Category Archives: Essays

Longer form pieces. Theories, commentary, criticism, submissions to publications.

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A dilemma for sonographers, and considering the greater good

I was on another panel last week. An annual gathering of sonographers (ultrasound specialists), nurses, radiologists and other imaging professionals. This conference covered a lot of ground, with sessions called ‘Face’, ‘Spine’, ‘Placental Function’ and other prosaic-sounding topics that didn’t leave much to the imagination. I didn’t attend these sessions, but somehow I can picture how they went.

The session in which I participated was titled ‘Sex and Ultrasound’ – sex, in this case, meaning gender. (I was amused to note we were slotted somewhere between ‘Diagnosis and Management of Limb Anomalies Which are not Part of a General Skeletal Dysplasia’ and ‘Thorax’.)

It was a small panel: me, a lawyer/bioethicist and a diagnostic radiologist; and a large crowd of several hundred people. The panel was assembled in chairs in front of the whole group to discuss Sex and Ultrasound as it pertained to a rather inflammatory news item (published in the Toronto Star) that had been making the rounds since last year.

The gist of the news report was this: some Toronto area hospitals were implementing communications policies which disallowed ultrasonographers from revealing the sex of their fetus. Instead, the patient would need to wait until she saw a physician, who had seen the written report signed by the radiologist. The journalist then noticed that, “whether by coincidence or by design”, these hospitals were situated amongst large concentrations of Southeast Asians, a cultural group thought to perform ‘female feticide’–aborting a fetus because it is female. The suggestion then, is that Toronto hospitals were making moves to combat this barbaric problem which immigrants have brought over with them.

(A follow-up editorial calling out this racism is here.)

Starting the session with this news item was intended to provoke and irritate. Fair enough. It was a conversation-starter, providing the backdrop for a number of questions posed to the audience.  Loosely paraphrased:

Do the audience members’ hospitals have a communications policy in place? Do the audience members feel comfortable talking to their patients? Do the audience members tell their patients what they see on the screen if it’s good news? If it’s bad news? Do the audience members tell their patients the baby’s gender but not other details? And more of the like.

This seemed an odd discourse to me.  Many pregnant women have had ultrasounds where the person scanning has pointed out fingers, toes, a healthy beating heart, and if it’s there and we want to know, also a penis.  I wouldn’t have guessed it was a matter of debate.

During the panel discussion I learned about some of the complicating factors:

Sonographers can ‘observe’ but not ‘diagnose’

The distinction between what you see and what you conclude because of what you see is an important one. Sonographers are allowed to make observations but not diagnoses. So one of the debated points was whether the sex of the fetus was an observation or a diagnosis.  Generally speaking most agreed it’s an observation–although things get murky if patients are getting abortions because of these off-the-record remarks.

The patient can generally tell what’s going on anyway

In the olden days before real-time scanning, the patient wasn’t immediately privy to the scan images or findings. The technician was essentially a specialist photographer, who would capture the images and send them to the radiologist.  The radiologist would then write a report and send it to the patient’s doctor – whose receptionist would phone the patient and tell them the news right then, or would schedule the patient for an appointment to discuss the results.

As technological advances made scanning more transparent to the patient, the sonographer, as yet unfettered by hospital bureaucracy, might freely chat with the patient and relay what he or she was seeing. Usually it’s a happy exchange, but what if the scan results aren’t as planned? In my case, the horrific discovery by the technician of Owen’s fetal hydrops rendered her speechless and insensitive, caught in her own discomfort. She wouldn’t look at me, turned the screen away from me and told me she couldn’t talk to me—all the while making a digital audio recording of the scan, narrating the abnormalities into a microphone which I could easily hear.

Real-time scanning has changed the nature of the testing. The patient can see what is happening, on the screen and on the technician’s face. She can ask questions, demand answers, look the unfortunate scanner in the eye while he tries to hide his panic when he can’t find the heartbeat the patient so eagerly wants to see.

If information is wrong, the hospital or clinician can be liable

If a patient makes a decision based on the unconfirmed ‘observation’ of a sonographer, and the observation proves to be wrong, the hospital may find itself at the wrong end of a lawsuit it perhaps felt could have prevented.  So rather than properly train the sonographers to have uncomfortable conversations (which, by the way, many can do quite capably), some hospitals and clinics wonder if they should ‘policy’ their way out of risk by not allowing them to talk.

