Ramping It Up: Children w disabilities, opinions, books

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.

And after a two week break . . .

I'm back in Intensive Care with Miz M! A break of two weeks and one day, in which she's been fine and perky, although a bit weaker than before. Giggly, interactive, even managed a weekend "up the coast". Then yesterday morning, picked her up out of bed, triggering a cough, and thought oh no, my sweet girl, you're looking a tad purplish-blue-ish. Change the nappy and count the breaths - at least 60 breaths a minute, means, officiallly "laboured breathing". And a bit of a temperature.

Into Emergency by 8.30 am. Into Intensive Care by 11.

And some more interesting bits and pieces and observations, for another time.

Doctor's Wives: An annoying, sexist, supposedly demographic label

Well, we know there's an election in the offing, because one of the most annoying labels ever has started popping up in media "analysis" again. "Doctor's Wives." 

The morning began in its usual, weekday manner: alarm goes off at 6, and while nobody south of the border believes it, it's cold in Brisbane. Wrap myself around beloved and try to ignore the time. Then the brain kicks in. What if M's feeding pump finishes and the alarm goes off. What about getting to the Children's Hospital for a bloodtest. Is there any glucolyte made up. I'm not working today, but Abe is, so life will be easier if I can get to the hospital with Miz M before he heads to work, so he and Clancy can hang together.

OK, so get up. Get going. Engage brain courtesy of coffee (thank you, darling, beautifully made). Read part of the paper while we both feed children, eat breakfast, plan the day. Not too much conversation yet.

I'm driving to the Children's Hospital, hoping they'll manage to find a vein to take blood from my girl, while listening to RN. And then, there it goes.  The label that makes me sit up straighter with annoyance, and begin the endless bloody debate with myself about whether it's worth jumping up and down about.

The inestimable Geraldine Doogue on Radio National Breakfast, talking to Michelle Grattan about the election, whenever it will be, and the role of the Asylum Seeker debate, and what Julia Gillard's approach will be. And Grattan says something about the "Doctor's Wives".

This, my friends, shits me.

OK, the whole tenor of the reactive Asylum Seeker debate is annoying too; and Abbott's claims are unspeakably awful. Not wild about the fear and loathing underpinning the public discussion, and maybe that's what I really should be frothing about. And yet and yet and yet.

The casual sexism of the "Doctor's Wives" thing is so ingrained that it's never ever pulled up, interrogated, slapped down, or even seemingly noticed.

I can see why Geraldine couldn't stop mid-discussion to say Oh by the Way isn't it timed you stopped using that outmoded crappy term. It would be supposedly too PC by half. But what exactly is it meant to represent? Supposedly, it's about Middle Class Women of Affluence, whose lives are defined by their man's career and income, and their implied political views. It's lazy shorthand, that creates a group of Trudes and Judes from KathandKim, and gives them supposed political "clout". Sure, demographic analysis might be useful. Sure, trends can be followed. Sure, politics can't be truly subtle enough to allow for the real twitches and switches and thoughts of even a single street . . . But who is really doing this research? The likes of Bernard Salt, who's trotted out to repeat platitudes and generalisations and claim that it's analysis of the Australian population?

Where's the real research? Where's the qualitative research that goes beyond surveys dreamt up by particularly unimaginative marketers who once did a course in sociological surveys, couldn't quite remember the principals, and didn't do any of the humanities courses because they decided they were too "wishy washy" (or, perhaps, too challenging)?

I mean, fuck.

And who are these "Doctors"? 

All male, apparently.

All married, apparently.

And I'll swear to my last ever election campaign this is not merely a self-serving argument - but I am, indeed, while following the Prime Minister's own unmarried style (and bugger off Bettina Arndt, too), living with a Doctor. 

Oh, so it's me that they mean? Feminist lefty grumpy Labor supporters who wishes there was more Light on the Hill and a bit more vision, with a disabled child and an interest in the Yarts and Culture. A very specific demographic, that one. If only we wielded the power . . .

Then again, my own beloved could be a Doctor's Wife, too, if by their shorthand they mean PhD's in history.

Oh, no, don't tell me, they only mean medicos who are GPs or possible surgeons. Who are male. Who maybe work in a private hospital or own a chain of medical clinics.

