parent

I am the Alpha Parent.

I’m pretty sure that for families with a kid who has special health care needs, there has to be one parent who has more control over the medical life of the child.  I have to say that my husband does a lot:  when Wendy is an inpatient at the hospital, he is the one who does the overnight shifts.  When we are home,  he gets up at two in the morning every night and checks Wendy’s blood sugar.  He is there in the morning to give Wendy her first round of medicine.  He helps with site changes for both her insulin pump and continuous glucose monitor.  And he is the one who largely deals with the health insurance that is connected to his employment.

In short, I am by no means alone in this partnership.

However.

I am an adjunct professor at small college ( I teach three classes per semester).  It’s part-time, so much of the day-to-day responsibilities fall to me.  These include, making Wendy’s lunch with a break down of the carbohydrates, having near encyclopedic knowledge of all of the carbs in her life, checking her blood sugar and making adjustments to her insulin ratios as needed, keeping in contact with the school nurse, making and keeping appointments with Wendy’s doctors, along with other tests and bloodwork, keeping track of her prescriptions, and being the “parent on call” in case of emergencies.  These emergencies might include high blood sugars, fevers, or symptoms that might land Wendy in the hospital.  Because she is immune suppressed, she gets sick easier and faster than other kids and it is a constant, everpresent fear.

This is, of course, in addition to the normal parenting duties: carpools, after school activities, sports, sleepovers, cooking dinner, and keeping the house clean enough so I’m not mortified when we have company over.  Oh, and then there’s the never ending paperwork for all of the above, and the fundraisers for Diabetes Camps and Transplant Olympics, and the few committees that I’m on at the hospital to make it a better place for sick kids.  It’s  a lot of work, parenting is hard, and these extra health issues make time tighter and more stressful.  I always maintain, though,that none of us know what we signed up for to be a parent, and we walk the path that we are given.  Mine just happens to have a lot more medical intricacy than most.

The bottom line is that, ultimately, I’m the one that keeps it all together.  I keep both the pantry and the medicine cabinet stocked.  I make sure that appointments are made, met, and followed up on.   I have the memory of all the medication, the insulin ratios, the carb count of numerous items, all that I can recall on command, along with most of Wendy’s current blood chemistries and her A1C.  I keep the ship afloat, so to speak.

So what happened when I was offered an opportunity to go with a group of students for a week to Central Europe to study the Holocaust?

Well, to put it bluntly, I panicked.

The thing was that  I really really wanted to go and had  a lot of offer my students:  I used to live in Central Europe, I’ve written a novel about it, I know the cities, the people, the culture, the history.  I’d be really good at this thing, leading students through holocaust sites and memorials.  It would be intellectually fulfilling and meaningful to me, as most part-time jobs just tend to be place holders for someone else, this would be real work that would affect the global outlook of these students.

I hadn’t been away from my family for a week since Wendy was born, and certainly not since she had gotten sick.  Michael had been away a few times, for a week or longer, but the longest I had ever been away was for four nights, and that was only with one child.  Now we had two.

Michael  was supportive of the trip.  He said I should go, that he would handle it.  So I set a schedule with all the names, dates, and phone numbers of the extra kids I pick up in the morning, or kids that come for an hour after school, all of the minutia that I probably hadn’t told him throughout the weeks.  I stocked the fridge with easy meals (Michael doesn’t cook) and I made sure that there was enough medicine. I also made sure that there were no doctors’ appointments, outstanding library books, or gaps in child care.

Then I took a leap of faith and left.

And nothing happened.

By nothing, I mean that I had a fantastic time.  I got to see a lot of places I haven’t seen in years, I got to be the “resident historian” on the trip, and I got to have real interaction with students, many of whom were going to Europe for the first time.  I missed my family, but they had a normal week, with all of their activities and events.  No one landed in the hospital, no one had an emergency.  It all went smoothly.

This fall, I was asked to go again over spring break 2016, same cities, same schedule.

I said yes.

And, predictably, I panicked.

AGAIN.

I guess that I’m a little bit of a control freak. As long as I have everything scheduled and monitored, I feel like I’ve got the best chance of keeping Wendy out of the hospital.  Fortune favors the well prepared.  But being in Europe fosters all of the “what ifs” in my life.  What if she gets sick before I leave?  What if she gets sick while I’m gone? What will Michael do? Who will watch Penny?  How long will it take me to get home?  Will my family feel abandoned?