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So back to the matter at hand:

The discussion was focused on gender, and whether or not sonographers should tell patients the sex of their baby if, based on their observations and experience with the mother, they suspect female feticide.

Many in attendance (including the presenters) easily identified the racist undertones. But, the discussion brought out points that are worth exploring. So let’s unpack some of the details, and explore why the answer to the above question is an unequivocal yes.

Rights of the fetus

  • In Canada, women do not need to explain their reasons for wanting an abortion, and do not need to justify having had one.
  • In Canada, a fetus has no legal status as a person. A live baby of course does, but a mother or physician cannot be charged with murder (for example) if they participate in an abortion.

For these reasons alone, it should be obvious that a woman cannot be prevented from having an abortion or be granted fewer rights because someone finds a suspected or (even known) reason for wanting an abortion distasteful.

Rights of the patient

  • Unfortunately, we don’t have a charter of patient rights in Canada. However in Ontario we do have the Ontario Health Care Consent Act, which protects our rights to refuse or consent to treatment.  There is also legal precedence to support that healthcare providers have a variety of obligations to the patient, including right to information. And most professional colleges and governing bodies in healthcare acknowledge the patients’ right to access their own medical information.  I realize as I write this that my knowledge of patient rights legislation is quite low…  If anyone wants to chime in about patient rights in Canada as it pertains to access to information (whether documented or not), please do!

Reproductive and human rights

  • It’s not lost on me that we’re talking about a 100% female patient population. One could say it is a population which the ‘powers that be’ wish to influence and subjugate for what is perceived to be a greater good. I probably don’t have to throw a rock too far to hit examples of how this misguided ideal can go horribly wrong.
  • Historically, the arrogance of medicine and healthcare has had ill effects for men and women alike. Lobotomies, forced sterilizations, over-medication, institutionalization, over-surveillance… This particular issue–fear of female feticide and poor resulting public policy–is not out of place in this unfortunate narrative.

 Just when I thought everyone was on the same page

My last comment in the panel discussion was to say that fear of litigation (which had been another related topic) and the desire to socially engineer all of humanity were two different things and should be discussed as distinct issues. They could probably do something about the first problem, but the second?  I thought not.  The scan in the ultrasound clinic is not the time or the place to express one’s distaste (or act upon it by withholding information) for a patient’s motives, especially if she is behaving within the bounds of the law.

This prompted a question from the audience:  “But what if,” she said, “what if I know for sure that the patient is going to have an abortion if she finds out she is going to have a girl?  If I tell her, wouldn’t that be like handing her a loaded gun? Maybe I shouldn’t tell her?”

I answered in a way you may have guessed (“Yes you should, and it’s none of your business”) and the other panelists had similar remarks. But I felt for her and her internal conflict.  With technological progress comes some of most difficult moral dilemmas of our time.

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“Bias and influence in decision-making”, Genetics rounds

thumbI gave a talk last week at Sick Kids hospital here in Toronto, for their Genetics grand rounds. I enjoyed myself immensely–the audience was highly engaged as listeners and I had enough time to build out some proper discussion points, beyond just telling our narrative.

I am including my slides below.  I spent the first 20 minutes sharing our story (notice the familiar photos!) then moved on to share some reflections on the nature of influence in decision-making.  There are a couple of points here that really deserve their own essays–will return to this topic later this week and share more fully.  Here were the main points:

Disability is treated as disease

  • This speaks to the prevailing perspective in childhood disability that one can ‘overcome’ if he or she just perseveres–in most cases of severe disability, this is simply not true.
  • Adult disability does not seem to have this same inspirational tone. Rather, many adults with disabilities I have met have integrated their disability as part of their identity and do not see it as a disease to be eradicated or overcome. For some, this idea (of ‘fixing’ their disability) is offensive. But, there is no room in the childhood disability industry for this perspective.

Advisors generally have no lived experience with the condition they are treating

  • An observation, not a complaint. Seeing many cases in clinic is not the same as living it. The issue here is that often the only advice a family gets is from people who haven’t lived the journey. I don’t believe this can possibly offer enough perspective. Why doesn’t healthcare support connecting new parents with much older families, or adults who have the same condition as their child?

Medical information is perceived as complete, true and enough

  • I suspect that the medical/research literacy of most new parents is fairly low. What is good information?  What is valid? Who funded the research upon which this study is based? What bias is the physician bringing to this conversation? What additional studies disproved this idea?
  • In my experience, clinicians have been as forthcoming and well-intentioned as they can be–insofar as their own personal maturity and level of self-awareness allow. There is no unbiased truth, but it sure can seem the opposite is true in clinic.

