The Second Time Is Different

Sending a baby into cardiac surgery is hard.

I brought Sammi to the hospital that morning in 2006, and she was wearing fleece pajamas covered in frogs. She was 13 months old and had a light layer of soft duck-fluff hair that stuck to my face when I cried, but she had perhaps a word or two in her vocabulary, neither appropriate for anything approaching real communication. She was beautiful and soft, and she smelled wonderful, and I could trace the shape her body made on my torso as she laid there, but had I lost her that day, far more of what I would lose of her was in the future and amorphous. Our experiences together until then were primal still — nursing and holding, touch and smell, fear and love.

It was all uncertain then: who would she be? what was she like when she was not sick? how would her voice sound when she learned to sing? 

She was a mystery, yet, and grieving a mystery is still grieving, but it’s fuzzy and intangible. I would never know quite what to miss. Continue Reading…

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What My Children Don’t Know

debi“Becoming a parent will change you forever,” popular wisdom tells us. Pregnant or waiting to adopt our first children, we are told all sorts of things about who we’re about to become. Our parents tell us, or our friends who already have children, or our friends who don’t already have children, or grannies at the supermarket, or obstetricians and midwives. They all have so many things to tell us about all the ways we’ll change.

They tell us we’ll never sleep the same way again. We’ll never watch the news the same way. Our life goals will change, they say, and we’ll come to laugh and cry over things that didn’t seem funny or sad to us before children. We’ll eat differently, shop differently, dress differently.

It’s all going to change now, they say.

The reality is that, as true as this is, some things about me never changed when I had children. After all, I had nearly thirty years on this earth before my older daughter arrived, and some things became ingrained. As a human being, the circumstances surrounding me changed, but at my core, I believe I did not. I believe that none of us really change: not with children, not with spouses or life partners, not with jobs or homes or communities. Continue Reading…

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Terrible Conversation, Part II

conversationGiving a child bad news hurts on every level. Integrity tells us to be honest, realistic, straightforward. Nurturing tells us to soften the blow. Getting the combination right means compromising both.

When we had to tell our daughter Sammi just before her fourth birthday that she had been diagnosed with an inflammatory disorder called eosinophilic esophagitis, we did it in an age-appropriate way that, thankfully, also forced us to simplify the problem for ourselves. The new diagnosis meant a host of food restrictions that would change over time, but we focused on the first six weeks that would exclude dairy, eggs, soy, nuts, and wheat. I wrote about that conversation in a previous post:

We explained that we had good news; we now knew why Sammi’s food kept coming back into her mouth. Her esophagus was sick! We drew a body on paper, showed them where the esophagus was, drew a frown on it. We talked about allergies, about our friend’s daughter with celiac disease, about feeling crummy and then feeling better. We brought out the list of allowed foods and cheered along as favorites were listed.

At that young age, she was hardly able to comprehend it. Sammi ate what we gave her, followed the rules, and over the course of the next three-and-a-half years, endured more than a dozen endoscopies. She did everything we asked. She even participated in a barium swallow study and a strange and very uncomfortable CT scan without ever asking us why.

Sometimes, I feel horribly guilty that she never asked why. Continue Reading…

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Public School, Major Surgery, and Careful Planning

Swallow, My Sunshine: Teeter TotterWe knew about our daughter Sammi’s impending major cardiac surgery five months in advance. That gave us plenty of time to research, plan, discuss, and codify our plan for her recovery as it related to school. Not everyone is lucky enough to have this much time to prepare, and so I hope the information below can be helpful to someone else trying to put together a plan on shorter notice. Even if you have enough time to prepare, this checklist can help you ensure that you’ve thought of all the things that might affect your child’s recovery when s/he returns to school.

504 Plan

The very first step we took when preparing for our daughter’s surgery was to inquire with the school district about getting a 504 Plan. Shorthand for “Section 504 of the Rehabilitation Act of 1973,” a 504 Plan makes official any accommodations a child needs in order to participate in normal classroom activities. In the state of Illinois, where we live, the board of education has provided an excellent, comprehensive article about how to apply Section 504 to shorter-term, temporary conditions (though the law also applies to longer-term and permanent disabilities). Creating a 504 Plan forces the school to work with you to accommodate your child’s health needs in a way that gives them the best possible access to their classroom and school activities.

Because we had been through the process of developing a 504 Plan before to accommodate Sammi’s food restrictions, this was relatively straightforward for us, but we also knew the importance of getting the information we put into writing in this plan into the hands of every teacher who would encounter our daughter in the course of her school day. In the end, we decided together with the school to have a meeting that included her classroom teacher, the district health coordinator, the school health clerk, the school social worker, and the school principal, as well as my husband and I. It gave us the opportunity to explain the surgery in detail to the whole team in person, allow them to ask questions, and to brainstorm accommodations together.