Seriously, these things run a loop through my mind, along with the accompanying guilt and worry.

Having said that, I know that Michael is incredible and capable.  I know that we have a caring community filled with people who would help if there was a problem.  And I know that we have family that can fly in if necessary and get there before me.  I also know that Wendy’s in a really good place, that her health has been stable for a while, and that in the future it may be more questionable for me to leave, right now it’s a safe wager to go.

But as the Alpha Parent, it’s really hard to let go of the worry and guilt, which ultimately lead to doubt.

It’s the doubt that I have to overcome.

(Photo:  The John Lennon Wall, Prague)

“Life is what Happens when you’re busy making other plans.”  –John Lennon

 

 

 

 

Resilience, A Beautiful Oops

Penny came home from school today SUPER EXCITED.

She said, “Mom, Just WAIT until you SEE this BOOK that I got at the LIBRARY!!!!!”

She showed me the book, Beautiful Oops! by Barney Saltzberg.

The gist of the story goes like this:  Even when something goes terribly wrong, with a little imagination, you can create something that will make you smile, and with the right point of view, it is beautiful.  Take a ripped piece of paper for example, it can turn into a crocodile.  Take a bent corner  and it can be turned into a penguin.

The idea is that even when life doesn’t go your way, you make it work.

And I thought, “Oh My God, she understands resilience.”  Or, at the very least, she knows that we value it as a family.

I wear very little jewelry.  But I happen to wear two bracelets, which I never take off. I even sleep with them.  They are both on my right wrist and from from Mantra Bands.  One says, “Persevere” and the other says “Choose Joy”.  I wear them because I have to be reminded every day, and some days are harder than others.  I’ve sometimes thought of getting a tattoo, but I don’t want to think about what it will look like when I’m ninety.

To me, the combined message on my bracelets the definition of resilience, persevering and choosing joy, and this is what I try to teach my kids.

I’m not going to be some glib, everything is going to be all right, happiness peddling soothsayer. It glosses over the real hardships of life.  The truth is that being a parent is hard, being the parent of a chronically ill kid is (arguably) harder, and there are lots of things that you can’t control that will drive you crazy, make you cry, and wonder about the fairness of the world.

But in our family, you take the problems, you look at what you’ve got and you either make it work or you change it and if you have a choice, you choose happiness.

When Wendy was recovering and we were waiting for a kidney, we found ourselves in an apartment in Charlestown, Massachusetts, a full two states away from our home.  Though we had amazing, uplifting support from friends and family, not many people lived near by.   Most of our week was taken up with doctors’ appointments, visiting nurse appointments, and lab tests.  But this was also a time for Wendy to recover and grow stronger.  We had decided to not send her to the rehabilitation hospital at Spaulding, because to put it quite bluntly, it was depressing and we just couldn’t do it.  Day care was absolutely out of the question, but Wendy needed to see and be around other kids, healthy kids.  I couldn’t just keep her in the apartment watching TV.

What we ended up doing was buying family memberships to four museums:  The Museum of Fine Arts, the Children’s Museum, the Science Museum, and the Aquarium.  Every day that we had a doctor’s appointment, we also went to a museum.  I would pack all appropriate medication that she needed along with a lunch, and we would be gone for the day.

MFA lady boat

At first , Wendy was so weak that she was just in a stroller and she tired easily.  We would have patterns of things we would do at each museum.  At the MFA, we would go to the gift shop first and pick out three post cards of art work she liked.  Then we would go on a scavenger hunt and find the pictures.  When we found each one we would sit for a moment and look at it and talk about what we thought was important or create a story from what we saw.  As she got stronger we found statues and mimicked their postures. (See picture at head of blog post.)

 

At the Science Museum, we always went to see the science in the park exhibit, where you could see science in action from outdoor equipment like the swings or the teeter totter.  We would also go and see the chicks and the monkeys.

At the aquarium, we would go to see the penguins.  For Wendy’s birthday, because she had been in the hospital for so long and because she spent her birthday in the hospital, the Child Life team adopted a penguin for her, whom we named Poppy, and we would go and visit him, then walk up the corkscrew ramp, while looking at all of the sea life in the giant cylinder that was surrounded by the ramp. When we got to the top we would look for the turtles. Then we would take a ferry home from the Long Wharf.

