Tag Archives: parenting

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My big theory of everything, or why stories are important

My child was born with severe, chronic, multiple disabilities.  Our path was not so much about fixing his problems as it was about ‘maximizing his potential’ and ‘harnessing his natural abilities’.  A modern and enlightened approach certainly, especially when compared to the mindset of previous decades.  But let’s be real: even with this generous perspective, Owen was still charted against typical, age-appropriate development and until the golden day when he would catch up with his peers (lol!) we would be doomed encouraged to continue his ongoing intensive treatments and therapies.  While no longer overtly stated and now wrapped in a rather cheerful bow, the ‘not good enough’ was implicit.

Despite the strides our society has made regarding children with disabilities, the treatment or fixing of a child’s severe disability remains such a priority it is often more important than any of the following ideals we cherish for regular families:

  • protecting early childhood – which typically means shielding the young child (and the mother!) from stress, performance expectations, grading and evaluations, scheduled work, focus on achievement
  • maintaining family equilibrium by giving each sibling equal attention, as well as leaving ample room for the parents to have an intimate relationship
  • allowing the parents–particularly the mother–to relish in the joys of caring for a young child
  • living within a family’s means and maintaining a balanced budget (going into crushing debt to pursue therapies is not uncommon)

Families with a child with disabilities willingly sacrifice these things and our institutions expect us to as well.  Of course no one comes out and says we must intentionally trade this for that, but when it inevitably happens we get sympathetic looks and reassurance that we’re doing the right thing.

I’m sure we could come up with a million and one reasons for why society works so hard to overcome and eradicate disability in childhood, but I can’t think of any that don’t fall into one of these four categories*:

  • Parents have a very hard time recalibrating their hopes and dreams for their children, as well as their own definition of what it means to be a good parent.
  • New parents don’t know better, nor are they taught or given options. They have likely never experienced disability before and are often taking on blind faith what is provided to them by healthcare.  (Ever notice that the more experienced a parent is, the less focused she or he is on ‘overcoming’ disability and the more focused s(he) is on relationship and quality?  Can healthcare not help young parents discover this wisdom sooner, rather than let them flounder around until everyone gets older?)
  • Parents are fearful. It’s an increasingly hostile world for adults with disabilities, especially those with severe disabilities.  Social isolation, institutionalization, poverty – the outlook is generally bleak.  In fact, some find this so bleak that they see mercy killing and growth attenuation therapy as justifiable options, carried out without consent of the person in question and for which otherwise reasonable people (and in the case of growth attenuation, medical ethics boards) can find empathy.
  • Because we can.  Medical technology keeps pace with our fears and sometimes takes the lead, telling us what to fix by virtue of its mere existence.

* I intentionally leave out the motivation that starts with “Because every parent wants what’s best for their child” – this is covered by the first point. And probably the second point.  Oh and maybe the third and fourth. Also, I appreciate that the desire to relieve actual physical pain is a motivation as well, but I prefer to stay away from the subjective and slippery ‘suffering’ attribution. Disability, even severe, does not necessarily mean suffering.

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I don’t for one second advocate for removing therapies for young children on principle–but I do wonder why there isn’t more inquiry on all sides, pondering the hard questions earlier on.  Questions like, will it be worth it? What is it we’re really trying to make the child do, and why? What would my child likely want?  Ought I trade my child’s childhood and my family’s remaining normalcy for what will likely be minimal improvements over a very long stretch of time?

But of course, hypothetical questions can only get hypothetical answers.

If I ruled the world?  More families and parents would tell their stories.  And those stories would be openly accessible to all who can learn from them–doctors, clinicians, researchers, families and the patients themselves.  We need to properly close the feedback loop instead of letting only medicine and healthcare provide partial answers.

 

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An unpublished post from the past which I might have called ‘Being Owen’.

with Jamie and Sallyanne at Canada's Wonderland

I’ve been cleaning up my half-written draft posts this morning (which mostly means trashing them) and stumbled on this one.   I wrote it about two and a half months before Owen died.

August 6 2010:

For the past 2 (or more?) years, I’ve distanced Owen and myself from any kind of institutional intervention or therapeutic activity.  We do our fair share of medical appointments and check-ups and things, but nothing preventative or programmatic.  Instead, I use our respite funding to hire enthusiastic, loving and intelligent support to take Owen out into the world and just, well, go do stuff.  In good weather, they go to the Royal Ontario Museum, the Science Center, the Art Gallery of Ontario and the community center and Bloorview for swimming.   They go on long walks, they run errands, they take the subway downtown, they watch every new kids’ movie that comes out.  In bad weather, they stay in – bake, crafts, read books.   And naps!  Daily naps of 30 minutes to 3 hours, depending on the previous night’s sleep.   Not a bad life, really.

