The Green Envelope On The Fridge...

A couple of week's ago Tess had a check up with her pulmonologist at Maine Medical Center. Knock on wood, the kid has had an amazingly illness free winter in an almost too good to be true fashion. Her doc was very happy with how she was doing, we adjusted some daily breathing treatments, and then things turned pretty serious. 

He asked me if Tess had had the flu vaccine this winter and I replied absolutely, she had it at the beginning of November (which was a little late for her but with moving off the island, we missed the island clinic one).  The doc was happy to hear because, as we all know by now, this year's flu season has been more deadly than most and children like Tessie are hit the hardest. 

I told the doc that I had a huge fear of Tess getting this flu in particular due to everything I'd been hearing about the deadliness of it and then asked if he thought I was overreacting with my fear of it. 

The short answer? No. I was not. 

I then asked the question that haunts my nightmares. If Tess does get this flu, did he think she would survive it. 

The short answer. Again, no. 

ARGH! 

Now before anyone starts to think this guy is a big jerk with no bedside manner, I can assure you he is actually an amazing doctor with a huge heart for these kids and their families. He had even fit us in on a day when he doesn't normally see patients because he wanted to be able to spend an hour and a half with us. Like, he had literally blocked that off in his calendar. He's a good doc and more importantly, a good man. 

What he did say, and which I already knew in my heart, was that the chances of Tess surviving this flu were very slim. Especially since Tess's lungs and body have already been throughs so much so it's just not the same as a healthy child getting it. And, even seemingly healthy kids were dying from it. 

This led to him bringing up the topic of an Advanced Directive for Tess and if we had one. He knew we had met with Maine Medical's Palliative Care nurse a couple of times in the past and had even filled out paperwork called  My Wishes that does deal with end of life care and what that might look like for your child. 

When he asked if Tess was still a full code I very emphatically responded with, "YES!" I want every measure to be used to try to save her if she crashes. 

He looked at me very kindly and asked me gently did I fully understand what that meant? I was confused by the question because, hello! Of course I knew what it meant....CPR, many, many meds, possible life support (temporarily until she gets strong enough to breathe on her own again), etc.

He then asked me if I knew just exactly what CPR entailed. Well, I have watched an awful lot of Grey's Anatomy and have taken several CPR courses so, yeah! Of course I knew.

Except I didn't know. Not really.

CPR would be painful. Chances are they would break her ribs and sternum. They would push cardiac meds. And if they did manage to restart her heart, chances were very good that this would not be an isolated incident. That it was a sign of her body truly wearing down and would happen again. Maybe not that day or week, but also not too far off.  He also said that if they got Tess back, she would most likely need much more help medically speaking than she does now. If Tess ever needs life support due to an illness, that most likely she will never come off of it and would have to live the rest of her life hooked up to a ventilator in order to live. He then added, "And we don't know if we get her back if it's going to be the same girl you know now and in all honesty, I don't think it will be." 

I was just shaking my head no the whole time he was talking. No way in hell was I going to allow anyone to hurt Tessie even if it was because they were trying to save her. Not after everything she's been through and would have gone through to get to that point of needing CPR. I couldn't imagine intentionally inflicting more pain on her. Not on my watch. And the bottom line for me, for us, is Tess has EARNED the right, when her time does come,  to pass away with ease and as much dignity and comfort that we can give her. She deserves it. It would simply be selfish of us to allow anything else. When I told the doctor that I also said that I can't imagine ever signing a DNR on her. It's like saying "I give up" and I will never give up on Tessie. 

He told me there was a form that we could fill out that was a step by step of what we would allow for crisis care for Tess and that we could tailor it to say whatever we wanted.  He felt, given the crazy flu season and Tess's fragile health, that we shouldn't hesitate to get one filled out so that it would be in all of her doctor's computer systems and we would have a copy as well. After that, he set up an appointment for us with Palliative Care again and, after dropping Tessie off at school on Monday morning, we went to fill out that horrible, but necessary, piece of paper. 

