The wolf and the trail of breadcrumbs

Over the past two years, I’ve shared a story at a few national conferences on digital health and patient engagement. It’s the story of how we first learned that Puck has Tourette Syndrome (TS), and the first time I realized how much energy and know-how it would take to navigate our health care system. It was a disempowering experience, but looking back, it pales in comparison to the messes we’ve encountered in trying to access care in the mental health system.

When Puck was eight, he started having severe headaches. He’d already been diagnosed with severe learning disabilities a year earlier, but he’d never really had any physical health issues. Our family doctor believed his headaches were migraines. She recommended getting some blood tests, and she suggested a CT scan just to rule out anything else.

We got the CT scan within a week. A few days later, on the Thursday afternoon before Easter, my doctor phoned me. (You know that’s never good: it’s usually the office manager or receptionist who phones, not the actual doctor.) She told me that  ‘something suspicious’ had shown up on the scan of Puck’s brain, and that while we shouldn’t assume the worst, we should prepare for it. 

There have been few times in my life when I felt as weak as at that moment.

The doctor said she’d send a requisition for the next available MRI, so that we could get a better idea of what was on Puck’s brain. All we could do was wait.

Weeks went by. Every time Puck got a headache, I imagined a ticking bomb in his head. I waited to hear about our MRI appointment. At work, I phoned my home answering machine every hour, hoping there’d be a message. There was nothing. After almost three weeks, I phoned my doctor’s office. The receptionist put me on hold for a long time, and then came back and said, “Oh sorry – we actually forgot to send that requisition. We’ll do it right now.”

And so, we waited some more. 

At the time this was happening, I’d recently finished working as the senior policy advisor to Nova Scotia’s Minister of Health and Wellness. I knew first-hand about the challenges with the health system. I read the frustrated letters from people who couldn’t access the care they needed in a timely manner. Almost weekly, the Minister and I spoke with people who were upset they couldn’t access specialized treatments or drugs they needed (or believed would help). I had thought that most people’s frustration with our health care system came from needing something extra; something more than our health system could reasonably offer. But now, going through this myself, I knew it was about the whole system: the lack of coordination, the lack of empathy, the lack of timely access to even the most routine care. 

Don’t get me wrong: I am a huge supporter of our Canadian health care system. But I believe many of the problems we face are not a Canada-only problem. So much of people’s frustration with any health system comes from the complete lack of compassion and information – the lack of patient connection to the decisions and communication about our care. Those are problems found in most systems, whether universal or insurance-based. Information IS power. It gives you a sense of control over a very out-of-control situation, and that goes a long way to giving someone peace of mind. Not knowing where we were in the system, or if anyone was even paying attention, was a horrible, powerless feeling that only compounded the powerlessness you feel when dealing with a sick child. 

Around this time, I complained about the whole MRI situation to a physician I knew through my work. She told me she might be able to help. She said her clinic used a personal health record, and that she’d be willing to take Puck on as a patient. I didn’t see how a health record on a computer could possibly help, but I was willing to try anything. So she helped me set up Puck’s record, sent him for loads more blood tests, and sent an MRI requisition to all of Nova Scotia’s then nine health districts to try to get us in faster, somewhere.

Puck had the blood tests the next day. Two days after that, I got a notification on my phone that the test results had arrived. I could go online and see all of them, in detail. I’m not a medical professional, and I can’t interpret medical tests. But each result came with an indication of what was considered a normal range, so I could see where Puck’s results fell. The doctor had also sent a note explaining which test results indicated a need for follow-up. Finally, I had information. It might not be the ‘smoking gun’ that would tell us what was causing Puck’s headaches, but it was, at least, a piece of the puzzle. I could look at those test results, and know what things I could STOP worrying about. For a parent with a vivid imagination and not a lot of information, that was powerful. Being able to access health information online was a huge step in addressing the power imbalance that exists between health professionals and patients.

We managed to get an MRI in another part of the province with a shorter wait. The doctor had also arranged an appointment with a neurologist at the children’s hospital (in a brighter, far more cheery part of the hospital than the mental health ER we later became too acquainted with). The neurologist was a delight. He played soccer with Puck in the hallway, put him at ease, and told us, happily, that the ‘suspicious thing’ on Puck’s brain was nothing to be concerned about – it was just an enlarged space between blood vessels. The headaches were, indeed, migraines. 

However, through all the testing and family history he did, he discovered that Puck has Tourette Syndrome. Incidentally, I was diagnosed with OCD at the same time – the two often go hand-in-hand, and I’d been living with manageable symptoms at the lower end of a spectrum my whole life. (My partner told the neurologist my symptoms made me ‘mildly annoying to live with’. I told him they made me ‘quirky’.)