At the Children’s Museum, we would play with the trucks or the water works.  When Wendy got stronger, she would climb the webbed construction in the center of the museum while I would sit at the bottom and watch her.

On the days that we didn’t have a doctor’s appointment, we would walk to different parks around the city.  As Wendy got stronger, she would attempt newer and more exciting structures at the playgrounds.  It was rehabilitation and education through play, and gave our days structure besides just going to the doctor, getting a blood draw, having the visiting nurse come.  We made it work.

Another issue was Halloween.  How do you go trick or treating with a diabetic kid?  For other parents the question might be, How do you take a kid with nut allergies trick or treating?  How do you keep your kid safe while still feeling like a normal kid?  Our solution at first was to go ahead of time to neighbors and give them items that Wendy could eat so that when she came trick or treating she could enjoy what they gave her. As she got older, we paid her for her candy, by the piece.  We would let her pick out 10 pieces and then pay her for the rest, which we would give away to charities, friends who didn’t trick or treat, or to the college students who studied where we worked. We had to make it worth Wendy’s while, so that she wouldn’t think it was unfair that she couldn’t eat all the candy she got.

penny wendy halloween 2011

 

Now there is the teal pumpkin project, which is an amazing solution.  Parents agree to have both candy and non-candy items, and then paint a pumpkin teal to tell parents of kids who can’t have traditional sweets that there is something their child can enjoy.  It’s a fantastic idea.

Every day we try our best to make Wendy feel as normal as possible enjoying as many of the things that non-chronically ill kids enjoy.  The target is always moving, both with Wendy’s health, her growing up, and new technologies that are on the horizon. The latest challenge has been sleepovers at other kids’ houses. But we do the best we can, with what we’ve got.  We teach our kids to do the same thing, find solutions that work.  Solve the right problem.  Be flexible.

Make it work.

Sometimes with the right point of view, the result is beautiful.

 

Communicating During Crisis

In the beginning of Wendy’s hospitalization, Michael and I arrived at Massachusetts General Hospital at different times.  I had first flown with Wendy from our home in Vermont to Dartmouth Hitchcock hospital in New Hampshire.  Then a few hours later when it had been determined that Wendy was in kidney failure, she and I were taken by ambulance to Mass General.  Michael and my mom followed later in the car, and typically, got lost in Boston because everyone does.

After we had both arrived and had gotten settled, one of the first things we did was go down to the coffee shop in the hospital.  We knew that we were in for a long haul.  Suddenly we were two states away, our parents were arriving, and we knew that things were going to be really tough medically, emotionally, financially, all of it.  In a whirlwind of chaos, we knew that we had to set down some guidelines for communication, and stick with them.  We were both horribly scared, but we knew that we had each other, and we had to keep our lines of communication open.  We agreed to some ground rules:

Be kind with your words.  “Don’t ever say anything that you can’t take back.” You know those words, spoken in anger, using absolutes like, “You Never” or “I Always”. Those aren’t helpful. We are a team and we will act like a team.

Be honest with your emotions. Just saying your emotions out loud makes you feel better because you’ve put a name to them. “I am scared” is a powerful phrase.  Don’t expect to have the other partner know how you are feeling, you need to state it.

Say when you need a break. Sometimes we need to take a step back, get a cup of coffee, walk outside and breathe a little fresh air. We would feel overwhelmed at some point in this journey. Those few minutes where you can separate and regroup your thoughts will save you in the long run.

I honestly believe that this agreement preserved our marriage.

These ideas didn’t fall out of the sky, we had done these things, more or less, over the years.  We had learned good communication through a number of avenues.  One way was living in the Czech Republic together. After dating for about a year, and after we had both graduated from college, we had the crazy idea that we would move to Prague and teach English to Czech students.  We didn’t quite realize the situation we had put ourselves into.  We had arrived in a small town well outside of the city and were essentially the only two people who spoke English.  Unlike western cities that had dual languages for menus or bus schedules, everything was only written in Czech. This made for humorous meals at the local restaurants when all we could do was point to something on the menu and hope for the best.  The other “English”teachers in our schools were the former Russian teachers, who were told overnight that they needed to switch to teaching English or face losing their jobs.  Not only was their English not good, but they weren’t thrilled to have native speakers teaching along side them.  We were on our own.