Come on, Michelle Grattan, isn't it time you interrogated your own labels? You're smart, you're sharp, how about not throwing out these lazy lines in the lead up to an election. So many other presumptions and assumptions are examined in the media, but this one slips through year after year. 

Oh, I stand corrected: just did a quick search and in an earlier election, Antony Green made a comment about how demeaning and silly the term was. Yay, Antony!

Impossible Meetings With Doctors

On Monday we sat at a table in a conference room at the Children's Hospital opposite two extremely nice doctors, having a conversation about "end of life decisions" for our girl. About intubation, resuscitation, levels of intervention, and what it all means for quality of life; for being kind, for making sure she's not in pain or distress. This isn't because she's about to die, but because she could have died a week before this conversation, and a month before that, and a month earlier . . . and because it might happen next month, or maybe next year.

It looks rather bland when you write it down. As if it's straightforward.

It can even look cold, or uncaring, or too clinical.

Oh, hardly.

Two weeks ago today Miz M really wasn't well when she woke up, even though she'd been fine the night before. Laboured breathing; very tired; working hard. Luckily, our fabulous physio and speechy were coming over that morning for an appointment, which meant they took one look and said, hmmmmm, something is not right here. A respiratory rate of 60+ (about twice what it should be for a 3 year old). Meanwhile, the airconditioning had broken, so I was having conversations about pieces of machinery that were broken, while awaiting the young woman who comes to give us respite for 6 hours a week, so I could break the rules and ask her to mind Clancy while I took M into Emergency. Aaaaah, she had a gastro thing and couldn't make it.

So, off to Emergency with a sicker and sicker Morgaine, and a rambuctious 20 month old. Cue, temperature (39.5); cue, low SAT levels (82); cue, mucho oxygen. And thankfully, a rather nice young doctor who found a portable DVD player and the Wiggles for Mr Can't Sit Still.

And by now, the doctors all say -- but weren't you? But didn't I? And I say yep, we were in here a month ago, and two weeks before that, and a month before that.

Four major admissions since the beginning of the year.

And for some reason, we always end up in the same cubicle, right opposite the doctor's station, where once she's been whipped in to be seen to (no waiting around for us! Ever! nothing like a crisis response to let you avoid a drama filled waiting room) then I can watch them. The large, comforting doctor who always introduces himself and shakes your hand, and you'd follow him anywhere he seems so kind. The blond nurse with messy hair who just screams competence, is in five places at once, and acted so quickly the time before last when M had a seizure and suddenly lost oxygen in Emergency. She's also a paramedic, it turns out. The Baby Doctors, who veer between anxious and arrogant depending on (ahem) gender (who said that?).

I even read exactly the same magazine two admission in a row. There were weeks between admissions, but the same 6 year old magazine was there, boring me to sobs. Always always always have a novel, pen and paper, a spare pare of undies and a toothbrush. And a toddler, with plenty of snacks. Abe had a meeting he couldn't get out of a fortnight ago, but Clancy was pretty fabulous really.

Oh, and M also has hyponaetremia (spelling?) - low sodium, due to SIADH - so I now know to say, no, not just a chest X-Ray and NPA (snot test), please take venous blood asap. Really. And when you get the terminology right, and can remember the names of half the nurses, they tend to believe you. Although they have such a horrible time getting bloods, that I almost always watch 3, 4, 5 different doctors try before they get it done.

That night, after Abe and Clancy had gone home, and we were still in Emergency, M's breathing suddenly looked odd. Can you check this, I said to one of those eternally calm, unflappable, older nurses - who then told me she'd been worried and had just gone to get the head doctor to look at her. Respiratory Rate over 80 per minute. Not so good. So we end up on the ward, for two nights and a day.

It looks like aspiration pneumonia this time (as opposed to Human Meta Pneumo Virus and RSV and an unknown wacky virus the other times this year).

The first night, I sleep on the ward - after hearty greetings of "Oh, we know this child, and we know this mother!" Yep, been to this ward, before, thank you! Even been to this room. We get up there late, it's almost midnight, and there's one other woman and her child in there. Large and cheerful, introduces herself. The next day, slowly, we exchange stories. This one's a bit more Suburban Gothic than most: dreadful parents-in-law who've accused her of faking her child's illness (endless 5 minute long seizures, that'd take some coaching); break up with her husband; baptist-home-schooling stories; best friend whose husband was abusing the kids. Aaaaaaargh. Makes me feel shockingly middle class and happy. Mind you, she was quite nice; while I kept bumping into others and having bizarre conversations with people filed under P for Peculiar in Hospital Central Casting. Oi oi oi.