Impressions and memories change over time

  • I spent a long time on this one and can’t cover this in a few bullet points.  In a nutshell: often, what mattered once doesn’t matter anymore.  Or, what didn’t matter then matters now. And, how things look today will look different tomorrow.
  • There is a tendency in moments of medically-based decision-making to over-focus on the only thing healthcare can provide: medical information.  Looking back on my life with Owen, none of the physical disabilities or required medical treatments are what I think about or remember vividly now.

Correlation does not imply causation

  • Social statistics are often mentioned in the prenatal ‘talk’–financial hardship, divorce rates, declining health of the caregivers–presented as a cause and effect relationship to having a child with disabilities
  • Divorce rates: shared as though this ought to be a factor in decision-making, or is at least an indication of how difficult life will be.  Problem 1: Who’s to say that separated families are not now better off?  Perhaps a life of disconnection and misery awaited them if they stayed together. Regardless, clinicians should not be trying to socially-engineer the lives of their patients.  Problem 2: Higher divorce rates do not necessarily mean it’s because the relationship ‘can’t handle it’.  Another possibility: challenge illuminates weakness and strength, accelerates maturity, fast-tracks inevitability. Divorce is a mature decision, not a random surprise. Seems like an irresponsible leap to threaten divorce (presented as neutral fact) while parents are making neonatal continuation/termination decisions.

My article in the latest Ars Medica journal: “Do Not Resuscitate”

ars medica cover 2It had become an annual event. Owen’s pneumonias seemed to happen every spring, a kind of rite of passage to clear the lungs in preparation for the inevitably muggy Toronto summers. We could always tell when it was coming—started with mild lethargy and weak smiles, continued through a body-heat phase that made his skin weirdly dry and clammy at the same time, right on through to the wet cotton-candy mucous tinged with yellow that he would cough up violently, causing the thick vein in his skinny neck to bulge. We eventually learned to read the signs before the next phase would start. Inhalants, antibiotics, steroids, and chest therapy became our spring tradition.


This article is available in the Fall 2012 issue of Ars Medica, A Journal of Medicine, The Arts and Humanities, published by the University of Toronto Press.

Masthead and Table of Contents | PDF of my article


I am probably telling this all wrong. As I write this I can now remember Owen in the hospital for pneumonia in the fall. And another time in the dead of winter. And not a few overnight stays in the summertime, when I was glad for the air conditioning and bright sun streaming down the hallways. When I try to recall these things accurately my memory can be alternately out of focus, and sharp as a tack. I try so hard to get it right but the recollections are slippery and tricky, morphing to suit whatever story I think I want to tell. I suppose it’s understandable. . . Owen has been gone now for sixteen months.

He died when he was twelve. The timing and circumstances of his death—alone, in his own bed, as healthy as he’d ever been—was a huge surprise. Unexpected, unexplained. In fact, the coroner agreed; his listed cause of death is SUDEP, Sudden Unexpected (or Unexplained) Death in Epilepsy. I have to admit I laughed when the coroner told me. He had to reassure me that it was indeed a real diagnosis, I could even Google it, and yes ma’am it is indeed a real thing. He clarified that, in our case, it was a diagnosis of elimination. Nothing else could explain Owen’s death and he’d had a history of seizure disorders as an infant. So, fair enough. I didn’t care any more about this ambiguity than I did about the lack of diagnosis for his condition while he was alive.

On paper, Owen was a collection of symptoms and descriptions. Spastic quadriplegia cerebral palsy, deaf, nonverbal, non-ambulatory, g-tube fed, incontinent, fully dependent for all aspects of daily living. He was also born 8 weeks prematurely and experienced a host of problems prenatally for which he required surgery, in utero. We had no explanation for any of this other than that a part of his brain—the basal ganglia, an important part of the deep brain that controls motor function—was underdeveloped. Why, no one had any idea. Often this malformation is caused by kernicterus, the result of dangerously elevated bilirubin in infancy. But this wasn’t our case. And besides, his troubles had started long before he was even born.

