A letter to my pediatrician after his explosive diagnosis:
Part 1: Setting the scene
Dear Dr “I”;
Edit: If this tl;dr then know this: Doctor’s surgeries are shitty places to get a decent assessment of a child.
Earlier this week, my son and I came for his 24 month check-up. You might have remembered us from previous visits, because we have always come as a 3-some: myself, my son and my husband. You have commented that it is “nice that Dad comes” – assuming, I guess, that he is the main bread winner. Actually, he is a Stay-At-Home Dad and I am a Work-out-of-Home Mum and this is technically his “job”. He arrives early, having packed a diaper bag full of those things needed to manage a 2 year old out the house with minimal disruption to people around him, and bouncing a toddler who has been well-dressed to my specifications. I am the one who arrives just in the nick of time, dashing into the surgery in a flurry, leaving a trail of apologies in my wake while I fend off emails on my cell ‘phone. I am also usually shedding small toys from my handbag that I packed this morning because I want it to look like I am deeply involved in my son and fear everyone’s judgement not only as a working Mum, but one who frequently works 6 days a week and in the evenings. I guess you don’t usually see all this because, actually, I have never known you to be on time.
However, this week our only child-safe vehicle was kaput and with a toddler in Houston that is a problem. So my husband offered to go and replace it, while I took Sam to his check-up. This time *I* was the one who arrived early, looking calm, dressed not in a forbidding suit but casual Mom-dress that I actually selected to look a bit fashionable, but also a bit cosy. How I would like to look if I was a Lady who lunches. Successful, but approachable. In tow, I had my son looking smart in a new outfit. I had carefully packed a ‘Thomas Train’ wheelie suitcase full of educational but engaging, wooden (not plastic!) toys. I selected those that would keep my son entertained, but also show off his intelligence, such as his ability to label every letter, tell you it’s sound, and give you something that starts with that letter. ‘A? Ah-ah-ah-ah… Apple!’.
Despite all this careful preparation, the visit did not get off to the greatest of starts because it was slap bang in the middle of nap time. Yes, I scheduled it for then, but there seems to be a microcosmically small window of time when we can get a morning appointment with you. I am still not even sure if it is possible. Call 2 months before the appointment due date? Too early – call back later. Call 6 weeks before? “TOO EARLY” says the irritated receptionist. Call 5 weeks ahead? The same receptionist gasps “Oh its so late! Why didn’t you call earlier? I guess we can squeeze you in in the afternoon”. I have never successfully figured this system out, so I just bring my son at times inconvenient to us, and especially to him.
You were running late (surprise!), so I wrangled my active, grumpy toddler around the waiting room which does have toys and fish and books and other children, so it’s generally not too bad. He saw a little girl, probably about 4-5 months of age. “Baby!” he yelled delightedly, and ran offer to offer her some of his cheese. Embarrassed (but secretly a little proud too) I apologized to the baby’s mum. She laughed and didn’t mind. It was going OK. I can do this. I can handle the Mum stuff. I can not only handle it, but handle it well.
The nurse came out – “Dr I is running late, we’ll take his blood first”. Take his blood? No one told me this. But, OK, whatever, I do whatever medical professionals recommend, so we sat in the lab waiting room and I filled in forms while my son spilled his milk on the floor and stomped in it saying “Splash!” and my carefully cultivated exterior began to unravel a little. This year’s form asked tonnes of questions – 4 pages of them. ‘Does your child point when s/he needs something’. Yes. ‘Does your child smile back at you?’. All the time. ‘Does your child bring you things to show you. Not for help, just to share?’. Ummm… not sure. I don’t see him in the day much… He brings me presents… this morning at the park he brought me an ants nest [I chided myself for throwing it down in disgust] but no… never just to show me, only to give to me. Circle ‘no’.
‘When there is an unfamiliar sound or person in the room, does your child look to you?”. I can’t really remember an unfamiliar thing happening… I can recall when strangers come over for a visit and my son (who is somewhat shy) gets uncomfortable he runs over to me, and asks to be picked up or holds my leg. I think. It doesn’t happen often. I search the recesses of my mind and curse myself for not being able to recall such a situation. OK, no, I guess he doesn’t ‘look to me’, rather he runs over to me. OK, I’ll circle ‘no’.