The next night, I go home. After so many weeks with our girl in hospital, poor Clancy is starting to notice. A mother who completely disappears? Not fair, really. And he seems fine, then gets a bit stroppy and overly emotional. So with a whole overcoat of guilt on, I head home. And was about to go back in the next morning, when the hospital calls to say, she's suddenly a lot worse. Oh, and they've put her up to 16 Litres of Oxygen (what? she was on 6 when I left) which is as much as they can give her on the ward. I go in, and the nurses won't leave her side. There's a flurry of doctors, of all varieties. Meanwhile, I had agreed to participate in a practice exam for one of the Registrars (I've done about four practice "long cases" this year, and any number of practice examinations - it kills time, and tends to be pretty interesting). So, we're going to transfer her to Intensive Care. Fine, I say, to the young doctor, I'll do the case with you as long as you don't mind that there's stuff going on at the same time. It's a way to slow my heartrate, but not, I suspect, his.

Six days in ICU. She was within a hair's breadth of intubation. They used BiPAP instead (where the machine breathes for you), then CPAP (a different type of pressure), before a transfer back to the ward for another - oh, I don't know - four days.

Thirteen days.

And last Friday, the neurologist came around, to say that he thought there was something else going on. Something besides the Hypotonic Cerebral Palsy, something that he can't quite get to the bottom of. I think he has a few ideas, but can't get him to really spell them out. It's because of the low sodium; it's because she's so very disabled. It's because she has no myelin at all in her brain. So he's ordered genetic karyotyping, and a "CGH Array", which is all about genome mapping and a possible chromosomal abnormality - of the rare and "interesting" variety. Demyelination. Leukodystrophies.

You know, he says, her prognosis is not very good.

Well, slowly, I had come to realise that. Maybe that's why I haven't been so good at writing here -- much as I really needed to.

Abe already knew. He knew before I did. And a few months ago we'd forced ourselves to confront that, and did it very badly at first. I began to work out how to ask the right questions, and found the research on Life Expectancy for children with CP when they have M's level of disability. Such limited mobility, being non verbal, peg feeding, little head control, having been born full term, tended to mean a 40 % chance of living to be ten, for example. But that's probably way outside what we can think of. Especially because there's something else gong on.

And poor Abe. My unthinking optimism made it very hard for him to say, look, her quality of life isn't very good. It silenced his despair. It didn't give him space to say, actually, this is pretty fucking heartbreaking. 

So I'd celebrate a smile - we both did - and a tiny tiny improvement, and he'd also be terribly sad about all the things she couldn't do. It took a really difficult conversation, months ago, to realise that our perspective on things needed to come closer together, or at least, needed to acknowledge each other better.

So I'd be worried about how vulnerable she'd be as a teenager or a young woman; and he'd tell me to live in the moment (which was fabulous), while really knowing that it wasn't something we were ever going to be dealing with.

And slowly, the question of how you deal with hospital and medical systems in a type of real crisis had come to the fore. A year ago, standing by a hospital bed while on holiday in Proserpine, a nurse asked us if we'd made decisions about resuscitation. It jolted me like the lightning that struck the character in Tracey Chevalier's latest book. We were completely unprepared then; not much better recently. What, exactly, does it mean, and in what circumstances?

So for the last month or two we'd started to talk about it. I thought Abe might know, as a medical person, but he wasn't sure how these decisions come about either, in light of a general duty of care and doctor's ethics, and how anybody can sensible respond to what you've decided. It's different if you're an adult, making your own Advanced Care Directive. It was on my agenda for an appointment with the paediatrician that was going to happen tomorrow. 

Then, after that conversation with the neurologist, I decided to contact the Social Work Dept at the hospital, and asked if they had any guidelines or reading or advice. What we really needed, was some terminology and a framework. Of course, it's bread and butter to them. It shows the ways in which these large institutions really are compassionate, and complex, and subtle. They deal with this type of thing all the time. A Family Conference, she said, that's what you do, with the doctors, and an advocate, and a social worker, and you go through in detail if this, then this; if this, then this; and it's in the Chart, and you can have a copy yourselves, and you can change your mind at any time.

Oh.

