We've been dealing with a kid who doesn't want to go to school. I know that seems like a redundant statement. What kid wants to go to school? There is your typical run-of-the-mill "I don't wanna go to school" and then there is the flat out school refusal. We have the latter. To say that it's been a challenge is an understatement. After my residency in internal medicine, I completed a 2 year fellowship in adolescent medicine. Teenagers don't have a set of medical illnesses more so than the rest of the population so it's not like gynecology and it's not like doing a subspecialty in an organ system like cardiology or gastroenterology. Teenagers have teenager problems. The stuff we'd see as practitioners of adolescent medicine, that wasn't an STD or a gynecological issue, was mostly related to the psyche. And the teenage psyche is both complicated and not fully developed. So, you can have a fully grown man-child or woman-child but their behavior is more fitting of a 5 year old and yet they can speak in complete sentences, but so much of what they might say is completely irrational. The 2 biggest chief complaints that we would encounter in the adolescent medicine clinical practice were eating disorders and school refusal. At the time, I found the process of caring for a teenager/family with either of these problems to be ridiculously frustrating and tedious. While calmly laying out an interdisciplinary treatment plan that included a whole host of health care professionals I found myself, in the back of my mind, screaming: "Just f-cking eat!" or "Just f-cking go to school!". I knew it was never that simple otherwise these seemingly rational and normal parents would not be at their wits end and in our clinic.
Fast forward to my own adolescents living in my home. There is a reason God makes children cute when they are little. It's so you fall in love with them because once they hit puberty, they cease being cute (unless they are asleep and then you can still see some remnants, vestiges of their former adorableness). Sure there are lots of great things about having a teenager in your house. Generally, they are very witty. They keep you current in the humor department. You can have conversations with them about "big" topics (politics, religion, current events) and these conversations give you insight into the inner workings of their mind. But, as I think I've mentioned before, their hard-wiring is not yet been completed. There are incomplete circuits and routinely you will get inappropriate power surges. A packet of hormones might explode within them at the same time you are discussing feeding the dog and all of the sudden your kid has a volatile and tear-filled response to putting kibble in the dog's bowl. The dog is the innocent victim. And you are too. Getting hit with friendly fire is a daily occurrence as the parent of a teenager.
In regards to school refusal, I was texting my dad the other day and appraising him of the situation. It had been a particularly frustrating day and I just wanted a "You are an excellent parent. Teenagers are crazy. You go girl." At almost 70 years of age the distance between being both a teenager and the parent of a teenager is farther for him. "Just make him go!" was his suggestion. "Well holy shit dad! Why didn't I think of that?" It was unfair for me to think he'd have any solutions and I'm sure I just agitated him by proposing a problem with such an simple and obvious solution. At the end of the text dialogue he suggested that our kids were somehow more poorly equipped to handle the complexities of life because, as doctors' kids, they are coddled and have no grasp on anything other than first world problems. Maybe accountant's or plumber's or Peruvian villager's kids don't have problems similar to my own kids. Or maybe accountants and plumbers and Peruvian villagers are just better parents. Who knows? I'll talk to him (my dad) in a couple of days and he won't have any lingering resentment about the conversation or even remember it for that matter. He'll remember, but in his mind, it won't have the significance I've given it. "What, your kid won't go to school? Dammit, he has no choice. Doctors' kids!" He doesn't remember the bullshit I put my parents through because that was 35 years ago and, as the non-custodial parent, he wasn't in the trenches like my mom was. That poor lady had poo flung at her on a daily basis (by me, not my brother. He was a saint.).