But…it’s not like he’s retired.  He’s a 12 year old boy with severe disabilities.  The default modern parenting mode is to Program!  Stimulate!  Engage!  Mark Progress!  Build Self-Esteem!  Be All You Can Be!  This is standard for regular kids and double, triple for kids with disabilities.   I lived in this mode for many years and wow, it really knocked me out.   I no longer buy it – partly because none of it made a difference for Owen, and partly because it was just a bottomless pit.  It was never, ever enough.

I know that all of that scrambling was futile, and yet I fend off uneasy feelings every day.  I see him watching the same cartoons, going on the same walk, laughing at the same book, sleeping in the same position, at the same time – every day, day in and day out.  Enough to make me want to scream.

Stingray Bay, at the Toronto Zoo

It’s right about then I remember something and it usually stops the internal dialogue in its tracks:  This is my reaction, not Owen’s.  What does Owen actually want?  Can I put myself in his shoes?   I wonder:  Would Owen rather be at a segregated school with a bunch of nurses?  Would he rather be relentlessly assessed and scrutinized?  Would he rather be reminded constantly that he doesn’t behave or engage in a socially acceptable way?   Would he rather be challenged and pushed and judged and monitored and have his square peg self shoved into a round hole in ways that no regular kid would ever tolerate?

I can’t say for sure, but I would guess not.  Owen’s fragile and broken body has been on a long, arduous journey and is constantly assaulted with medications, surgeries, lack of privacy, minor humiliations (when’s the last time you pooed your pants at the mall?), intense physical manhandling, and exhaustion from lack of sleep and muscle tension.  Surely this is enough for a child to endure without throwing Expectations and Progress Tracking on top…?

Even if I had more time and money, I wouldn’t actually do more.   It takes almost superhuman focus and commitment to just get through a day with Owen. Imagine what it takes to get through a day actually being Owen.

at the cottage

Disability or not, I think children need space to be without their parents breathing down their necks.   Children with disabilities, for some reason(s), are expected to work harder than their peers.   To catch up.  To not fall behind.  To fit in.  To prove something.  The pressure of this is hard for a parent (usually the mother) to keep up with – the messages from school, medical professionals and therapists can be persistent and persuasive.  And weirdly seductive.

I’ve written before about projecting my own fears and sadness onto Owen and how that has impacted my own ability to advocate and care for him… but I contemplate now how that must have felt (or feel?) for him.  To be so watched and scrutinized and measured and fussed over.

I suspect that being the subject of intense parental focus is more exhausting than even the physical challenges.

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How to make a disability disappear

Within months after Owen was born, I was told he was deaf. Inside, I shrugged. “Oh well,” I thought. He almost hadn’t been born. He almost hadn’t lived. He almost didn’t come home from the hospital at all. Deafness didn’t seem like a real problem to me. People are born deaf all the time, aren’t they? And they manage, right? It was a guess, but it seemed logical.

His deafness came more and more to the forefront of our lives as therapist after therapist emphasized how difficult language acquisition would be considering he couldn’t hear. He had hearing aids which gave him some environmental sounds, and he’d been doing auditory-verbal therapy for a while – but words and language? Couldn’t hear them. We all agreed that he would need a visual mode of communication.

No one in our direct circle of care was opposed to sign language, in theory. But they had legitimate concerns. How many deaf people do we know? Where will he go to school? How will he communicate back? One of the biggest concerns was that American Sign Language is fleeting, like spoken language. Sign it in the air, and it’s gone. How were they going to use the tools of choice-making, voice-output, auditory scanning?

English and American Sign Language (ASL) are both complete, robust languages. Spoken English though, has a direct one-to-one correlation to written English. You can write what you say. ASL has no written counterpart. It must be captured in essence, then written in English. We could use signing to convey nouns and verbs but there was no real hope of proper language development with such a mishmash of approaches and with Owen’s inability to expressively communicate in ASL himself.

So, English it was. Written, spoken, picture representation, supported with occasional signs for the nouns and the verbs. I was armed with strategies and Velcro and picture cards. Checklists, binders, goal sheets for logging progress.

I was taught to see everything as a teaching moment. That the possibilities for language acquisition were endless! And that his only hope for receiving and expressing language was. . . me.