So suddenly, it happened. Just the two of us, and these two rather wonderful women doctors, having an impossible meeting.

Forward forward forward back

Had a wonderfully productive and inspiring working day on Wednesday, including an hour and a half with a generous "expert" full of ideas and lateral ways of thinking. Read four articles and part of two books, made some connections, felt as though I'd got quite a lot done. Terrific therapy session with Miz M yesterday (Thurs) morn, with a straighter back than I'd seen, more head control, and generally beautiful cheerful responses from her. Clancy slept for the entire session, then I took him out for a bit or rampaging while M had some respite time. Got back at 5 and hmmmmmm, the stoma site is looking a bit dodgy, just as the gastroenterology dept at the Children's hospital closed.

A-huh, here we go.

Then M woke very early, felt a bit hot, and yes the site looked even dodgier, with a granuloma having developed.

We knew that a GP wouldn't have a clue what to do, so off to Emergency at the Children's hospital, with some lovely nurses and v nice doctors, all women.

Have come to the unscientific conclusion, based entirely on anecdotal evidence, that 80% of all women doctors are called "Katie".

Home again with more ointment etc, and no chidlcare, and me not being at work.

Although I did get to admire the style of the pharmacist at the hospital, who clearly played a social-equity role in juggling brands of drugs and sizes of prescriptions to ensure people could afford them, who soothed troubled souls and dealt very cheerfully with the marginalised souls chatting loudly on the lounge . . . who were there for the methadone clinic. So after a few teeth-grindingly annoying interactions with local pharmacists who question every medical request you make, expect you're going to relay an entire complex medical-and-disability-related history in the middle of daggy suburban shopping centre, and who have Chip on Shoulder Didn't Get Into Medicine air . . . well, I was terribly cheered and impressed by this guy. I figure it's the face-to-face with reality impact of working in a large public hospital.

So, home again again home again, jiggity jig.

Oh yeah, and must fine Mary Beard's blog, given that I've now finished the book . . . A Don's Life, indeed.

Falling off the blogosphere: And Gastrostomy insertion

I seem to have fallen off the blogosphere recently for no very good reason, although it includes an overdeveloped sense of guilt. Am struggling with the fact I have a work meeting this morning that means I'll leave from home, so have decided that the 20 minutes before 9 am can be used for "me", but no more.

Miz Morganise finally had her gastrostomy/ PEG insertion two weeks ago today. As always, it took considerably hustling and being a pain-in-the-arse to the hospital, all of which paid off. Whiel being determindedly "Lovely", I kept calling to see if they'd scheduled the operation, as I knew she'd been categorised as urgent in late November, but there'd been a hiaitus over Christmas. So by presenting myself as persistent but friendly, and ever so slightly implacable, meant that when other people cancelled, we got a last-minute "how about next week" call.

So, to recap: a gastrostomy is a tube and "button" that goes directly into the stomach and means M can be administered food or fluids more easily. We'd spent six months putting a naso-gastric tube down every morning, to give her water, as her "delayed swallow" and low strength means that ordinary water moves too fast in her mouth, with a risk of aspiration, and drinking thickened water is a slow process. This way, she was properly hydrated - happier - and a bit stronger. But sticking an NG tube down your child's throat is no fun. It's also not as hideously hard as it sounds either, or not with a child as easy going and low-tone as Miz M, but it's no picnic. It makes my nostrils twitch just thinking about it.

So the PEG will be a great long-term solution, although again any visit to the Children's Hospital, with a General Anaesthetic and post-operative pain is a bit of a trial. And the fasting, with a wee girl who simply cannot understand why she's not being fed: aaargh! And then in finding the right position for the PEG, they had to have two gos, so there was an extra puncture mark, and they had to hold off feeding her for another 24 hours. Thirty six hours without food and drink, when you're not quite three, don't know what's going on, and have pain in your tummy from an op . . . had me reaching for all the platitudes. If only I could take the pain and deal with it myself. If only I could somehow transfer and absorb it.

Then again, as always, the Children's hospital is an extended exercise in being grateful, lucky, and sobered by events. The baby screaming in the middle of the night. The pre-raphaelite beauty in the next bed, only 11 years old, with a mystery infection that had her pale and limp, but with a raging tempreature, and a whole "barrage of tests" as they say. And very nice parents, who'd spent a week livng and sleepign by her side. Luckily, it was sorted while I was there.