Michael and I lived in a single converted classroom in one of the two schools in town.  It was inconvenient, especially because it also housed the early care for children, who liked to just walk in to see what we were doing.  There was no telephone, and it was only the dawn of social media.  The situation was less than ideal.

We realized quickly that if we had an argument that there was no one else to talk to in the whole town.  Necessity became the mother of good communication.

Prior to that, we also had experience with something called a “Full Value Contract” from Gettysburg College, where we both attended.  A full value contract was introduced to us through Gettysburg Recreation Activities Board, or GRAB.  The idea was that everyone had an equal say and it was up to the individual to be clear with how they were doing, as no one is a mind-reader.  Neither Michael nor I were in GRAB, but one of our best friends, Hutch Hutchinson, was one of the first student leaders, and he led trips for student groups, including groups that we were in.   Michael and Hutch hiked 500 miles of the Appalachian Trail together.  (Hutch continues this work at Boston University, where he leads the Common Ground seminar for first year students.  You can see a video of it here.)  “Full Value Contract” was a part of the vocabulary we brought with us to the Czech Republic, and it served us well.

Lastly, Michael and I knew that when we were stressed, that we used a certain “tone”.  You know that tone.  It’s 50% of communication, and when the words and the tone don’t match, it’s the tone that trumps the conversation.  Way before we got married, we agreed to state when a day was going to be stressful.  We would say, “Today is going to be tough, so I want to say I love you now, in case I forget later.”   This might include buying our first house, or going on a trip, or going into labor and having a baby.  This was an inside joke, almost a code for us that we needed to treat each other well not knowing what the day held in store for us.

We brought all of these tools with us to the hospital, and yet we still felt the need to take time away and actively state our three ground rules for communication when we got to the coffee shop.  This isn’t the recipe for every happy family in the world that is going through the trauma of a chronically or terminally ill child.  But what I’m saying is that you have to find what works for you, what will sustain you even through the darkest times.  Only you know what will work for you and your partner, but they key is to find it, agree to it, and stick with it.

It will serve you well in the long run.

 

Link

Courteous Vs. Helpful

Wendy and I have spent a lot of time in various doctors’ offices lately, and I’ve been reminded that there is a right way and a wrong way to treat a young patient and her family.

Here’s an example of a doctor’s visit that didn’t go so well last week.  It started late in the afternoon, after school.  The doctor was new to us, arrived fifteen minutes after we were in the exam room, did not introduce herself, nor called me anything but Mom.  She did not address Wendy by her name once.  We were there because Wendy had hurt her knee, but the doctor asked a lot of questions about her medical history.  It bordered on nosy.  Granted, Wendy’s medical history is chock full, and I understand that there are a lot of questions, but not necessarily for a hurt knee, other than the fact that she can’t take NSAIDs like ibuprofen because it is bad for her kidney. The doctor also commented on her bifocals as unusual, again nothing to do with Wendy’s knee.  As we left (and thank God that Wendy was out of the room already) she said to me, “Don’t worry mom, she has to do SOMETHING the normal way.  Maybe her knee will be it.”

Unhelpful comment, doctor.  It is not your place to editorialize my daughter and her medical history.  It’s your job to tell us what to do about her knee. Meet us where we are in this moment.

Today we had a totally different experience.  We saw a doctor who has been following Wendy since the beginning of her illness, almost since the first day of it.  First, she saw us downstairs in line waiting for coffee and paid for our order. Then she met us upstairs, where we addressed concerns I had about medication and blood pressure.  She had the nurse come in both to say hello and to confirm medications and prescriptions.  She ordered labs, and though it was a new computer system, made sure that it was working, printing out the labs herself after the front desk couldn’t find them in the new system.  She looked at Wendy’s ultrasound, told us what it said, and we arranged for a meeting in a month.  She wished Wendy happy birthday, and we left.

Granted, this second doctor has known us for a long time, and we have a very special relationship with her, but that doesn’t mean that the first encounter with the first doctor was what we should be willing to accept as care for a child.  For the sake of argument, let’s say it is the difference between being courteous and being helpful, and it applies to everyone from the doctor to the receptionist at the front desk.