Of course, this is a truncated version of what it is like for me to fill in this damn questionnaire, because I am filling this in while watching an over-tired toddler careen around the room. So my thoughts actually go something more like
“When there is an unfamiliar – Yes you can have some cheese – sound or – Please stop giving the baby cheese – person in the – No you can’t have a cookie – room, – Please stop yelling – does your –Sam! Stop yelling, you can’t have a cookie, but you can have a banana – child look to you?”. I can’t really – No banana? How about milk? – remember – Here is your milk – an – Oh no, the milk is spilled, shall we clean it up?– unfamiliar thing – Very good!! Put the paper in the trash please – happening… – No! The trash! Don’t give it to that little boy! – I – No! Stop making him eat it! Oh God, some mother is going to be hella pissed at me now – can recall – Shoot, where did I put *my* bag? Where is my wallet? – when –There it is! But wait, where is my… Sam! Put all your letter cards back” – strangers come ‘Oh God, where is Sam?!? I’ve lost my child. Oh, he’s counting the fish. Very good. Yes, there are three fish – over” and well… you get the picture. These are my thoughts as I search the depths of my mind for memories of obscure situations and try to quell the growing tide of Mummy guilt that I don’t know my child as well as I should, haven’t been observant, have missed these key times in his life… all the while trying to fill this damn questionnaire in. I wish my husband were here, we’d tag team it – one would fill in the questionnaire, double checking with the other, and the other would amuse Sam with increasingly silly games. We’re a good team. We’re not bad solo, but it is somewhat uncharted territory. But I pride myself for being honest in this questionnaire. Wary of Mums who think their child can do no wrong, I err on the side of caution.
My “successful but approachable” exterior was becoming slightly more disheveled.
Ahhh.. we’re being called for the blood draw. “Sam, shall we go see the nurse?”
*Curses myself for making it a question”. “Well we are going anyway”.
Sam toddles in, and is strapped in a chair on my lap. He doesn’t want to be strapped in a chair. He wails. The nurse pricks his finger and he is a little annoyed, but hellaciously pissed when she keeps squeezing blood drops out. Repeatedly. Despite him repeatedly saying ‘No, no, no!”. This is not helping his mood. When the blood taking is done, I walk off with my over tired, angry toddler and find ‘Room E’. Looking at the letters distracts Sam from his anger – he dutifully called out each letter on each door and when he sees ‘E’ says ‘Yaaaaay!”. Wait, what? He has to go *in* Room E? But he wanted to continue telling Mummy what all the letters were. He loves letters! He hates sitting in small bare rooms! Oh man, is he angry.
But, he’s pretty reasonable, for being one of the the irascible, irrational, unpredictable things known as a toddler. Distracting him with his toys works somewhat. Then I find a book – a new book! A book from the doctor he hasn’t seen. Sam sits down and gets busy “reading” the book – turning the pages and pointing out everything that he can. The nurse comes in. Sam doesn’t look up – it’s a new book!! “Sam, can I measure your head?”
With nary a pause he says:”Nope”.
She looks unsure. I don’t know if I should intervene? I decide not to – I am not the medical professional here after all. She continues:
“Sam, I am measuring my head – look! Can I measure yours?”
Without really looking up: “Nope.”
The nurse looks like no 2-year old has ever refused the amazingly wonderful treat that is having your head measured. I am decidedly unsurprised by this response, but she seems unsure again. “Sam, would you like to touch the tape measure?” I try to help: “Sam – would you like to look at the tape measure? It has numbers on!”
Sam is smiling. There is a train in the book! Sam’s favorite thing! He glances askance at the strip of thin paper, makes a quick decision and turns back to the train. “Nope”.
The nurse starts to get desperate. “Maybe I can measure Mummy’s head!”. I decide I have had enough of this charade. While I appreciate her efforts not to touch a child without their permission and her efforts to engage Sam – and I really do – this is becoming a farce. “You’re just going to have to do it anyway”. “Really?”. “Yes! Just do it! He’ll be fine”. The nurse measures Sam’s head… he doesn’t mind, until it obstructs his reading “No, no, no!”.