Owen had multiple severe disabilities all of his life. He certainly had a lot going on but none of his conditions were obviously life-threatening. Except for his weak and compromised lungs. At the best of times his breathing was noisy and wet. At the worst, he struggled ardently to catch a breath. Stridor, they called it. ‘Turbulent air flow in the upper airway’ causing high-pitched wheezing and reduced air intake. His skin would become frightfully pale, his body warm and limp, his chest would collapse inward as he tried to inhale. Evidence of a hard fight against infection and fluid accumulation in the lungs.

I always knew his lungs were his weak link. I had imagined that Owen would likely die because of pneumonia or related complications. So perhaps I shouldn’t have been surprised when, during a spring stay in the hospital, the doctor pulled me aside and asked if I would consider signing a DNR order.

Owen was around six years old. Despite the frequency of visits to the hospitals all over the Greater Toronto Area, I had never been asked before. I wasn’t even entirely sure what a DNR was.

“It stands for Do Not Resuscitate,” she said.

The words drifted in through my ears and settled somewhere deep, probably near my own basal ganglia. My body felt warm and clammy, my breathing suddenly becoming more shallow. Perhaps it was sympathetic pneumonia, a way to connect with my little boy passed out in the hard bed just on the other side of the wall.

“That means you don’t save him if it looks like he’s going to die?”

“It means no heroic measures. It means he can die peacefully.”

I imagined rib spreaders. Emergency transplants (of what, I had no idea). Months on life support. I imagined failed dramatic rescue attempts that I would live to regret. Previous doctors had warned that kids like Owen, if placed on a ventilator during an illness, sometimes don’t come off at all. I pictured a permanent breathing tube.

Her suggestion seemed so reasonable. I didn’t want my boy to live like that. And he probably wouldn’t live through those interventions anyway. It was a short conversation.

“Sure, I’ll sign it.”
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When I told Michael that night, he was quietly horrified. Why hadn’t I thought to ask him, check with him first?

“You told them to not save our son?!” he said. “Undo it!”

He wasn’t accusing me of not caring. I knew it then and I know it now. I had dedicated myself completely to my two sons and had provided Owen with a quality of life that was almost unheard-of for a child like him. No, Michael wasn’t thinking I was harbouring a death wish for Owen. I think instead he was accusing me of making an uninformed decision, one that I had made unilaterally, unexplored and unquestioned, in a highly uncharacteristic fashion.

I felt my insides collapse. He was right. I hadn’t considered the decision carefully and had signed the document as casually as I had signed the request for a television in the hospital room. I couldn’t even tell him what the form said. I felt I had failed our family, myself, my son. I called the hospital and had it removed from his file.

Owen didn’t die then. In fact, it was as though the DNR gave him the push to get better. He recovered in typical Owen-fashion —practically bounding out of the hospital (at least in spirit) with the clearest lungs ever and a look of thrill on his face as he breathed in the fresh air as we emerged through the automatic parting doors to the outside.

After that, I didn’t give another thought to the DNR. Not to the specific one I signed and not to the overall idea. In fact Michael and I didn’t even finish talking about it. We didn’t need to; I think we both felt we had dodged a bullet and our discomfort with the whole topic manifested in silent, complicit agreement that we would never bring it up again.

The months and years rolled on and as a family, we ebbed and flowed with Owen’s pneumonias and other health-related problems. Sometimes I wondered, “Is this going to be the one?” But not often. Pneumonia had become so much a part of who he was that we were used to the sudden drop and surprisingly quick rebound. Eventually, the once annual event became less frequent and less severe. Our ability to help prevent its onset and lessen its severity had reduced each subsequent pneumonia to one that we could treat at home, like one treats a common cold.

So it wasn’t because of the threat of pneumonia that compelled me, years later, to sign another DNR.

Owen was around ten years old. He was recovering, at home, from a health crisis which had required a six-week hospital stay in intensive care. (I am fast-forwarding deliberately. I am skipping past the part where Michael and I split up and I moved into my own apartment, and I tussled with my soul to figure out how life was now supposed to go.) Looking back now, I find myself wondering why no one raised the question of a DNR. At one point Owen had been somnolent—unrousable—for almost 24 hours. He was in a tailspin of symptoms that alternately looked like overdose then underdose of a medication that was being administered directly into his cerebrospinal fluid, through an implanted device called an intrathecal baclofen pump. It was a confusing time for everyone. Surely, it would have been the right time for someone to suggest a DNR? But no matter now. He lived through the ordeal and came home, weakened but on the cusp of what would prove to be the best years of his life.