I don't have a solution for the school refusal. We are working on it along with a team of professionals (which we can afford, for better or worse, because we are doctors) and every day is a new beginning but not in the inspirational meme sort of way. It the "Holy F*ck, what's gonna be behind door number 2 today?" sort of way. Seriously, I can go to work and manage a complicated patient with heart failure, diabetes, chronic renal insufficiency, hypertension and hepatitis C but this stuff reduces me to a weeping pile of rubble. I know one day said child, his father and I are going to look back and laugh and joke but right now it's like a million little daggers being thrust into my side with a generous heap of rubbing alcohol being poured on top for just the right amount of sting. You sit there and think, WTF is wrong with my husband and me that we can't get our kid out the door and into the school building? It's probably worse because we are doctors. That kind of hatred towards academics and goal setting has never been in our framework so not only is it maddening to not get them out of bed, it's absolutely mind-boggling that someone, someone that you made and has your DNA, does't get the same life-affirming fulfillment from completing assignments and having the teacher like you and making good grades. How could a child of mine not like to plan and make mental lists and organize? What is wrong with this person? That's the thing with parenting; it pushes you beyond your natural limits. I'd never, in a million years, choose this challenge. If this were a category on Jeopardy and I was a contestant, this would be the absolute last column I'd choose. For me, this is kind of like sky-diving or bungee jumping or getting a tattoo. I'm intrigued and have respect for people who fall into that category, but I just couldn't do it and not out of judgment or belief that it is right or wrong, but because I don't have to do any of those things to complete my tasks in life. I can detour around those options. But you can't detour around the option of raising your kid even when you feel entirely unequipped to raise that kid to maturity. In my mind, a pack of angry wolves would do a better job than my husband and I are doing right now. And at least they have the option of eating their young.
None of this is to say there is anything wrong with my kid (other than he doesn't want to go to school right now, but that is a temporal problem that will be solved. And in his defense, he's incredibly smart so he probably can miss about one third to one half of the school year and not really miss anything and still make good grades). And honestly, there is nothing wrong with Lee or me. I think most parents have this same dilemma a million times a day for a million different scenarios and at all stages of their children's lives. Some people quietly deal with it in their own way but not me. I need validation (back to the text conversation with my dad). I need validation from complete strangers and from my parents and from Stacey the mailman. I really am that insecure and maybe it makes a little bit of sense that my spawn might have some anxiety. I always have this internal dilemma of whether or not I'm going to post the stuff that I write onto a wider platform (because I am so insecure and crave validation) but usually I show it to a few people and the process of typing it out helps me make it sense of it all. Someday I hope my kids read this. They can read it now but it will make more sense when they are older. It's a decoder for them, in a sense; a key to why mom was the way she was. An archeological relic that helps you understand a society or a people. So Evan, Jake and Annie, I write this for you and know that if nothing else, you 3 are the best things in my life. Even in the most challenging of times and circumstances. I am prouder of producing you 3 than anything else I've ever done in my life. I know I've messed up along the way and will continue to do so but you 3 are all that matters. Take that with you to the grave and apply it to your own families and children. It's what keeps society moving forward. You will always be my greatest legacy. I love you.
Saturday, September 17, 2016
Tuesday, September 13, 2016
Class of '86
I just returned from my 30 year high school reunion. I wasn't the most popular person in high school. I wouldn't say I was unpopular, just regular. High school is such a crazy time filled with sturm und drang. At no other time in your life are you filled with such uncertainty and anxiety. Physically your body is morphing into its adult version of itself and you have no control over the changes. Everything is hairy and pimply and weird and back in the 80s, we were just starting to talk openly about things, but mostly we hid our shame. Had your period at school and bled through your clothes? That was embarrassing shit that you just didn't tell anyone other than the school nurse. If your parents couldn't get you or bring you a change of clothes, it was a fate worse than death. It's not that boys had it much better. There is that pesky thing called a penis that has a mind of its own and erections can happen at the most inconvenient times; math class, lunch, homeroom, locker room. I'm not sure what is worse.
Anyhow, back to the reunion. Once you've lived long enough to make it to your 30 year reunion you've gotten to the point in life where you are okay with yourself. You've passed the point of caring what anyone else thinks about you (this happens at about age 40, like clock work). You go back and everyone is a doughier, wrinklier and sometimes hairless version of their 16 year old self. At the 5, 10 and even the 20 year (still not 40 years old yet) there is still vanity, though it is inversely proportional to the time it's been since you graduated. At the 30 year reunion, you're not interested in putting people back into their Breakfast Club category; criminal, princess, athlete, brain, basket case. Because you've lived your life (and gone through all the "adult bullshit" as one of my classmates so eloquently phrased it), you just want to actually know these people you've known forever. It's a shame because one or two nights is just a tease. How can you possibly search the soul of every single person in your graduating class when you only have 2-4 hours. I want to know every single person's story. The ups and downs, the heartaches and the joys, the disappointments and the victories. I want to know the names of your children and your grandchildren. I want to know how you've made your living, who you married, who you divorced. In essence, I want to know how you've lived your life. I want to squeeze it down to an ingestible form that I can swallow and digest and make part of my fiber. When you share history with someone there is a covalent bond, unseen and hardy. These are the people who share the most fundamental and intimate of memories with you, memories that you don't share with even your spouse (except for the rare exception of childhood or high school sweethearts); snow days, school trips, substitute teachers, football games, skipped classes, crushes, embarrassing moments, nights out. The memories are trapped in your head (and sometimes your yearbook) like a vault and no one else has access to these things except the people who were there when it happened. It's instant validation that these experiences actually took place and helped shape who you are. We shared the same air for several years. You are a part of me and I am a part of you. And when you are at your 30 year reunion and pushing 50 years of age, you are going to have the conversation with those people you wished you had talked to back in high school. We are each others people.