I’m not complaining about these activities, I’m just setting the scene for your entrance. I am just letting you see a glimpse into how we arrived at the point we saw you.
The nurse, Sam and I go out the room to weigh Sam. He’s cool with standing on the scales and looking at the numbers. Just under 30lbs. Perfect. He doesn’t want to go back in the room – the letters! He wants to tell me about the letters on the doors outside the room. Amazingly, he is actually pretty good about going in the room, with a minimal but short wail. Me, nervous of medical professionals, unsure how to interact with them, is starting to get more flustered. I’m getting hot. I regret straightening my hair and wearing it down, and wish I had just pulled it up. When it is height time, I haik Sam up onto the bed, he’s pretty tolerant of this – he fusses when it takes too long. I apologize, but these are things toddlers do, right? They are starting to know their mind, and starting to want to control their world. It’s part of the territory, right? No toddler wants to lie on a bed when there are toys and books around. That’s why I like people with / who have had / who work with toddlers. You know the deal, and I know my toddler has not yet hit the ‘terrible 1s / 2s / 3s / whatevers’ so I think he looks pretty good. 37.5″ tall. Not bad. Growing well.
The nurse runs through the checklist: “Is your kid walking?” Yes. “Is he eating a variety of foods?” Yes. “Is he regularly eating fruits and vegetables?” Yes. “Does he have at least 50 words?”. I pause…. I am no good at guessing numbers of things or distances (like… I am often crazily off). It’s hard to think on the spot of 50 words that Sam’s knows. While also managing my cranky toddler who wants to be outside. “Yes, think so”. “Is he sleeping?”. “Ha! No! He was! He has decided he doesn’t want to go to bed this week!”. You are big on sleep and sleep training, and I suspect you are going to go to town on this. We’ll have the familiar jokes that I am a ‘softie’ (actually, more often than not it is my husband who ducks out of your strict commands – please quit with the gender stereotyping). You’ll tell me that ‘we need to put the kid’s needs above our comfort’ and I’ll pretend to be meek about it, and we’ll make a plan. I know how these things go.
The nurse asks me if I have anything to ask the doctor. I hate this. I always feel I have to ask something so that I appear engaged and interested, but as a developmental psychologist who grew up at a busy child minders, who has nannied, volunteered with kids and taught early years education, I generally don’t have any questions. But dutifully, like preparing for a job interview, I have thought of one “Do you have one of those informational leaflets that you print out on potty training? Like we have had ‘how to feed your child’, ‘how to interact with child’ ” and so on? Do you have one for potty training?”. Actually, I don’t need one. I know how to potty train. But I want to give it to my husband who is not moving on this important issue. “You’re STILL doing that?” she asks, incredulous. I am confused. Do I need to remind her my son is only 24 months? Like, this is not a big deal yet? I becoming more flustered and stressed. “You have to ask the doctor”. She says. OK. I am now resigned to another lecture from you. But we’ll work it out. You’ve been a good guy so far. A good pediatrician. We’ve recommended you. Our friends have followed our recommendation. Now I feel guilty about this, but – more on that later,
And she leaves. We wait for you. I sniff – ugh, dirty diaper. I take Sam to change him, and we bump into you going through Sam’s questionnaire. You love kids. You clearly really love kids. You always greet Sam with an excited “Hey Sam – how are you doing?”. You don’t today. You look wary. You look hesitant. “Hi Sam” you quietly and go back to your papers. I worry about your last patient – I hope that you didn’t have to give some bad news to a family. I change Sam’s diaper. Surprise! He doesn’t want to go back in the small room. He does. But he’s pretty grumpy about it.
We play some games together and wait. I am disheveled, and feeling crappy from the nurse. All doctors make me nervous and I am anxious about seeing you. Sam is at the tired toddler stage where at any moment he could throw a fit. He’s doing well, but he is cranky, tired, and really wanting to be at the nurses station where he saw a large jar of lollipops. We’re managing, we’re doing OK but it is not an ideal situation.
Then you come in…. We will discuss how *that* went in part 2.