When he was discharged from the hospital, I withdrew Owen from school. I hired a small, diverse army of young caregivers, each working part-time, to give Owen experiences that he would not otherwise have. I was self-employed as a web developer and needed my daytime hours to make a living. So Owen’s caregivers would take him out every day, sometimes just to the local park, sometimes to lunch with a friend, to a movie, the museum, to go swimming. Most days, he spent more time with them than he did with me.

I chose to forgo my usual criteria for hiring caregivers. Instead, I hired based on personality, not credentials. I figured that the duties of caring for Owen were teachable skills. But decency, likeability, emotional intelligence—these were not. So I surrounded us with motivated, smart individuals who could just figure stuff out and enjoy life with Owen.

The drawback? Some of them had little to no emergency or even healthcare experience. I remember watching one of the caregivers pack up Owen’s bag for an afternoon outing and thinking, “What if Owen started to choke on the subway? What if she had to call an ambulance? Would she know what to do? What decisions would she make on his behalf? And could she live with her decisions afterwards?” I realized that I had handed over the care of my immensely vulnerable son to a group of young people who were, for the most part, unprepared to handle a crisis. It wasn’t fair. For anyone.

The decision wasn’t hard to make. I requested a standard DNR form from Owen’s primary physician. We went through it point-by-point, crossing off things that didn’t resonate and adding things that made more sense. Michael and I reviewed it together—calmly, intelligently, without the surrounding hysteria that accompanies decisions made under great stress and pressure. We settled on a final document that truly reflected our intentions for Owen, knowing we could amend it at any time.

The hard part was talking to the caregivers. One cried while reviewing it. Mostly they were sombre and serious. Possibly for the first time, Owen’s fragility was in clear focus and the worst-case-scenario was something real. But the relief everyone felt was palpable.

Owen didn’t give us a chance to implement the decisions reflected in the DNR, or to test our wills against the pre-made choices made in a different time and place. He died of his own accord, at his own time, leaving none of us with a harrowing memory of watching him die because of a form signed in the cold light of day.

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Newtown and me

I am not haunted as much by the images as I am by the sound bites. “Point blank…” “Ages 6-7.” “She turned on the intercom.” “They hid in the closet.” Several times a day, these and phrases like them repeat in my head, and when that happens, I have no control of the tears that fall.

I did this to myself, filling my brain with the sounds. I work from home most days and when no one is around, I turn on the television to find out more. To see pictures of the town, learn about the killer, listen to the vapid and mostly useless updates. The details are comfortably numbing, like reassurance that if it’s still on tv then it means somebody out there is doing something about it.

But if someone comes into the room, I quickly turn the channel. I am mildly embarrassed to be such a ‘rubbernecker’. I already know what I need to, and there can’t possibly be anything new on tv that a glance at a newspaper won’t provide. So, I wonder, what’s with the obsession?

My own son, Owen, died two years ago, when he was twelve. I have made it through two birthdays (his), two more (my own), yet two more (his brother’s), two Christmases, and two anniversaries of his death. As we approach Christmas number three, I am thinking, “Enough already.” I don’t want more opportunities to remember that I am the mother of a son who died. It’s a fact that follows me around no matter how I try to reframe it in my mind.

Readers of my blog know I have an uneasy relationship with this identity. The mere fact of being such a person – a mother whose child has died – disrupts connection, jars the brain, upsets, brings vivid images to mind and immediately shifts perceptions of the person I have just told. To fill the awkward silence that ensues, I would sometimes add, “And he had multiple severe disabilities.” Which would bring its own fresh reactions, then a look of comprehension. Like that somehow explained something.

I felt compromised in those moments. I overexposed Owen and myself to people who, no matter how hard they tried, would never comprehend the impact of his death or his life. I would be left holding the bag of their misunderstanding and assumptions.

In the weeks after Owen’s death, I would sometimes whisper, “My son has died. There is nothing worse.” This helped me remember why some friends distanced themselves from me and others wanted to get closer. The thought of losing a child is both horrific and fascinating. An acquaintance told me that she thought of me as profoundly and fundamentally changed, like I’d crossed over into a different plane. Another friend said, wide-eyed, “It’s just not the natural order of things.”

My partner, Carsten, did his best to comfort me, tried to figure out how to help. When he wasn’t getting groceries or driving my (then) 10 year-old son to school, he spent many evenings with me on my sofa as I stared into space, cried into his lap, drifted in and out of fitful sleep.

