Ramping It Up: Children w disabilities, opinions, books

Anxious

The children are fine; the sun is shining; and I have a knot in the stomach the size of Sweden. Apart from the odd bit of hormonal rage last night and this morning, it's mostly about this damn election. A win by the conservatives, Tony Abbott as PM, fills me with huge anxiety. But I also hate the fact I haven't had a visceral, light on the hill, passionate, ideological, response to anything in the Labor campaign at all -- even as a rusted on Labor voter. Nothing. Nada. Nyet. I want a woman Prime Minister, with brains, without God, with a vision. So give us a damned vision, Julia!

Picture apologies

Sorry for the hopeless sideways pics. I'm usually good with technology, but the dying mobile phone gave me no joy with uploading photos. So this was the half-arsed, couldn't change format, quick version.

Not our chair

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Feet

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Liberty swing. Woosh!

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Icu

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Being a test case: Paediatricians, hospitals, and a Dysmorphic Appearance

Early last week, in an oddly calm moment, I went for a walk with Miz M to a nearby cafe, and counted up this year's hospital visits from my diary. Fifty one days over six admissions, including eleven days in Intensive Care. I didn't bother counting up the outpatient appointments, the visits to pick up equipment, the therapy appointments. Neither did I count the number of books I'd read at the bedside, the number of days of work I'd missed, the amount of guilt I'd dished up for myself, the number of nurses I'd spoken to, the posses of doctors I'd met, the emails I'd sent to friend. The number of times Clancy had wondered where I was, and where his sister had disappeared to. The litres of oxygen she'd been given.

The number of months that might be left in her little life.

Some things, even with a little red Moleskine diary, can't be easily quantified.

But I did the adding up the day after she last came out of hospital. Another twelve days in, including five days in Intensive Care. This, only two weeks after the last almost identical admission.

And then, being a sucker for punishment, five days later I was back there, voluntarily, spending a morning with Miz M being an examination subject for paediatric registrars who are on their way to being consultants. I knew the drill. For the last six months, whenever we've been on a ward, doctors pop in to ask if they can use her as a test case, for their practice. They scour admissions, looking for "interesting" cases. Oh, to be boring. What they want is the not easily categorised, the tricky, the multiple disabilities, the chronic and acute, the odd ones out. I've done many a "long case", which means I talk talk talk about the pregnancy the birth the early days; the signs something was "not quite right"; the tests, the lack of a diagnosis, the speculative diagnosis, the clinical presentations, the other tests, the waiting for results, the next tests, the referrals the therapy the eventual maybe that's a diagnosis. Then, after you're parched from talking and each and every one has said, "oh, do you have a medical background" (no, bugger off, I just pay attention in class), then they finally examine my girl. They then go off to write it up and present her to a panel. The good ones ask you new questions; the good ones give you something to think about. It was in this context I was first asked if we'd thought through our decisions on resuscitation. It's in this context they ask you about depression and your relationship and what next. 

Somewhere, I imagine a group of examiners rolling their eyes. Here's Morgaine again. Haven't we already heard her story 8, ten, twelve times already?

And then there are the "short cases", in which the parent or carer is invisible - no context here, no storytelling, no asking questions - and it's "only" about examining the child. She usually lifts up her hand in her languid, soft way, and rests it on their hand or their stethoscope. Gives them a little pat. Giggles when they try to get her to follow a toy with her eyes.

And I figure it's a pay-off. It's a public hospital, they treat us very well, why not do what you can?

And I figure it's strategic. This way, they know her. This way, we might learn something.

So when they asked if we'd do a "real" exam with her, we said yes. When I say we, Abe rolled his eyes at the idea of another morning in the hospital, so I said I'd go.

And there we all were. Yet another community you never thought you'd be a part of. A group of people who may very well look Peculiar with a capital P to outsiders. Children with rare and unusual conditions, looking "different", requiring all sorts of aids and equipment, sitting around on chairs that are too small on a Saturday morning. I meet yet another woman who's on her own, and has had to leave her job, and who's coping with a child who has rages that last for an hour and a half. Who has what they call "challenging" behaviour. I meet a very poised girl of about twelve or thirteen, who seems relaxed about being examined and poked and prodded and asked questions about herself. A small boy who looks partly melted - not from burns, but rather as if while growing something simply slipped. He's a wizz on the computer, and uses makaton signs to signal his pleasure to everyone. Miz M just smiles happily.

We're on for a short case and, after a month or two in which we'd had our meeting and made our decisions about resuscitation etc; in a week in which we'd met with the non-cancer Palliative Care team, and acknowledged that what she has is a "Life Limiting Condition" (a new phrase for me, and oddly precise - not terminal, not in decline, but definitely "Life Limiting" given we don't know when the ultimate crisis will hit); in a time like that you think nothing else can be confronting. What's to think about?

But of course, a group of new doctors will examine her. Clinically. Of course. And I will keep it zipped, apart from saying, "she can roll" when I put her on the bed (oy, so don't let her fall of, right!); while they will hold forth and give their pronouncements. 

Here is a three year old girl, they say, who cannot walk. Examine her legs, from a neurological perspective, and give your findings.