I'm raising 3 teenagers of my own right now. I don't remember adolescence being this hard. I remember adolescence being exactly this hard. You remember the feeling and the emotions (Oh the emotions. So many, many emotions) like a distant cousin. It's all oddly familiar and yet at the same time, so inconvenient and maddening and fast. How can this person who lives in my home, who I call my child and who calls me parent act so odd and alien? How can they be filled with so much angst about something so inconsequential? Do they truly think the earth orbits around them as though they are the anchor of the universe? How can they be so sweet and then so evil? I took my 14 year old kid with me to one of the gatherings. He was mildly amused at first and then infinitely bored. I'm glad he came with me not just because I like to spend time with him, but I hope on some rudimentary level he absorbed the inconsequentialness of temporal worries. You grow up, you move on, you reconnect. You glean the ripeness out of every situation and you keep going. These people who show up to things. They are good people. All 3 of my kids, they will encounter hundreds if not thousands of good people who have a different set of burdens. Their burdens may be lighter or heavier but they are burdens nonetheless and everyone has their own breed. I hope that he, and my other 2, are respectful of that; we all have our junk. People are fragile and exercise caution because even though you may not see it on the outside, everyone has stuff on the inside. And while each person's poop may be different, it's also the same. We all have poop and that's what makes every single one of us vulnerable. And vulnerability is not bad. I just hope it doesn't take them 30 years to figure it out. It's gonna be okay. It's all gonna be okay. Even when it isn't okay, it's still gonna be okay. You got lots of other passengers on your ship with whom you can share and ask for support. Weakness can make you strong.
Thanks Class of '86 Chamblee Peeps (and Class of '81 Huntley Hills) for setting the mold. XOXO
Anyhow, back to the reunion. Once you've lived long enough to make it to your 30 year reunion you've gotten to the point in life where you are okay with yourself. You've passed the point of caring what anyone else thinks about you (this happens at about age 40, like clock work). You go back and everyone is a doughier, wrinklier and sometimes hairless version of their 16 year old self. At the 5, 10 and even the 20 year (still not 40 years old yet) there is still vanity, though it is inversely proportional to the time it's been since you graduated. At the 30 year reunion, you're not interested in putting people back into their Breakfast Club category; criminal, princess, athlete, brain, basket case. Because you've lived your life (and gone through all the "adult bullshit" as one of my classmates so eloquently phrased it), you just want to actually know these people you've known forever. It's a shame because one or two nights is just a tease. How can you possibly search the soul of every single person in your graduating class when you only have 2-4 hours. I want to know every single person's story. The ups and downs, the heartaches and the joys, the disappointments and the victories. I want to know the names of your children and your grandchildren. I want to know how you've made your living, who you married, who you divorced. In essence, I want to know how you've lived your life. I want to squeeze it down to an ingestible form that I can swallow and digest and make part of my fiber. When you share history with someone there is a covalent bond, unseen and hardy. These are the people who share the most fundamental and intimate of memories with you, memories that you don't share with even your spouse (except for the rare exception of childhood or high school sweethearts); snow days, school trips, substitute teachers, football games, skipped classes, crushes, embarrassing moments, nights out. The memories are trapped in your head (and sometimes your yearbook) like a vault and no one else has access to these things except the people who were there when it happened. It's instant validation that these experiences actually took place and helped shape who you are. We shared the same air for several years. You are a part of me and I am a part of you. And when you are at your 30 year reunion and pushing 50 years of age, you are going to have the conversation with those people you wished you had talked to back in high school. We are each others people.