So M came home with her new PEG, but with a long tube attached, which'll be replaced in 3 months time with the permanent, discreet version. Meanwhile, ther's a rosette of plastic and a 30 cm tube poking out from just under her ribs, requiring ingenuity and the sewing of buttons and loops of elastic to her clothes. And just when Clancy had worked out how to sit and roll on top of her like a puppy, without biting, in a way that made her laugh with pleasure. So now we're having to keep them apart in case he pulls at the tube, which worries me in terms of the message we're giving both of them. But hey, it'll all be fine.

The odd thing about the hospital visit though, was the combination of being bored and distracted that happens. I took along the Peter Carey novel, Parrot and Olivier in America, which I know I'll just love. It seems to be a bit more like Illywacker in style, which is my fave of his. But no, I couldn't immerse myself in it as machines beeped etc. So just in case, I took along my cheapo, lolly-pink, portable DVD player I'd bought in the hope of doing more yoga and boxing workouts in the shed (which I've managed about 5 times so far, but here's hoping), and a set of the HBO series "True Blood" that I'd been given for Christmas. Well. My oh my. Funny and clever and just the ticket, although sitting by your sleeping child's bedside holding her hand while watching an erotic and explicit, blood filled scene of vampire sex, when a nurse comes up behind you to ask some question or other that I missed because of earphones, is a bit bizarre.

Oh look, four minutes to go before I switch to conscienscious mode, so what else: still reading Hilary Mantel's Place of Greater Safety on the French Revolution, which I'm loving but is taking me forever; read 2/3 of Mary Beard's Don's Life (in book form, not the blog) last night, and was completely engaged; just loved Colm McCann's Let the Great World Spin, but perhaps I already mentioned that.

And am also in a dilemma about an elderly neighbour who I've befriended and/or adopted. She's Italian, and her English is very bad. She's desparately lonely, so I was happy to invite her in and chat to her, and in some ways she's pretty easy going. But she's started to come around every day, and it's a bit exhausting. Even more, she frames her life entirely in terms of hardship, negativity, work and thigns being difficult. I'm not suggesting it hasn't been tough, but the answer to everything is "ver hard, work very hard", not just about herself but about me. If I say what I've done, she'll say, "Oooh, it's so hard for Mama", and I simply cannot and will not frame my life as a negative grind or a tragedy. So I worry that it's just the lefty soft part of me that's doing this, and wonder whether I'd be quite as forgiving if she was an old Anglo woman. Am I being suckered into the Romance of the Migrant Story? But there are also things I quite like about it, and I'm more than happy to explain why the letter she got from the govt is ok, and doesn't mean she's in trouble, to pick up things for her, to give her a glass of wine on the lounge. But I'm goign to ask some Italian speaking friends for some words to throw into the conversation, to try to explain why I need to be strong, resilient, positive, happy. I tried to ask her yesterday when she'd been most happy in her life, what made her happy, and she just said, "I no ounderstand", and I don't think it was just the language. A reminder, instead, about the different way lives are lived and understood.

Ooops, two minutes past 9, the guilt clock is ticking. Better go.

Your Daughter? That's My Worst Nightmare

If only I could write like Hilary Mantel - whose wrenching, angry, memoir Giving Up the Ghost made me laugh out loud, or snort and snuffle into the lounge to the surprise of both Abe and Clancy. Because she's intelligent, because she's a good researcher, because she's articulate, doctors spent a lot of time being surprised by her and, because it's the late 1960s and early 1970s, they pathologise her rigour and turn it into psychosis. One doctor tells her she's conscienscious, with a mind for detail, in a mildly accusatory way. She was studying law, and so goes on to say, "I tried to imagine the other kind of law student, the kind who favoured the broad-brush approach, who took on the law of trusts, for example, with a grand generalist's sweep and dash." Well, it made me laugh.