What a traveling sideshow we became. At the zoo – pushing Angus’ stroller in front and pulling Owen’s wagon behind, binder in my backpack and key photo cards loose in my pocket. “Look Owen! Fish!” Hand undulating in the sign of a fish, pointing to the weirdly pale puffy creature in the eye-level aquarium, then blocking Owen’s view with a photo of a fish that looked nothing at all like the thing in the tank. Then, pause to dig out the photo of a butterfly, the exhibit of which was just around the corner. It all took less than a minute, in a waking day comprised of 720 minutes. So much to do.

What an unnatural and frustrating way to spend time – facilitating every moment of family and social interactions for someone else. It actually required that I exit the scene, disappear from the experience myself, and try to see it through Owen’s eyes so that he could be there instead. In those moments, it left Owen without a mother and me without the pleasure of being with my boys.

I eventually stopped. It was a years-long attrition of letting go of the effort, of not caring any more, of seeing the absurdities and uselessness of such intensive facilitation. Even if there were small gains, they were not worth the cost. Instead, I turned to our back-up plan, our last resort: ASL.

I became fluent, hired deaf support workers, became involved in the deaf community. I won’t lie: It was hard work for me and more than a bit humbling. But so much easier than other attempts at language development because I could stop trying to force Owen to learn and perform. Rather, I surrounded him with a full language in the hopes he would absorb some of it. And clear the way for actual experiences instead of mediated experiences only brought to Owen through the construct of picture cards, gestures and over-articulation.

Owen’s deafness had started out as being the worst of all possible disabilities. The therapist had looked sad, serious. Said, “We can do amazing things for kids with disabilities to help them access language. Switches, controls, voice output, sensors, eye-gaze. Use the hand, foot, head, knee – anything they can control, we can harness. But if he can’t hear? Well. . . it’s much, much harder.” I remember the moment as grim.

Now, years later, Owen’s deafness ceased to be an actual problem. It went from being the most of my worries to the least. It went from being the severest of disabilities to just one of many characteristics that made him uniquely who he was. The about-face was so complete that there were many times I forgot he was deaf. Or, I forgot that his deafness was a particular thing any more than was his curly hair or his funny duck-like quack.

I can’t say that Owen learned to communicate with sign or that he understood everything that was being signed to him. I have no idea how much he took in and processed. Or at least, I can’t prove it. But I can say that everyone around him relaxed. I can say that Owen seemed to enjoy life more and that there was less in the way of him having a good time and connecting with others.

Owen being deaf was no longer a problem. Not because he had learned how to hear, but because I had learned how to see.

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Good enough

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I am watching my boys growing and I am stunned at how quickly their childhoods are giving way to eventual adulthood.  I get ahead of myself a bit perhaps – they’re only 9 and 11 – but they’re over half way to what we typically think of as ‘grown up’.  So I feel entitled to take a moment to contemplate what has come before now and marvel at how much has been packed into what feels like a short time.  And to look forward, and wonder what is to become of these 2 young boys.

Interesting.  As I started writing this I thought it would be about Owen and how he might remember his childhood, and how he might feel he got or didn’t get what he wanted or needed.  Instead, I feel drawn to thinking more about Angus, Owen’s younger (but so much older) brother.

Angus is Owen’s champion.  His advocate.  Often, his voice.  He is outraged at the little indignities Owen suffers on a daily basis (heard on an elevator:  “what a lucky girl to have such curly hair!”  Angus:  “He’s NOT a girl!”)  He is thrilled when Owen knocks over his tower of soft blocks.  He is deeply worried for Owen’s health and wellbeing and does not want to hear about his surgeries or sufferings.   Angus has not one ounce of self-consciousness or embarrassment about Owen and is fiercely loyal.   I sometimes wonder about Owen’s eventual death – Is it soon?  Will I be there?  Will anyone witness the moment?  Whatever morose thing I’m thinking,  I feel the hot surge of my own grief and I then immediately think ‘Angus!’.

After me and Owen’s father, Angus is next in line for taking up Owen’s torch.  Angus knows this although I have never said it.  He often talks about looking forward to getting his driver’s license so he can ‘drive Owen around’.  He wonders what it will be like for him and Owen to live on their own one day, together.  I say nothing, but my heart breaks wide open every time.

I realize now that so much of what I do concerning Owen – how I speak about him, how I engage with him, how I care for him, how I include him – is as much for Angus as it is for Owen.   And it’s for Angus that I must model a life that is balanced, good and, well, fun. I don’t ever want Angus to think that he must suffer or break his back in order to offer love and care to another – his own brother or anyone else.  And I am determined to not let Owen be anyone’s reason for having a bad life.

Regardless of whether Angus does eventually become Owen’s caregiver and/or guardian, I want him to look upon his brother lovingly and respectfully and with an open heart, without the cloud of guilt or fear or burden that so many of us create for ourselves.