I'm raising 3 teenagers of my own right now. I don't remember adolescence being this hard. I remember adolescence being exactly this hard. You remember the feeling and the emotions (Oh the emotions. So many, many emotions) like a distant cousin. It's all oddly familiar and yet at the same time, so inconvenient and maddening and fast. How can this person who lives in my home, who I call my child and who calls me parent act so odd and alien? How can they be filled with so much angst about something so inconsequential? Do they truly think the earth orbits around them as though they are the anchor of the universe? How can they be so sweet and then so evil? I took my 14 year old kid with me to one of the gatherings. He was mildly amused at first and then infinitely bored. I'm glad he came with me not just because I like to spend time with him, but I hope on some rudimentary level he absorbed the inconsequentialness of temporal worries. You grow up, you move on, you reconnect. You glean the ripeness out of every situation and you keep going. These people who show up to things. They are good people. All 3 of my kids, they will encounter hundreds if not thousands of good people who have a different set of burdens. Their burdens may be lighter or heavier but they are burdens nonetheless and everyone has their own breed. I hope that he, and my other 2, are respectful of that; we all have our junk. People are fragile and exercise caution because even though you may not see it on the outside, everyone has stuff on the inside. And while each person's poop may be different, it's also the same. We all have poop and that's what makes every single one of us vulnerable. And vulnerability is not bad. I just hope it doesn't take them 30 years to figure it out. It's gonna be okay. It's all gonna be okay. Even when it isn't okay, it's still gonna be okay. You got lots of other passengers on your ship with whom you can share and ask for support. Weakness can make you strong.
Thanks Class of '86 Chamblee Peeps (and Class of '81 Huntley Hills) for setting the mold. XOXO
Friday, September 2, 2016
The Middle
Hi friend!
I miss you. Life gets so busy with the ‘musts' and ‘shoulds' that it's easy to get bogged down; water logged with responsibilities. While you have been busy raising your babies on the other side of the world, I have been doing the same over here. Neither one of us has an easy job. Toddlers and 3 year olds are just as complicated as teenagers. The fear over their physical safety and development is every bit as real as the fear over their physical safety and development.
I've been burdened with worry over my child. The worry has been smoldering for several years and on the eve of matriculation into another phase of adolescence, I am anxious that I have waited too long to take action. The only problem is there is no clear path. It's like trying to carry soup in a paper bag.
This kid of mine is not like the others. He is of me but not like me. I don't know how to decode him. It is pushing me past the natural limits of myself.
Not sure when I wrote the above. It must have been in the spring. Now it's the fall. And things are no better. We've been to see the psychologist as a couple, individually and he's seen her. We've been to 3 different psychiatrists and we are starting a third medication. I am sick with worry. My husband is sick with worry. We don't know how to reach this boy. Some days he is with us. Parts of days he is with us, but mostly he is detached. The latest medication is supposed to treat an underlying depression which is probably the result of unrecognized anxiety. Once the medication takes affect and the depression lifts, then he'll want to engage. Hopefully.
This is the kind of fear like no other. When they were little I'd worry that they'd harm themselves unintentionally. Now I worry about him harming himself intentionally. He assures us and the mental health professionals that he isn't suicidal. He told me he could never do anything to make me sad. He doesn't realize the irony of that statement. He has no idea the depths of my sadness. How can I be happy or have peace when my boy is in turmoil.
The beginning of the school year has been rough. He doesn't want to go to school. He hates school. He's certainly not stupid. The standard model of schooling doesn't fit him. It's uncomfortable and constricting. There is no room for independence and questioning and movement. I get it but I don't get it. I've always been a rule follower. Give me a set of rules and I'll follow it to my death and get a gold star in the process. I'm also very creative but that creativity has been more active as an adult. I guess in many ways I was stifled as an adolescent but I was too scared not to follow the rules. I feared consequences. This one doesn't. Or maybe he does, but he is so anxious/depressed he can't make himself follow through.
We've looked at alternative forms of education. We've toured 3 different schools in the past 2 weeks of school. Nothing is the silver bullet. The issues are still going to be there but they'll just be housed in a different environment.
Reluctantly on my part, we are starting an selective serotonin re-uptake inhibitor on him. It's funny because as a physician I don't mind prescribing these drugs and I can extol the virtues for my patients and even for myself. But, when it's my boy, I am paralyzed by fear by the "what ifs". What if he becomes suicidal? That's my biggest fear.