I also loved this, when being treated appallingly by dickhead lecturers at university, who couldn't see why a woman should be studying law at all: "Some people have forgetten, or never known, why we needed the feminist movement so badly. This was why: so that some talentless prat in a nylon shirt couldn't patronise you, while around you the spotty boys smirked and giggled, trying to worm into his favour . . . It was assumed that marriage was the beginning of a woman's affective life, and the end of her mental life." (pp 160-161) And goes on to describe how, in job interviews, you were grilled about marriage, intentions, when you were going to "start a family", by "some grizzled ringmaster, shifty and semi-embarrassed as he asked a girl half his age to tell him about her sex life and account for her next ovulation." But really, it's  one of the best descriptions of pain and illness and misdiagnosis I've ever read. I had thought that both Joan Didion and Susan Sontag, even David Rieff, talked about illness and hospitals and the medical system well but, really, Mantel takes the cake by describing this ostensibly sweet self who was raging and railing and almost screaming with frustration inside a body that was going out of control. But then again, maybe I only think that because I finished reading it in the last few days, so it has inhabited my imagination.

That, and Colum McCann's Let the Great World Spin - vibrant, clever, convoluted, sad, utterly gripping. In some ways, a novel about grief (I wept through one entire chapter; then was buoyed up the hard edge and street rhythm of the next, which left me surprised at the left-over sniffling); in others it has the euphoric poetry of Philippe Pettit's tightrope walk between the Twin Towers balanced over everything, turning your eyes and the character's eyes up and up. Then some cringeworthy moments of race politics where you can hardly look at the page. Still, it helps to have seen the doco Man on Wire, about that tightrope walk, to give you Pettit's arrogance and his poetic hopes, given that he walks in and out of the novel. Must go and find some more words by McCann, because this Irish-American storytelling was really something.

And on the whole entertainment thing, I've also managed to see two films (ta-da) and start a few other novels. Saw Jane Campion's Bright Star which was so beautifully framed and gorgeous to look at, and wasn't Abby Cornish fabulous, sweetie? And the opening scene, full of laundry and washing lines, like elegant birds in the landscape, made it a very domesticated, women's film, without being a conventional Chick Flick (which is a dopey term, but hey). For a story about a relationship with a male poet, it was so covered in cloth and held together by handstitching, with views below stairs and in the kitchen, so that the work of capital-R romance was on display. No "Elven Grot" for Keats' rather more earthy Lady of Shallot, rather a house that had to be rented and walls that were a little thin. Given that nothing much happened, it still held me . . . and of course, wept through the last bit, and emerged from the cinema with mad hair and a red nose, in the middle of a hot sunny day, and had to slink down the street without a tissue, feeling rather tenderised.

And then saw Avatar in 3D (on the "now for something completely different" stakes). It was so completely and utterly "filmic": a huge spectacle, roaring over your head and leaping right into your face. And yes, some ooga-booga spirituality and none-too-subtle colonialism versus the pure indigenous hearts and minds. But what a beautifully imagined world, with lovely detail. Am still wondering, though, what to make of the soldier with a disability at the centre of it: there he is, being self-sufficient and capable, and seems to have enough ramps and access points to get around in; yes, we see him being discriminated against by some macho marine pratts, but he doesn't give a shit; and the promise is held out to him that, if he could afford it, he could get working legs back again. So, is this the future? And then there's the project he's working on, where he has a "conventional/ unconventional" body by inhabiting this alien avatar. He first disappears into this pod, this terrible claustrophobic space that keeps him still and make him terribly vulnerable (exposing both him, and a central plot problem; that, and what happens when his alien self is asleep. Lucky there weren't any little alien babies nearby or he would have been in big trouble for sleeping through). His broken/ disabled body is left behind; he stands up and walks and runs and exalts in the physicality of his new alien body, that can not only stand up, it can leap, almost fly. He's remembering old sensations. Get up out of your wheelchair, my child, and walk. What if he'd been a kid who never could walk, who had to learn afresh: would he have enjoyed it as much? Must the disabled body always be positioned as something that's "wrong", so that even living virtually, while isolated in a pod, where "at least" he can walk is better than living in a new way in his own body. With all that military technology, you'd think he could have a pretty fine chair. I really want to know what the properly thought through disability activists and theorists think of this one. I don't really know what to think. A few links here, including a man who says hey, we don't all necessarily long to be "fixed".

But here's the link back to a non-alien, non-green-and-scaley skinned ordinary life. What if the person in the wheelchair is imagined not as a person - or a child - but rather as the worst possible scenario, the "nightmare"?