Schoolwork

Sammi was going to be missing, at minimum, three weeks of school. Though she was only in third grade at the time, we wanted to be sure that she didn’t fall so far behind in foundational subjects like math that she couldn’t easily catch up. We also knew that complications could occur that would keep her out of school longer than we anticipated, and so we wanted to be prepared for that.

Once again, being aware of the law in our home state was useful. In Illinois, if a student’s doctor determines that the student must be out of school for at least ten days, the district can be reimbursed by the state for providing tutoring services either at home or in the hospital. We were able to get our daughter’s surgeon to sign paperwork affirming that projected missed school before the surgery, and therefore we were also able to have the district find and hire a tutor in advance. Having the extra notice beforehand even allowed them to look for a tutor who spoke Spanish, since Sammi was enrolled in a Spanish immersion classroom.

Safety

We expected Sammi to return to school with two large incisions healing on her back, one across each shoulder blade. Under those incisions, scar tissue between her ribs would be healing slowly. She would not be allowed to carry a backpack, reach her arms up above her head, or move very quickly. Being jostled hard would likely be very painful, as even deep breaths would feel different to her with both sides of her ribs healing. In short: there would be many opportunities during the course of a normal school day for her to get hurt.

Working with the school health clerk, the principal, and her teacher, we began by developing a plan for the beginning and end of the day. In the morning, Sammi would arrive at school just before the bell rang that gathered students from the playground to line up near the door, and instead of waiting outside, would bring a friend to sit in the school office with her until the halls cleared. The reverse would happen at the end of the day, avoiding crowded hallways. During the school day, movements between classes would occur with friends flanking her on either side.

Activity Restriction

Sammi would not be allowed to return fully to her normal activities for at least six weeks after the surgery. That meant there would be no Physical Education class and no outdoor recess. The school’s initial suggestion that she simply sit on the sidelines for those activities was not an acceptable solution for us; we didn’t want her spending an hour a day watching her friends have fun while she sat and watched. Instead, we came up with a list of alternatives and a schedule for her to follow:

  • Reading to the kindergarten class
  • Helping tidy and organize the art classroom (the art teacher was a favorite)
  • Playing math and literacy games in the library
  • Helping me when I volunteered in the school bookstore

Each day, she picked a different classmate to join her during these twice-daily activity times.

Emotional Support

We knew that Sammi would feel overwhelmed, sad, angry, or simply frustrated at times. We also knew that her classmates — who had been together as an insular group for four years — would have questions, worries, and big feelings of their own before and after she returned to school. Including several emotional support components in the 504 Plan helped us set these expectations early on.

The first day of school following her surgery, the district health coordinator and the school social worker visited her classroom and told the students there about what had happened. In simple terms, they explained the surgery and told the students that she was doing well. They worked with the class to make cards and offered any students who needed it the opportunity to process the information privately with the social worker. Just before Sammi returned to school, they met with the class again to discuss her restrictions, how she’d likely feel, and to let the students ask more questions.

The social worker also checked in with Sammi several times once she returned to school and left her with an open invitation to visit her anytime.

Peace of Mind

In the end, though the highest priority for us was to keep Sammi safe, it was also important for us to feel proactive about the time after her surgery. There was nothing we could do for her during the surgery, and little we could do for her in the hospital. Once she was home, we would have to prepare her for her return to school, and we wanted to know that we could give her answers confidently about what it would be like for her there. That was very valuable for us in the months we spent preparing.

If you need help developing a 504 Plan for your child, here are some resources:

 

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Checking In With You

snowDear Reader,

I am writing to you from the window of a coffeeshop. I sip from my hot mocha, listen to my headphones, and look out at the cars going by. Where I live, there has just been snowfall, and the pedestrians are like me on my walk here: bundled, hunched against the cold, hurrying. Inside, people surround me, but I’m trying not to engage with them.

I’m thinking about you. Who are you? Why have you come?

For years, I spent countless intent hours searching for information that would help me solve the mystery of my daughter’s health issues. Even when we thought we had a solid diagnosis — laryngomalacia when she was an infant, repaired double aortic arch when she was a baby, reflux when she was a toddler, eosinophilic esophagitis when she was a little girl — I wanted to know how to handle it. I wanted to know how other parents made their children’s lives easier despite the diagnoses. I wanted to know how other parents made their own lives easier despite the diagnosis.

I was hungry for connection and knowledge. I was desperate for validation, advice, and other parents to either assuage my fears or tell me how they made their peace with the same ones. Continue Reading…

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