 As it turns out, these things were all part of a long trail of breadcrumbs that we’re still following for Puck – a trail that now includes learning disabilities and severe mood disorders. I suspect we’ll soon be adding new breadcrumbs to the trail. Every time I think I’ve got the trail figured out, the signposts disappear, or the trail stops altogether – or the Big Bad Wolf, in the guise of the health care system, comes along and gobbles up the trail, leaving us lost and alone.

There is no easy way for parents to navigate complex health systems. Throw in both physical and mental health systems — which, after all, are not integrated and are two completely different experiences — and it’s twice as confusing and time-consuming to navigate. As a parent, you have to know who to talk to, and you need to know how to speak their language. 

I know how lucky I am. I had connections I could call on for help. I knew the language. Most parents don’t have that. I remember sitting and waiting, as Puck was motionless inside the MRI machine. I was so anxious, so terrified of what they might find. Seeing him stuck in there broke my heart, and I had a premonition that it was only the beginning of many such heartbreaks, as our journey through the health system unfolded. I remember, too, thinking of all the parents who couldn’t follow the breadcrumbs. Maybe they didn’t know who to turn to for answers, or they didn’t even think you should question your doctor. My heart broke for those parents…the ones who are still waiting by the phone, waiting for an appointment for a test that might give them answers, even though the requisition was lost weeks ago or sent to the wrong fax number. 

We have a right to expect that our information will be handled in the most efficient and compassionate way possible (are fax machines really that efficient, these days?). Parents with children experiencing a health crisis – whether that’s physical or mental – are in crisis, too. The system shouldn’t add further burden to these families asking them to create their own trails, alone.

We’ll never get back where we were before we started on this journey. And with this huge wolf following behind, eating the breadcrumbs…how will we ever find the trail that takes us where we need to go?

Breaking Up

It’s never fun, as a parent, to see your kids bullied by mean girls, or left out of social groups, or losing a friend. It’s a rotten part of parenting, but we can hope our kids have  the resilience to manage these social interactions (with our support) — to learn from them, move on, and find new places where they can belong and thrive.

That becomes a little harder when your child is dealing with mental health and neurological issues.

Puck recently spent a day with his long-time best friend — a boy he’s known since Primary, at his old school. I knew something was wrong when Puck texted me to pick him up early from the friend’s house (he’s usually begging to stay longer). He went straight to his room and shut the door.

It took him a few hours to tell me what had happened: his friend had told him he has a new best friend now.

Puck cried when he told me, and kept crying for a day. He’s still heartbroken. He has other friends, but this was his best friend, and was one of the few positive links he had to his old school. 

At times like this, I don’t know the words to make it better. I can’t kiss it and make it stop hurting. I am simply a sponge: I sit with him and absorb the tears, the emotions that are still too big for him. I add them to my own big fears and upsets, and squeeze it all out when I’m alone so that the sponge is ready again when he needs it. And he needs it, often.

Rejection is such a theme for us, lately. I keep trying to help Puck find the places where he’ll belong and thrive: friends, school, activities, the mental health system. We find rejection at every corner.

The same week his best friend “broke up” with him, he got dumped by his psychologist. This was the third psychologist in the past six years to suggest it just isn’t working out. Once, it was blamed (rightly) on Puck (he was uncommunicative and resistant to therapy). The second therapist, who Puck had actually warmed to, left the city. This time, the therapist graciously bowed out after eight months,  saying some version of “It’s not you, it’s me” (except, it was clear she really felt it was about Puck, not her). We were sent on our way, with a ‘good luck’ and not much else.

Therapy, like friendship, is an intimate relationship — especially for a child like Puck, who fears opening up about his feelings after years of feeling judged and rejected. We can’t expect friends to always be there for us, perhaps. But shouldn’t we be able to expect that mental health professionals will try their hardest not to underline the feelings of rejection and inadequacy that are already in play? It’s good to admit that you aren’t the right one to help, or that you’ve taken it as far as your skills allow. But if you aren’t the right one to help…who is? Where do we go from here? How do we find what we need?

We are back at the start, with no mental health support. Alone.

Puck is not unaware that he’s been rejected, again. He’s old enough to understand what’s happened; he understands his role in it. He also understands that he needs some support in working through his emotions and developing coping strategies. He knows he’ll need to find that somewhere, and that the whole process will begin from step one. That’s an exhausting prospect for him.

Where does this leave us? Well, I can go through the listings or get recommendations from friends or professionals I know, and try to figure out who might be a good fit. Then, we’d go through the screening process again, maybe even costly psychological testing again (out of pocket, because we’ve long ago maxed out our insurance for the year). And then, we’d once again spend months in the ‘getting to know you’ phase, watching Puck bristle at having to explain to adults, once more, what he struggles to understand himself.  We would be months away from any actual constructive therapy.

The other route available to us is to call the children’s hospital and go through their mental health referral process. We’ve tried this before, and I have friends who’ve recently done it, too. 

It did not go well.