Gawd: those poor people were so very very very nervous. Bells rang. There were masses of junior doctors around the place to help (and I recognised about 90% of them from the Emergency Dept and various ward rounds), and we had a Group of Three examiners, who put these doctors through their paces. As well as the usual range of tests and reflexes (none!), they all talked about her Dysmorphic Appearance. And here we have the confronting bit. Our usual doctors had been a bit shy about this. The neurologist suggested it; our regular paediatrician poo-poohed the idea. But there were four new doctors, and three examiners, all commenting on her "dysmorphic appearance".

Am I being too technical here? It means Funny Looking.

Apparently, when children are first born, doctors and nurses used to sometimes write "FLK" on the charts. It meant, Funny Looking Kid - because some conditions, especially chromosomal abnormalities, really do have distinct looks about them. (The most well-known, of course, Down Syndrome.) But just in case, they have a quick look at the parents, and sometimes they'd write "FLK/ KLM": Funny Looking Mother. Look no further. I gather this practice is now frowned upon. Hence, the Dysmorphic Appearance.

So. Her large head; the shape of her large beautiful blue eyes; the position of her ears; the space between her eyes. Another also suggested that her face wasn't as mobile as it might be - certainly, she smiles sweetly, but it is true she doesn't express the same range of emotions as her little brother, who has the toddler's tendency to Emote like Laurence Olivier at every turn. So every doctor had something to say about her look - although they also had a range of suggestions for what her condition might be and how you'd test for it and what you'd do next. As well as the hypotonic CP, they all suggested genetic caryotyping, which is only just happening for us now (no results yet), so clearly there are a few chromosomal disorders they have in mind. And only one who I think was way off the mark.

Interestingly, the last woman was the most nervous - which is saying something. You could have run a small car off the energy being generated in the department that morning. She was also the most dithery in her manner and presentation. And this is where I don't know whether my PC-antenna had been too finely tuned, but I got a distinct sense of impatience from one of the examiners, as soon as this woman walked in the room. Immediately. Was it the headscarf, the muslim attire, the long robes? I hope I was being overly sensitive.

And so I took my beautiful little FLK back home.

When the Wheel falls off the Wheelchair: Can you build a raft with a ramp?

I drove up to the Children's Hospital again this morning, but not for the usual reason. Morgaine is fine, and has been out of hospital for ten days now (twelve days in, five of them in Intensive Care) and was in the backseat giggling with her brother, who was wont to make a fuss. I was driving around in circles, trying to find a park near one of those places where parents from out of town can stay while their children are wrangled and poked and labelled and examined time and again. Finally, I just parked illegally and tried to make contact with this woman I'd never met before. A woman I had been put in contact with just last week, by The Therapy Place, as she was contemplating the same type of Special Needs Car Seat we have for Miz M. Fine, I said, give her my number; happy to talk. 

Happy may not be the right word for it. 

By the end of that phone conversation, I realised she needed something much more than I could provide. She needed a whole network and professional advice; she needed money; she needed decent equipment; she needed a partner who hadn't upped and left in the face of their daughter's disorder; she needed medical advice; she needed not to live so far away; she needed help with a child who makes M look strong in comparison. Miz M can now hold her head up for 15 seconds at a time sometimes. I'd been celebrating that, and then realised it was a tiny tiny incremental shift and still didn't compare with any usual range of "normal". Well, this girl can't hold her head up at all. So fragile; so lacking in strength; so terribly in need of modified equipment.

But I turned up, and showed her what we had and how it worked. The footpath was beginning to vibrate under my feet with her level of stress. It wasn't so much that she was about to cry - eyes fill with tears regularly in this world of ours - as that she was about to disintegrate before my eyes. Bits of her were spitting out and edging apart at the seams, for lack of knowing what to do next. She'd clearly pinned some hope on me turning up with a solution . . . but it's not quite right. I suggested she contact Technical Aid for the Disabled, to see if they could do the modifications for her, but the despair hardly allowed her to know where to begin. And she hadn't heard of many of the organisations or possibilities or lobbying or hustling out there.

And then one of the wheels fell off her daughter's wheelchair. She nearly lost it. What if we'd been going down that hill; why didn't they fix it yesterday; I'm going to raise hell with someone very soon. I hope she raises hell with the right place, rather than spitting fire indiscriminately.

This woman needs the National Disability Insurance Scheme - and, I'd suggest, a good organisational support structure that could ask some of the questions she doesn't yet know to ask.

And then here's my ethical dilemma: the question of breeching trust. I contacted the head of the social work section of the Therapy Place, and left a message saying that I thought this woman needed more help. Urgently. Partly, I know what she needs is a friend to debrief with, a person in a similar situation to talk to, and I don't think I can be that person. I don't want to be that person - there's the selfish bit. I recognise the jangly need; the awfulness of not getting answers; the perplexity of not knowing how to ask the right questions . . . but I know my strategies are different. But I also know I'm not alone the way she is. On any cold night, in any moment of frustration and fear and anger I not only have Abe who wraps himself around me, who I can and do turn to; I have a liferaft of friends. A liferaft, not just a raft. 

This woman needs a raft. With an outboard motor, and maybe a little house built on top of it, filled with cups of tea, books, and a computer filled with useful bookmarks. And either a how-to guide or a flat pack version of it, that she can build for herself. How's that for an overworked Ikea-ish metaphor.