And I want him to believe that anything he does for Owen, borne out of these energies, is good enough.

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Life as the Decider.

Owen and Jennifer

(photo:  summer fun at the cottage)

I have been thinking lately about my role as Owen’s primary caregiver and advocate and the process involved in making tough medical and care-related decisions.  I’d always thought it was quite simple:  do what I think is right given what I believe to be true at the time.  ‘Right’ means 2 things:  what do I think Owen would want, and what would I want if I were him.  Using this admittedly rudimentary yardstick, decisions have included (but are not limited to):

  • not getting a cochlear implant
  • using hearing aids
  • not using hearing aids
  • not getting a g-tube for feeding
  • getting a g-tube for feeding
  • learning ASL
  • learning Blissymbolics
  • not learning Blissymbolics
  • homeschooling
  • not medicating Owen for sleeping
  • medicating Owen for sleeping
  • going to school
  • not going to school
  • not getting a baclofen pump
  • getting a baclofen pump
  • removing a baclofen pump
  • and now recently – not getting deep brain stimulation

Each of these decisions was followed by loud pronouncements to family, friends, doctors, and then within months completely reversed with much quieter assertions  of opposite intention.  “I will NOT…”  or  ” I could NEVER…” or “I will ALWAYS…”  were replaced by “It wasn’t working so…”  or  “I just couldn’t bear the ______ (lack of sleep, discomfort, hassle – choose one)  anymore”.

So far, no regrets.   Decisions are made, things change, new decisions are made.  But life with Owen is getting much more muddled and complicated and on reflection I see that none of this is simple.  I’d like to move forward having learned something from our almost 11-year journey together.  Maybe I need to broaden my definition of ‘right’ (as in ‘do what’s right’).

As I have mentioned in previous posts, Owen is deeply uncomfortable a lot of the time.  However, his pain threshold and tolerance for the discomfort is increasing.  In other words, he’s used to it.  BUT, and it’s a big but, his pain isn’t the only issue at stake.  At stake are his health, his manageability/quality of care, my health and wellbeing and Angus’ eventual involvement in Owen’s care.  Consider this:

  • Owen’s dystonia and spasticity are wrenching his body out of alignment.  His hip is dislocated from the twisting and writhing and I think his opposite shoulder is next.   When sleeping, his body is totally twisted in what some of us in the yoga world call ‘little boat twist’ -  head turned to one side, knees bent  (and drawn in) and dropped to the other side.
  • Owen is getting hard for me to manage. He’s not huge – only about 45 pounds – but imagine carrying (safely) a 45 pound wiggly, slippery fish.  Or strapping that fish into a wheelchair in a seated position (oh, and don’t forget to attach/fasten the lapbelt, chest harness, neck support, pummel… quick!).
  • Owen is even harder for others to manage.  He didn’t show up on my doorstep as a fully formed 10-year-old Owen.  He and I have travelled this road together.  His new caregivers though are a whole different story.  I am acutely aware that for the young women I’ve hired, Owen is a huge challenge.  Physically, mentally, emotionally.
  • I don’t really sleep.  Owen’s bed is beside mine and I often need to adjust him or change him in the night.  He might sleep deeply from around 11 pm to 3 am.   At a time when most of us can just yawn and turn over, Owen somehow wiggles himself into a pretzel shape and can’t get out.  He’s also extremely tight and needs to be untangled.  By then he’s entered a different phase of sleep and is less calm.  He jerks, spasms, thrusts, postures – the only way back to sleep is to be held in a kind of fetal position (by me).  I sleep on one side and basically hold him down while he twitches and flinches for the next 3 hours or so.  We muddle through most nights, he and I, and get about 5 or 6 hours of sleep total – but for me it’s not restful or deep. The toll on me is undeniable.
  • Owen’s brother, Angus, already feels responsibility for Owen.   He recently announced that he will want to live on his own for a bit “in his 20′s” but then in his 30′s he will live with Owen and take care of him.  Angus is 8.

Really, this list could go on and on.  My point is that in addition to Owen’s comfort, I need to consider the long-term ramifications of my decisions and Owen’s ongoing care.  I want him to be loved and cared for for the rest of his life – in order to make this happen, medical decisions must account for this.

My responsibility as his mother, advocate and substitute decision-maker requires that I consider so much more than what Owen would want.  Partly because there are so many other issues to consider (some of which are listed above) and also because I just have NO IDEA what Owen would want.

I’m going somewhere with this – check the next post.  This one is getting too long, even for me.