Being courteous is answering questions directly, but not necessarily providing any solutions for the patient or parent.  Being helpful is when you team with the parent, even momentarily, so that you can come up with a solution to the problem at hand, so that the parent doesn’t feel like they’ve been hung out to dry.  Being courteous is saying that your patient needs a test and it’s in Building Such and Such.  Being helpful is showing the parent how to get there, why it needs to be done, and what the results will mean.

Let’s face it, families are rarely in the doctors’ office because something good is happening. Therefore, the parent is often stressed.  The child is either sick or in pain, and additionally he or she can pick up on the parent’s distress.  Add to the mixture the traffic getting in, finding a parking spot, the possibility of getting bad news,  any new information that might be thrown at the parent, and there’s an overwhelming sense of doom in the waiting room.  No one is there because they want to be.

So it’s important to treat these families better, then say, someone who is ordering a double-tall-skinny-latte at the drive up window at Starbucks.  “I’m sorry, I can’t help you with that,” rings a little hollow when you have a sick kid in tow, knowing that tests will be ordered, waiting for bad news, in a room that (let’s face it) could be a little more child friendly.

The difference is compassion.  Compassion is the key to a successful trip to the doctor.

Compassion is the empathetic concern for the misfortunes of others, accompanied by the desire to help to alleviate that suffering.

Most people get into the health care business because they are compassionate people who want to make a difference in the world. They have bad days too, and hey, they’re human.  When you encounter a whole office that is merely courteous, however, then you know that something is wrong. Sometimes the system has beaten compassion out of them with deadlines to see so many patients per day, etc.  So for the sake of argument,  let’s go through some of the things that make a health care professional helpful.

Dear Health Care Provider:

Please read the chart before you walk in the door.

Please learn my name and don’t just call me “Mom.”  If it’s possible, learn if my child has a nickname.

Please tell me who you are and what you job is, and how you can help us.

Please listen to my concerns.

Please listen to my child and talk to her like she is a full partner in this process, because she is.

Please explain what the next steps are and what your concerns are; tell me why we are doing what we are doing.

Please follow up as promptly as you can with information on tests.

Additionally, the truth is that it’s the little moments, those little compassionate moments, that we remember in health care.  We remember when the doctor gets on the floor to play with our kid, we remember when they sing a song together.  We remember when the nurse looks for samples so you don’t have to immediately go to the pharmacy.

We remember when the doctor tells us bad news and holds our hand.

Ask any parent of a chronically ill kid about a compassionate moment that a health care provider showed, and they will be able to give you ten, because those are the moments that we WANT to remember.  It provides dignity and humanity to an already suffering population.

It is the compassion that binds us together, and it’s better for the bottom line. People who feel that they are valued come back.  The Schwartz Center for Compassionate Care in Boston has tried to measure compassion.  In this article, they show that hospitals that recruit candidates with compassion, train how to be more compassionate, and reward those members who show true compassion have better retention rates, and fewer return visits to the Emergency Department.

Compassionate Care makes a stressful situation better.

What if you’re not encountering helpfulness and compassion?  Some things I do as a parent include introducing myself to everyone in the room:  Doctors, nurses, medical students, you name it.  I introduce my daughter.  I give a brief history if the doctor hasn’t done so to everyone in the room.

If I am not getting the answers I want, I say so, sometimes not so nicely.  I have been known to say, “If I ask you a thousand questions you need to answer them, because I’m the mom” (Please note, this perhaps wasn’t my finest moment.)

If I’m nervous, I write down my concerns ahead of time to make sure we get to them.

I ask why questions.  “Why are we doing this test?  Why do  you think that?”

I thank the health care provider and try to name the thing they’ve done.  Every time. I make Wendy do it too. “Thank the Phlebotomist for the blood draw.”

I’ve also written complaints when something has gone seriously wrong with patient care.

My daughter is more than a diagnosis, she’s a person.  The health care system can’t just treat her, they have to treat the whole family.  It’s just the way it is.  We are a package deal.

If you are a health care provider, please consisder be more compassionate, more helpful, and not just courteous.  Just being courteous won’t get you anywhere.

Rather, it will encourage me to find a better experience for my daughter and my family.