No one can prepare you for how much you will love your children and how much you will agonize over them. How your heart will break in ways you didn't even know was possible. How you will pray continuously and not even know for what you are praying. How you will loose sleep, imagine the worst, hope for the best, plead with God. How you'll love your spouse and also hate them because you have a b s o l u t e l y n o c o n t r o l o v e r a n y t h i n g and the only thing you can lash out at is the one you love the most. You can't believe it will happen to you. Not your kids. They will be different. No evil will befall your house. How you'll fold laundry and wash dishes with a blind ferocity because at least by doing this you are accomplishing something.
All I know is I love him but I don't know how to love him. My best efforts are lost in translation. Again and again, I offer him up to God like Abraham did with Isaac. "He is yours, God. He is yours.", is my breathless chant. I get some small glimpses now and again of my boy and I cling to that and to His promises. Meanwhile, my heart aches and I am waiting for the skies to clear.
I miss you. Life gets so busy with the ‘musts' and ‘shoulds' that it's easy to get bogged down; water logged with responsibilities. While you have been busy raising your babies on the other side of the world, I have been doing the same over here. Neither one of us has an easy job. Toddlers and 3 year olds are just as complicated as teenagers. The fear over their physical safety and development is every bit as real as the fear over their physical safety and development.
I've been burdened with worry over my child. The worry has been smoldering for several years and on the eve of matriculation into another phase of adolescence, I am anxious that I have waited too long to take action. The only problem is there is no clear path. It's like trying to carry soup in a paper bag.
This kid of mine is not like the others. He is of me but not like me. I don't know how to decode him. It is pushing me past the natural limits of myself.
Not sure when I wrote the above. It must have been in the spring. Now it's the fall. And things are no better. We've been to see the psychologist as a couple, individually and he's seen her. We've been to 3 different psychiatrists and we are starting a third medication. I am sick with worry. My husband is sick with worry. We don't know how to reach this boy. Some days he is with us. Parts of days he is with us, but mostly he is detached. The latest medication is supposed to treat an underlying depression which is probably the result of unrecognized anxiety. Once the medication takes affect and the depression lifts, then he'll want to engage. Hopefully.
This is the kind of fear like no other. When they were little I'd worry that they'd harm themselves unintentionally. Now I worry about him harming himself intentionally. He assures us and the mental health professionals that he isn't suicidal. He told me he could never do anything to make me sad. He doesn't realize the irony of that statement. He has no idea the depths of my sadness. How can I be happy or have peace when my boy is in turmoil.
The beginning of the school year has been rough. He doesn't want to go to school. He hates school. He's certainly not stupid. The standard model of schooling doesn't fit him. It's uncomfortable and constricting. There is no room for independence and questioning and movement. I get it but I don't get it. I've always been a rule follower. Give me a set of rules and I'll follow it to my death and get a gold star in the process. I'm also very creative but that creativity has been more active as an adult. I guess in many ways I was stifled as an adolescent but I was too scared not to follow the rules. I feared consequences. This one doesn't. Or maybe he does, but he is so anxious/depressed he can't make himself follow through.
We've looked at alternative forms of education. We've toured 3 different schools in the past 2 weeks of school. Nothing is the silver bullet. The issues are still going to be there but they'll just be housed in a different environment.
Reluctantly on my part, we are starting an selective serotonin re-uptake inhibitor on him. It's funny because as a physician I don't mind prescribing these drugs and I can extol the virtues for my patients and even for myself. But, when it's my boy, I am paralyzed by fear by the "what ifs". What if he becomes suicidal? That's my biggest fear.
No one can prepare you for how much you will love your children and how much you will agonize over them. How your heart will break in ways you didn't even know was possible. How you will pray continuously and not even know for what you are praying. How you will loose sleep, imagine the worst, hope for the best, plead with God. How you'll love your spouse and also hate them because you have a b s o l u t e l y n o c o n t r o l o v e r a n y t h i n g and the only thing you can lash out at is the one you love the most. You can't believe it will happen to you. Not your kids. They will be different. No evil will befall your house. How you'll fold laundry and wash dishes with a blind ferocity because at least by doing this you are accomplishing something.
All I know is I love him but I don't know how to love him. My best efforts are lost in translation. Again and again, I offer him up to God like Abraham did with Isaac. "He is yours, God. He is yours.", is my breathless chant. I get some small glimpses now and again of my boy and I cling to that and to His promises. Meanwhile, my heart aches and I am waiting for the skies to clear.
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