We've just arrived 'home' from the Adolescent Clinic. It's a complex clinic - blood work and docs and social workers and pharmacologists and nurse practitioners and psychologists. It was that last group I was most wanting to see.
I gave our NP a heads up on how things have been going with school attendance, Babygirl's aches and pains and the missed medications. It's pretty impressive how mentioning missed meds gets everybody's FULL attention.
While I was off filling in the social worker and asking for advice (and using up all the tissues in the box in the room), the psychologists were concentrating on Babygirl. My concern was that she could be depressed, which is a very bad thing indeed when one considers that there is one death by suicide every 14 minutes in the US. And my next concern was, what the heck next? How do I deal with what is clearly not limited to a physical problem?
Up until December, I'd have said that Babygirl did not stay home from school for any but the best reasons, and that her honest feeling was that she'd rather be with people at school than alone at home. But the past two months have had me increasingly concerned about her voluntary isolation: Her tendency to remain in her room even when her dad and I are home.
I'm guessing from the team's response that she is not entirely unique. Pain and sickness lead to isolation and fear of pain and isolation and....it just cycles. Getting kids to return to school when they know they are going to be in pain is a tremendous challenge. They were pleased that we'd already clamped down and made her go, and even more pleased that we'd been tough with the school nurse - they don't want her to go to school to hide in the nurse's office.
So they told her that she HAS to go to school, even if it hurts. That if she pushes through the pain, it will get better. They explained that her anxiety about the pain is making the pain worse. They also told me that they think she is 'school-avoidant' and that the anxiety could escalate to the point where she won't go if we don't start making her (which was pretty much what I was thinking when I freaked out on her last week). They want us to confiscate her Nook and her iPod if she does stay home. They want her to hook up with a local counselor (easy enough - we know a good one) and to see if there is anything we can do to support her socially, which seems easier said than done.
Overall it was a productive visit. Oh, and her labs are okay except apparently we were supposed to be giving her more bicarbonate than we have been.
Tomorrow she participates in a study on cognitive function in chronic kidney disease, and then we come home.