I felt the initial shock of Owen’s death physically — I couldn’t eat, and more than once, retched into the sink. I regained my appetite, but only for boring food. After several weeks, Carsten suggested we return to our favourite restaurant. “Not yet,” I said. “That’s for happier times.”

Those months were so lonely, but they were also important and precious. I got to be alone with Owen and his death. I held on tight for fear of losing the smells and the sounds and the memories. Another friend had lost both of her parents in a short time, a few years before. “I know this will sound weird,” she said, “but enjoy this time.” It did sound weird but I knew what she meant.

I didn’t hold on to those feelings for much longer. Five months after Owen’s death, Carsten’s father died. He was in his home in Namibia, the African country to which Carsten’s family immigrated when he was a child. We had a short twenty-four hours or so in which we believed it was a ‘natural’ death; giving Carsten time to reflect on his father’s long and prosperous life without interference. I prepared myself to support him through the flow of grief that was sure to come. I understood, after all, and it was my turn to support him.

As details unfolded of the last hours of his father’s life, we learned he was the victim of a violent crime. I felt the news resonate through my body like an earthquake. My own son’s death did nothing to prepare me for this. The violence, coupled with scant details, haphazard police work, the other-side-of-the-world disconnection, the family’s shock and pain, Carsten’s frustration and anger… I was barely functional, never mind helpful and supportive. My whispers to myself were replaced with, “Yes, there is worse. This is worse.”

Carsten traveled to Namibia as soon as he could. It didn’t make sense for me to go with him for several reasons and I was relieved to stay behind. When he returned a few weeks later, we both felt calmer and more connected. The cause of his father’s death was no longer at the forefront, and Carsten could, for real now, start to feel the purity of his sadness. We reminded ourselves that a life lived ought not be overshadowed by the manner of the death.

Two years later, Carsten rarely shares even the most general information with others. The details don’t matter—they shock, distract, interfere.

And now, I am glad to be reminded of this once again. I turn the tv on tonight to discover I am not interested in the latest updates. Instead, I see my own loss staring back at me in the sweet little faces. My shock at the horror and senselessness is not top of mind; I am thinking of the parents and families and the very long journeys they are now facing.

When the funerals are over and the cameras leave, they will be left to pick up the pieces and come to terms with their new (imposed) identities as bereaved parents whose children died in violence.

I don’t need to watch in order to connect with their grief, or my own. As the talking heads drone on, I turn off the tv and send a telepathic message, “You are not the parent of a child who died. You are the parent of a child who lived, for a while.”

This article is a reprint of a guest blog post at Mamapedia, a parenting blog out of Chicago. They occasionally re-post content originally published here, but this time I was invited to comment on Newtown specifically. It appears on Mamapedia under the title “Life after Loss

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An excerpt from my latest writing project, this is a chapter intro called “Decision-making”

treeI have thought a lot about my role as Owen’s primary caregiver and advocate, and the process involved in making medical and care-related decisions. I believe now, looking back, that this was the hardest part. Harder than the caregiving itself. Harder than the social manoeuvering and system navigation and scheduling nightmares I had to wade through to get anything done.

As tiring and mind-numbing as it was, that stuff was ‘just work’—stuff that could be accomplished with time and a bit of presence of mind. Book an appointment, apply for funding, make some calls. Multitudes of working people comfortably do these sorts of thing for a living–daycare staff, construction workers, project managers, office managers. Schedule, plan, build, do. The difference is, of course, they get paid to do the things they choose to do, and typically start work for the day after a full night’s sleep. But even accounting for this, the most grueling work of caring for Owen was not in the day-to-day management.

No, the hardest part was the endless decision-making, combined with the emotional investment. The mental strain of the what-ifs, sifting through the pros and cons. Questioning, defending, wondering, trying, convincing. The mental and emotional toll was high.

I hadn’t always felt this way. In the early years, I thought the physical work was all that differentiated me from the other moms. That my parenting was just like theirs, my concerns and fears the same. Others would say, “I couldn’t do what you do!” I’d reply, “Oh sure you could! You’d just follow your instincts like you already do! Parents always know best!” We’d smile at each other, me and the moms, playing along with the ‘different but same’ charade, congratulating ourselves on our progressive thinking but each of us not revealing what we both knew already: that she was so grateful she didn’t have a child like mine.

