In pursuit of a child’s potential: a parent’s reflections on hope and futility
by Jennifer Johannesen
(reprinted with permission from Brainstorm: A newsletter about ethics, neuroscience, and society. Prepared by the Neuroethics research unit at the IRCM. Vol 8 No 17 Dec 2015)
From the author: Parents with young children with severe neurodevelopmental disabilities are extraordinarily committed to helping them achieve as much as they can, despite the significant odds against them. I was one of those parents until I started to question why we were working so hard, to achieve so little, at such tremendous cost. I have met many families who share this experience. Hopefully this story sparks a discussion about the role clinicians can play in helping families like mine establish realistic goals and priorities.
Owen’s brain scans didn’t give us many clues. Although his basal ganglia were underdeveloped (this news caused a flurry of inquiry but produced no leads), there was little else to hint at why Owen was the way he was. He was about as disabled as you could imagine: he could not crawl, sit, stand, walk, chew, swallow or hear. He was a tiny boy – just 58 pounds when he died, at 12 years old. The list of medical issues and complications was alarmingly long. In a way, it was remarkable he lived as long as he did. He died sometime overnight while the surrounding household slept, unaware of his struggle to turn himself back over. (The diagnosis was SUDEP – Sudden Unexpected Death in Epilepsy – which was given despite the fact that Owen didn’t have epilepsy, and despite his post-death position. His autopsy revealed that he did not suffocate.)
I mention Owen’s scans because for a while, in the early days, I thought they would reveal his secrets. Owen’s doctors and therapists would explain to me that his brain was misfiring; it was sending wrong or mixed signals to his body, causing his dystonia and spasticity. So I made the logical assumption that his problems were located in his brain, and I became especially focused on brain scan results. Unfortunately more scans didn’t reveal more information – especially as there was nothing to see. (By the way: I could say the same about bloodwork, genetic testing and muscle biopsies. He endured a lot of tests, none of which revealed the clues I was seeking.)
All of this to explain that none of us, including his doctors, knew what was wrong with him. We only knew what we could see, which is that he was developing in unusual ways, never meeting developmental milestones, not gaining any skills. But this wasn’t too discouraging: our unfruitful quest to answer ‘why’ left plenty of room for hopes and dreams. No diagnosis meant there were no limits—which suggested that anything was possible.
Our therapists were creative and energetic. Together we heroically embarked on a years-long journey to help Owen ‘reach his full potential’. We tried to figure out communication, gross and fine motor function, and literacy. We charted out goals and plans, noting with each failed benchmark that there was always next time. To aid development (and handling) Owen was implanted with an intrathecal baclofen pump (a small programmable pump that administers anti-spasticity medication directly into the cerebrospinal fluid), and we began to explore deep brain stimulation. For a while, I felt purposeful and fulfilled – I performed well and was praised as ‘such a great mom’. It almost didn’t matter that Owen seemed to simply be along for the ride, not concerned in the least that he wasn’t achieving the goals we’d set out for him. And it almost didn’t matter that somewhere in the back of my mind was a small but rapidly growing sense of futility.
I don’t know if I would have changed course if Owen’s baclofen pump hadn’t malfunctioned. But it did—he endured a long and difficult few weeks in intensive care as the neurosurgeon and his team tried to figure out why Owen appeared to be experiencing intermittent symptoms of overdose and withdrawal. It was a dark time of difficult decisions and terrible waiting. At one point I lay beside him in his hospital bed, contemplating uncomfortable thoughts. What sort of childhood was he experiencing? What sort of mother had I become? If he dies now, will I find comfort in all that work? How will I remember our time together?
Shortly after discharge from the hospital, I rearranged our lives. I withdrew him from school and any therapy that had come to feel pointless—which, frankly, was all of them. We focused instead on meaningful experiences and enjoyable excursions. (These decisions were not made lightly or recklessly – please read this post for more context, or my book, No Ordinary Boy, for a fuller account.)
His last few years of life were spent with people who loved him, doing things that were enjoyable for all. The physical work of caring for Owen became no easier, but we were relieved of the tyranny of chasing Owen’s ‘potential’, which had cost us so much already.
Jennifer Johannesen (@jenjohannesen) writes and speaks about healthcare and disability. She is completing a Master of Science in Bioethics and Policy at The Bioethics Program of Union Graduate College and the Icahn School of Medicine at Mount Sinai. Her book, No Ordinary Boy, is available on Amazon.
I am beginning to play with the notion that “achieving potential” has more to do with “normalizing” a child to fit into societal parameters than to actually ascertain and pursue in a supportive way what might be, for that child, a good life. That being said,we still have to be vigilant in watching for treatments or therapies that might make life for our child easier, more comfortable, or more accessible to him or her. Anything that can assist the child to advocate for him or herself is also important. Balance is everything, though, isn’t it? So much easier to see with 20/20 hindsight.
I agree – I’m certainly not suggesting we throw the baby out with the bathwater. My recommendation primarily is that families need better coaching, not just cheerleaders.
As for hindsight: it’s pretty much all I’ve got.
My hindsight comment was actually about how I look back on things now that my daughter is an adult. I hope it wasn’t misconstrued as diminishing the value of your perspective. I agree with you about the need for better coaching.
Oh! I didn’t misconstrue… I was in a hurry to post :) I knew what you meant.
Although child mortality is common in paediatrics, clinicians refuse to consider the possibility of pending or sudden death. For those with severe disabilities, it may be plausible to argue, “Independence is not exclusive to having a life worth living.”
Happy New Year!!!