It begins with a phone screening, during which the person reading from the script refers to you consistently as (you guessed it) “Mom”,  because you are obviously just a generic sketch of a parental-type person as opposed to an adult trying to hold together a family in crisis. After you have broken down in tears from frustration and their lack of empathy, you will be given an appointment with a mental health professional, anywhere from two to six months away. You’ll later receive a letter stating the time and date of the appointment. These appointments are in the middle of the work/school day, making it difficult (if not impossible) for many parents to accept them without losing work and pay. If you miss that appointment, your file is closed. If you request a change in date/time, you might be waiting another couple of months.

It’s not a system that’s friendly to financially marginalized families, or any family that doesn’t have the flexibility to get to an appointment in downtown Halifax in the middle of the day.

When months have passed and the appointment finally comes, you get asked all the same questions you’ve answered before. As a parent, you’ll be asked to fill in more questionnaires about your child’s behaviours and symptoms, and how it is affecting them and your family. A friend of mine had the awful experience of having the answers she’d written about her child (which she thought were confidential) read back, word-for-word, to the child. Not great for building trust at a time when emotions are already fraught.

At the end of the appointment, you’ll get handed some brochures and helpful websites to visit or books to read (at this point, I seriously think I’ve read every book and could redesign every website, especially since that’s the only help I can access in the months between mental health appointments). 

And then comes the moment of truth: what will they do with you? 

There might be some community-based resources they could refer you to — but too often, when this is requested, the professional isn’t familiar with the community resources available.

You could get sent to a psychiatrist or psychologist in the hospital’s clinic (I’ve never actually met anyone who was offered this option).

You can be referred to a phone-based family coaching program. This program is award-winning, and I personally have not taken it, so perhaps I shouldn’t comment. But I do know people who have taken it. Again, the times for the phone check-ins are not always flexible, so not helpful for shift-workers or for people with family commitments beyond this one child in crisis. Building skills and family resilience are absolutely important, but many I know who’ve taken this program came away feeling blamed; they left feeling it was their inadequate parenting skills that got them in this mess. If they just knew the right things to say, if only they behaved better, little Johnny wouldn’t have a mental illness.

(I bet they’re also referred to as “Mom” on those phone check-ins.)

You can be put on a waitlist for group support. For Puck, this would be a support group for kids with anxiety disorders (which is only about 30% of what’s actually going on with him). The group only happens a few times a year, and there is always a wait list for registration. So you’re looking at other six-12 months for that option. If Puck was offered this, by the time his place on the waitlist came up, he’d likely be placed in the group for 13+. However, he is immature for his age. He’d be better served in a group with younger kids, not teenagers. But that wouldn’t be an option. I know him — he would be intimidated by those bigger kids, and wouldn’t go. Another six-12 month of waiting, wasted.

Puck will start school in September, and his teachers will have the expectation that we’ll have conferences with his support team…which is now non-existent. I am, once again, his support team. It falls on me to be the expert in things I’ve never been an expert in. I will be the one to research possible interventions, to figure out why he is reacting a certain way, to try to find a path forward (at least I’m putting my social work degrees to good use, I suppose). We are fortunate to have a fabulous family doctor with a background and interest in mental health, so at least we aren’t entirely on our own. But realistically, we’re a good eight to 10 months away from any meaningful mental health support. 

Add to that the fact that even if we managed to get psychological help, there is no holistic approach. I certainly don’t expect someone to have expertise in all the issues Puck has going on: Tourette, learning disabilities, anxiety, depression. But there should be help for parents like me to put all those puzzle pieces together and find the experts who can help, who will talk to one another, who will see kids like Puck not as one issue to be treated, but as complex individuals with lots of things going on. I am SO tired of explaining, “This is probably not the anxiety, it’s likely Tourette…”. Someone else needs to help connect these dots.

We need a Tinder for mental health professionals… swipe right for ones that work with your specific issues, have actual availability, and won’t call you Mom.

It would be nice, too, if at least one of them asked how I, as the parent who lives with these issues 24/7, is doing with all of this. (Not. One. Ever. Has.) The generic “Mom” is supposed to be some kind of super-robot, I guess, who is capable of handling all the emotion, confusion and screwed up family dynamics, while managing to work outside the home, and function as an enlightened liaison between home, professionals, and school. 

Our mental health system claims to use an ecological/systems approach that considers the complex interplay between the client and their environment. I see little evidence of that. The effort to get kids through the system quickly and reduce numbers on wait lists means that kids are reduced to a single issue to be treated, not a complex mix of strengths and challenges. They are boxes to be ticked off; files to be dealt with and closed. They are widgets to be pushed through an increasingly dehumanized system, rejected out the other end, and sent back to Mom to deal with.

And ‘Mom’ has to be that super-robot, capable of providing support without any impact to her own emotions, because, too often, we’re the only mental health resource our kids have. 