We live next door to a very nice, very social, couple. Two women who talk and laugh loudly, and know how to throw a generous party, with a bottle of champagne or 50, and everyone invited. So just before Christmas, I wandered over, leaving Abe (who wasn't in the mood) at home with the babes. There were lots of people who I'd seen in the street but not properly met. Often glimpsed as we all head off to work, or wrestle stuff into cars, or chase dogs down the street, or do 85 point turns (me) in a very narrow street with bugger-all parking. A young couple were there, pregnant with their first child. Young Professionals, who I didn't find wildly interesting, but I threw back too many glasses of sharp cold white wine and became all wide-eyed and overly-enthusiastic about everything (sigh, must grow out of that). So we talked about the baby, and the guy said things about how they were having one who'd be all dressed in frills and pink, making me grind my teeth with irritation, but really - perfectly nice, all very bland and middle class, everyone well educated and had read the right books on pregnancy and health. I'm not into giving out unwanted advice, or pretending I know how to do things. I did say they should yell if feeling overwhelmed, just on the basis that the snot/ green baby shit/ weird behavious might be reassuringly familiar.

So we talked about pregnancy, and health, and labour, and I did say that yes, with Miz M, it was a healthy pregnancy, full term baby, no known problems, and yet yes the mysterious, severe, disability happened anyway, and here's our lovely girl, likely to never walk or sit, may or may not ever talk, will need us forever.

Disability.

"That's my worst nightmare", he said. I was a little bit pissed so didn't get at all offended or upset, and just did my usual, "Oh well, you just cope with what you cope with, don't you" routine. But really, my daughter is your worst nightmare? Full marks on the subtlety stakes, I say.

And it had been a week of it. Not long before that, Abe and I had actually managed An Event without children. We organised a babysitter, and went out to a Christmas drinks thing for Abe's work, full of medicos and scientists and heirarchies like I'm not at all used to. Standing around on a lovely verandah with a view over the city and (again) very nice wine, and met some interesting and not so interesting people. A fabulous young woman who was a paediatrician and very funny, who pointed out a very senior guy she worked with, and that she'd always thought he looked as though he should be wearing a puffy shirt and being one of the three musketeers. It was D'Artagnan at thirty paces from then on. A man who ran a branch of an airline, but clearly didn't read the papers, which was odd. And a woman who told me she was a physiotherapists before she retired, and worked with people with disabilities. "Physios are terrific," I said, startling her with my conviction. So I had to explain why, and told her about Miz M's work with therapists . . . and then, in another act of great subtlety, she told me how her children used to be mortified when she'd be out with them and she'd see a client and go to say hello. "Mum", her kids would say, "why do you always have to go talk to the people in wheelchairs with pasta stuck to their foreheads". Oh ho ho ho and Merry Christmas to you, too, good to see there's a laugh to be had there too . . .

Wheelchairs on TV - and other representational bits and pieces

I've spent years attuned to the way women and girls are represented in popular culture - decoding it and recoding it, approving or being outraged, reading and watching and responding. But like the freshly converted, am astonished at what  I'm seeing,  that I've found with this newly acquired quivering antena in relation to disability and popular culture. (Cut away to the eye rolling from people who've been thinking about this for decades - and yes, fair enough.) It's not that I was entirely clueless before, but the urgency increases when it's your girl who's one of the "crippled kiddies", whose image is most often seen in news stories about charity and "gratefuness", in subplots about pity, in asides about hardship, as shorthand for difficult lives, or in tabloid newscaff programs as a way to represent a split or problem or crisis in a relationship.

And then there's the "good" stuff.

I've learnt to whip my head around and pay attention when I notice a fluffy critter in a children's show who's propelling themselves along in a wheelchair. To wonder what Miz M will think when she's old enough to notice, that there's a song-and-dance routine in wheelchairs on Glee; to hope that the irreverance in Malcolm in the Middle might continue. To be pleased at the way the woman in the BBC show about the choir is an attractice, feisty, character with a platinum bob and a tendency to be hilariously blunt FIRST, and a Little Person second, that's in All the Small Things. Wondering if the new drama, Cast-Offs, on BBC 4 will make it to Oz, given that the six leads happen to have a disability, rather than it being about disability. To seek out children's books that deal with disability, like "Rolling Along with Goldilocks and the Three Bears", which is currently one-year-old Clancy's favourite. To talk to a friend whose a children's book author about whether and how disability might be inlcuded, withOUT a preachy, didactic, moralistic tone to the book. Finding a whole project about this in the UK, "putting disabled children in the picture", complete with illustrations ready to be used.