I did believe it at some level–that we shared the same parenting concerns–but I felt an underlying disconnect from ‘everyday’ parenting. I was trying to convince myself that it was only on the outside I was different from the other moms, that only on the outside was Owen different from the other children. I had joined the clubs of Certainty and Arrogance of new motherhood, believing that, like all the other confident new moms, “I can’t go wrong because I’m the mother!”

To be fair, I didn’t go around making decisions relying solely on the zeal of my near-religious conversion from urban working girl to earth-woman-mother. Only partially. I developed some guiding principles, realizing that I, in fact, in most circumstances with Owen, actually had no instincts.

So I applied a framework. I would consider such evolved questions as, What do I think Owen would want? Or, What would I want if I were him? Using these enlightened yardsticks, I made important and difficult decisions regarding healthcare, education, family, home life, caregivers, therapy. . . always satisfied in the moment that I had made the right decision, given what I knew at the time.

“Given what I knew at the time.” The escape clause! A way to backtrack without acknowledging I might have made a mistake. And a way to justify changing my mind. Naturally, these (like most) decisions often didn’t last. A better decision–more informed, appropriate, balanced–would emerge weeks or months later. I would stifle feelings of mild embarrassment as I explained my progression from confidence to compromise–to family, therapists and doctors.

In truth, I have few regrets. I made decisions, things changed, then I made new decisions. It was a natural evolution—with experience and maturity, I became a better parent to Owen after much trial and error. As Owen grew, I found I couldn’t rely on basic principles anymore. There were a number of factors that made me reconsider how I was making decisions.

Context

To begin with, I realized that Owen and I didn’t live in a vacuum. Until his father and I separated when Owen was 9 years old, we were a family of 4 (sometimes 5, with my step-son Justin). Later, we lived just Angus (who is 2 years younger), then with my partner, Carsten. In addition to family, there were the multitudes of caregivers I had hired to look after Owen most days. Owen also of course spent time in his father’s household, which had grown in Owen’s later years to include Justin (who had moved in full time), Michael’s new wife, and her young son. So the effects of decisions I made rippled through many other lives as well.

Assumption of complete information

Another factor that changed how I made decisions was a dawning awareness that I had been possibly making decisions based on wrong or incomplete sets of information from healthcare itself. At first glance there was nothing to be alarmed about: I would look at information I was given, evaluate the odds, wonder as to the likelihood of something working as hoped or expected. But there are (at least) two problems here.

One: The information I was getting from healthcare was presented as true and complete, as though statistics and results were empirical and irrefutable and by their very nature not the results of opinions or agendas.

Two: The way I defined success was heavily influenced by the way healthcare defined success. Survival and functional improvement were the way outcomes were measured and reported. If I had asked, “But how did the child feel about it afterwards?” or, “But what did it cost the family in terms of pleasure and opportunity cost and good feelings about each other and themselves?”. . . I doubt I would have gotten an answer. (By the way, I never did ask those questions. They never occurred to me.)

Non-objectivity

There was also the problem of perspective. I came to see that–even if I considered what Owen might want, or what I would want if I were him—there were still a million nuances and approaches and considerations. And all of it influenced, dictated, by my own assumptions and priorities. This is less easy to figure out because of course I can only be me and would have to become some sort of sociopath to pretend to not be.

My close proximity to Owen—biologically, emotionally, physically—was all part of what made me the best advocate for him. I can’t not acknowledge the importance of that intimacy. Yet, surely my own history and biography can intrude in unconscious ways? Surely I ought to wonder what these filters are as I continue to make decisions on Owen’s behalf, acknowledge my own conflicts of interest?

So. Yes, asking myself “What would Owen want?” is a lovely question and a great starting point. But it’s really not that simple.

blog post 2

Dismantling ‘Team Owen’

I remember the first time, years ago, when I saw the video of Team Hoyt. (If you don’t already know: Team Hoyt is an athletic father-son duo – Dick Hoyt carries, rows and cycles his severely disabled adult son, Rick, through grueling triathlons.) It was sent to me by a friend, with a note that said, “I saw this video and thought of you and Owen! How inspiring!”

I hesitated to press play. But I watched. Rather not inspired, I felt irritated, confused, and not a little put out that someone would think of me when she saw this video. I had no idea how to understand her excited note, or interpret what it said about me, or Owen, or her.