If you give a Mom a popsicle…

When Daisy was a toddler, we had a fluffy calico cat named Scarlett O’Hairy. Daisy adored her and wanted to be just like her. She’d sleep like a cat, all curled up with Scarlett in a patch of sun on the floor. She tried eating like a cat (but even her love for Scarlett couldn’t convince her to take more than one bite of the foul-smelling food). Once, in the wee hours of the morning, Daisy saw Scarlett jump off my bed and decided to do the same thing. While Scarlett landed gracefully in the laundry basket, Daisy fell into the dresser and split her forehead on a sharp corner. This resulted in a trip to the pediatric emergency room, and four stitches. Another time, Daisy took up Scarlett’s favourite pastime – digging in the houseplants. She ripped leaves off the plants for Scarlett to eat and crammed mouthfuls of potting soil into her own mouth. This resulted in a call to poison control, and a decision that maybe a baby brother or sister would be a safer companion than a cat.

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Scarlett O’Hairy: on Wednesdays she wore pink.

 

We’ve spent a lot of time in the emergency room over the years, for cat-induced and other ailments: ear infections, kidney infections, strep throat, croup, broken bones.  Eventually, toddlers pass out of the Walking Germ Bag phase. Trips to the emergency room become so infrequent that the kids actually look back on them fondly: misty watercolored memories of being safe and warm, wearing brightly coloured johnny-shirts and wrapped in warm flannel blankets, and being treated by kind people who gave them popsicles and stickers and cool-looking bandages. 

My memories of those visits are equally nostalgic. Maybe that sounds strange – I mean, what parent looks fondly back at illnesses and middle-of-the-night trips to the ER? But like my kids, I don’t remember the illnesses much. I’ve thankfully forgotten the vomiting, the search for clean sheets in the middle of the night, trips to the hospital through dark streets with time standing still. What I do remember is how we were all treated. My kids were treated with compassion and kindness. I was also treated so well. Everything was well-explained, follow-up instructions and appointments were clear, and the health professionals seemed as concerned with how I was coping as with how my kids were managing. Once or twice, I even got a popsicle of my own.

I’m nostalgic for that, because these days my visits to the ER are for Puck’s mental health crises — something that can’t be treated with stitches or antibiotics, and is a genuinely terrifying kind of pain. And when we get past this, my experience with the mental health emergency room is not a memory on which I’ll look back fondly.Read More »

Fantasyland

Everything in the room is colourless and plastic. The grey walls haven’t seen paint in years. (Are they actually painted grey? Or has time and neglect turned them this colour — a blend of sorrow and blur?). In the middle of the room are three beige, too-small plastic chairs – the sort parents force their rear-ends into during kindergarten visits. One bigger, mottled faux-leather chair, ripped and spilling orange innards, dominates the space – the only speck of colour in a room devoid of cheer and decoration.

This is where furniture and parents’ hopes come to die.

Just down the hall (around the corner where the other families can’t see us) is the regular children’s emergency department. I’ve been there plenty of times, with both my kids. We’ve gone there for middle-of-the-night ear infections, cuts, broken bones. There are clean cubicles adorned with stickers of cartoon characters. Nurses bring popsicles. They do their best to ensure children are comfortable and not scared.

This time, we’re here for a broken mind, not broken bones. It seems they don’t bring popsicles for that.

It’s two weeks before Christmas. Just a week earlier, we were on a family vacation to the most magical place on earth. Earlier that morning, I’d been on the national morning news, talking about a book I wrote.

Now, we sit in this colourless room, waiting for a member of the mental health emergency team to talk to our 12 year old about why he’s suicidal. And as we sat there, I was getting texts from people to congratulate me on my media appearance, or to comment on my vacation photos.  These two realities don’t align. But which one is real, I wonder? Read More »

Mental Health Week (or, “At least you’re not really sick…”)

This blog is still in its infancy, but people are asking me why I’m doing this. Why am I putting my family out on public display, even with thinly-veiled identities? Am I brave, or irresponsible, or in need of therapy?

(Well, ‘yes’ to all of those.)

But really. I can tell you why I’m doing this: stigma. I have spent decades of my life pinned down by the stigma of living with anxiety and of having recovered from an eating disorder. I have felt invisible and fake, and convinced that people wouldn’t like me if they knew who I really was.

Enough of that bullshit. This is who I am. I am not perfect. I am not particularly strong, or brave, or smart. I am flawed but surviving, and I can do that better if I tell the truth about my life. Our society, in general, will do better if we all tell the truth, and smash through the stigma that comes from living with mental illness. Mental illness is isolating enough without having more isolation imposed on you by society’s stigma. I don’t want Puck to feel the isolation I’ve felt. I am committed to working for change.

Things are better than when I was Puck’s age, for sure. Somedays, though, the stigma shows up where it’s least expected.Read More »