Discovering that there's a whole program on the BBC that uses Makaton signing and is not only about disability, but also acknowledges communication and developmental delay. Something Special.

Begin to seek out dancers and performers with a difference; to see their performances online.

Wonder what it means that Sam Worthington plays a soldier with a disability in Avatar. What exactly is going on that he then "escapes" his disability, and is re-embodied in a colonial type myth and a functioning, alien body? (Really have no idea what to think about that one, although it does make me remember a great blog I read from a woman who found the use of Wii-fit liberating, as it allowed her to "play" sport, to use her body's strength in ways she found fun and inclusive.) But cyborgs and avatars? Is that about embracing bodily difference, or wanting to "fix" it? I bet other people who actually know stuff have talked that one through, and I'm not just thinking Donna Haraway either.

And then am pulled up by realising how much I hadn't thought through, how complex the issues are, and that "representation" in and of itself may not be everything. Read an opinion piece arguing that actors with disabilities should be used to play characters with disabilities, written by the v interesting writer Lennard Davis. Although, as often happens in these debates, the vitriol behind some of the responses isn't that attractive.

So, it gets back to the old questions of what, and whether, and how, and controlled by whom, do images or stories "just like me" mean. Which, when I put it in such a convoluted way, doesn't look like anybody's "old question" at all. Hmmmm.

Wheelchairs on TV - and other representational bits and pieces

I've spent years attuned to the way women and girls are represented in popular culture - decoding it and recoding it, approving or being outraged, reading and watching and responding. But like the freshly converted, am astonished at what  I'm seeing,  that I've found with this newly acquired quivering antena in relation to disability and popular culture. (Cut away to the eye rolling from people who've been thinking about this for decades - and yes, fair enough.) It's not that I was entirely clueless before, but the urgency increases when it's your girl who's one of the "crippled kiddies", whose image is most often seen in news stories about charity and "gratefuness", in subplots about pity, in asides about hardship, as shorthand for difficult lives, or in tabloid newscaff programs as a way to represent a split or problem or crisis in a relationship.

And then there's the "good" stuff.

I've learnt to whip my head around and pay attention when I notice a fluffy critter in a children's show who's propelling themselves along in a wheelchair. To wonder what Miz M will think when she's old enough to notice, that there's a song-and-dance routine in wheelchairs on Glee; to hope that the irreverance in Malcolm in the Middle might continue. To be pleased at the way the woman in the BBC show about the choir is an attractice, feisty, character with a platinum bob and a tendency to be hilariously blunt FIRST, and a Little Person second, that's in All the Small Things. Wondering if the new drama, Cast-Offs, on BBC 4 will make it to Oz, given that the six leads happen to have a disability, rather than it being about disability. To seek out children's books that deal with disability, like "Rolling Along with Goldilocks and the Three Bears", which is currently one-year-old Clancy's favourite. To talk to a friend whose a children's book author about whether and how disability might be inlcuded, withOUT a preachy, didactic, moralistic tone to the book. Finding a whole project about this in the UK, "putting disabled children in the picture", complete with illustrations ready to be used.

Discovering that there's a whole program on the BBC that uses Makaton signing and is not only about disability, but also acknowledges communication and developmental delay. Something Special.

Begin to seek out dancers and performers with a difference; to see their performances online.

Wonder what it means that Sam Worthington plays a soldier with a disability in Avatar. What exactly is going on that he then "escapes" his disability, and is re-embodied in a colonial type myth and a functioning, alien body? (Really have no idea what to think about that one, although it does make me remember a great blog I read from a woman who found the use of Wii-fit liberating, as it allowed her to "play" sport, to use her body's strength in ways she found fun and inclusive.) But cyborgs and avatars? Is that about embracing bodily difference, or wanting to "fix" it? I bet other people who actually know stuff have talked that one through, and I'm not just thinking Donna Haraway either.

And then am pulled up by realising how much I hadn't thought through, how complex the issues are, and that "representation" in and of itself may not be everything. Read an opinion piece arguing that actors with disabilities should be used to play characters with disabilities, written by the v interesting writer Lennard Davis. Although, as often happens in these debates, the vitriol behind some of the responses isn't that attractive.

So, it gets back to the old questions of what, and whether, and how, and controlled by whom, do images or stories "just like me" mean. Which, when I put it in such a convoluted way, doesn't look like anybody's "old question" at all. Hmmmm.