At the time, my son was around four years old. Owen was born with multiple severe disabilities (primarily spastic quadriplegia cerebral palsy), which meant he couldn’t walk, sit, crawl, stand, hold up his head or swallow safely. He was also deaf and non-verbal. He was four years old and I was only just beginning to come to terms with his disabilities. I had thought for a precious, short time, that he was just a bit behind and would likely outgrow his lack of function. “I think he’ll be a typical ‘preemie’,” I said to friends, “Slow to develop at first but he’ll catch up!”

Instead, Owen missed developmental milestone after milestone, always looking and behaving like the weirdest baby you’d ever seen. Like most kids with disabilities, he was charted against regular developmental tables. Owen’s results always flat-lined across the paper while the ‘typical child’s’ line would curve mockingly upwards.

Finally, sometime in his third year, he was given an official diagnosis of cerebral palsy, along with a dishearteningly vague prediction that he may or may not ever develop beyond his current state. I had yet to muster the courage to contemplate what might lie ahead.

So, the video arrived at a bad time. It jolted me because, as the images flashed across my computer screen, I sensed that my son was easily as disabled as Rick Hoyt. And that no amount of triathlons or viral videos or inspired email exchanges was ever going to change that.

——

Medical and therapy teams were encouraging in our pursuit of improvements for Owen. They were always focused on possibilities and potential, looking to maximize and harness Owen’s strengths in order to move him in positive directions. “You never know what they’re capable of,” a therapist said, “It’s always better to try! Don’t close any doors!”

To that end, we explored endless configurations of switch access and devices in order to facilitate choice-making. We tried dozens of wheelchairs, standers and walking frames to aid mobility and appropriate positioning. We experimented with picture symbols, sign-supported English and Blissymbolics to support language development. Like many parents in my position, I became a better expert than the experts and even developed my own programming and tracking sheets, so I could offer reports and progress notes at our frequent team meetings.

I totally embraced it. I loved the busy-ness and productivity and positive reinforcement from the professionals, doing everything I could to give Owen the best possible future. I couldn’t imagine doing any less, and was always trying to figure out ways to do more.

As I continued to immerse Owen and myself in his therapies and treatments, I could finally identify with Dick Hoyt (Go Team Owen!). Or, I should say, with the media image of Dick Hoyt. I was running my own triathlon, carrying and rowing and cycling Owen around with me, showing everyone how anything is possible if you just apply yourself. If you just try hard enough.

——

I didn’t crash in an obvious way. I didn’t flame out or shrivel up or find myself in a psychiatric ward. Sure, I was getting tired. But that’s not what slowed me down.

Instead, I was gradually awakening to the fact that not one of our interventions, despite our best efforts, was actually helping Owen. Small progress might be noted here and there, but it was inconsistent and hard to repeat. At the park, in the store, even at the dinner table—there was no time or space for rigging up the picture board along with the switch and the buzzer and the mounting apparatus and the photo cards. All of our lessons seemed to be for the lessons’ sake, without practical application. Granted, this is how learning often happens: a skill is developed in an artificial and safe environment, to be brought out into the world when ready. But, we were taking up his entire childhood—years—so he could learn what . .? Apple? Dog?

At the same time I was coming to my own understandings of this futility, Owen experienced a sudden medical catastrophe that landed him in intensive care for many weeks. His implanted medical device, an intrathecal baclofen pump, seemed to be causing extreme disruption to his body. He was unrouseable for over 24 hours, and for the first time in his medically-complex life, I wondered if he was going to die.

I lay beside him in his bed, in the dark, and contemplated some very uncomfortable thoughts. “What if he dies? How will I remember his childhood?” Then, “What if he lives? How will he remember his childhood . . ?” This second thought was more harrowing for me than the first.

——

I had already begun to withdraw Owen from his therapies by the time he was hospitalized, and the reality of his health status made it a fait accompli. I even withdrew him from school, and organized a youthful, eclectic caregiving team to fulfill my new goals for Owen: varied and meaningful community-based experiences and interactions, at a pace we could all manage.

I made the change just in time; Owen passed away just two years later, at the age of twelve. I am grateful to have few regrets. He had a good life, which included two wonderful years in which we didn’t try to achieve anything, and more importantly, I didn’t try to prove anything. I had dismantled Team Owen.

I was no longer reactive to the Hoyts’ story because I had found my own way to be. “Good for them,” I thought, and I meant it. I thought of them as archetypes, not heroes. I found contentment, deciding for myself that ‘trying hard no matter what’ just wasn’t serving us well anymore. And maybe, it never did.

(This is the article rejected by Abilities for not being empowering or positive enough.)