Charlie and I have always said that the quality of Tess's life would always be the most important thing. Tessie has a good life. She loves her life. Her family. Oreo. Her school and friends. If she gets so sick that those decisions do need to be made, then Charlie and I have made them together with only that in mind. That Tess deserves whatever is best for her. Not us. If it was up to me, I would say DO EVERYTHING JUST SAVE HER! But that would be selfish. That would be for me, not for Tessie. And that's just not fair. 

In the end Charlie and I opted for a modified Full Code. Do everything you can to save her but no CPR or cardiac meds are to be given. We will  not have her hurt even more during a time when she will already be suffering and needs us to be strong for her. We will have her use breathing support if the doctors believe she has a chance of surviving as well as any and all other meds that could help her but that's where we are drawing the line. At that point it will be up to Tess and God. 

And I pray we have the courage and strength to remember this if and when this terrible time ever comes. 

In the meantime, the Advanced Directive sits in a green envelope that's hanging on our fridge because apparently paramedics are trained to look for them there. As you can imagine, having that staring at you everyday and knowing what's in it brings it's own heartache but I think the bigger heartache would be dishonoring Tess in any way. 

But it also sits next to happy things. Life affirming things like Blake and Bobby's Christmas Card and Ellie's Dean's List paperwork along with, on the other side, an art project of Tessie's. 

So the green envelope's heartache is lessened with daily reminders of the good stuff in life along with the hope and prayers that it will not need to be opened for a long, long, long time. 

. 

You've Come A Long Way, Baby...

When you first truly understand that your child will have major, lifelong disabilities, it is absolutely devastating. There is just no way to sugar coat it. All of the hopes and dreams that you have for your baby are suddenly crushed beneath the weight of words like, Intellectual Disabilities, Global Developmental Delay, Spastic Quadriplegia, Hypsarrhythmia Infantile Spasms (that eventually will change over to Intractable Seizure Disorder) and so many other terms that just break your heart and, for a while, your spirit. There will be anger and fear and so much sadness that you don't know how you will possibly be able to handle this new world. A world you never in a million years thought you would have to live in.

You attend more meetings than you could ever imagine and make friends with therapists, doctors, social workers and counselors because they are the people you now talk to the most in this new world.  You cry and rage and even try to pretend that it's not as bad as it feels like it is because if you admit it really is bad, it feels like you are betraying your child whom you love with all of your heart.

 You will see other babies and toddlers your child's age and silently compare what your child ISN'T doing. It will hurt so badly because it will make you feel even worse and you are so irrational in your grief that you're almost mad at these babies who are developing "normally". And when you notice that feeling you will give yourself a mental slap because WHO DOES THAT?! And what does it say about you that you, even for a nano second, feel like this? You are lost in a storm tossed sea of  emotions. Joy one minute, anger the next, fear the next, and so on and so on until you are sure no one can possibly survive this type of storm. Yet you hear stories every day in your new group of friends of people who, not only are surviving, they're thriving in it. You'll wonder how they ever got to that place and if you ever will.

You may even avoid bringing your child around other kids their own age or, in my case, ask the people closest to me who had kids Tess's age to not tell me all of the new, fun, and exciting things their kids were doing because I just couldn't take it emotionally. And your true friends and family members will not only understand, they'll go out of their way to try to protect you and make you feel okay about it even though you know it's not okay to ask that of them (forever thankful especially to Kris and Ali for protecting me during those years). Then one day, you'll see those same "normally" developing kids alongside your clearly delayed child and your brain won't compare. You won't marvel at the differences. You won't even feel a little bit sad about it. It won't even be a blip on your radar. You'll be able to not only listen to all of the awesome things your close friends and family members kids are doing, you'll WANT to hear them and go out and support them however you can. You will know in your heart that disability is just a word and that your child is just exactly who they are supposed to be in the world and you will marvel at them and what they have taught you.

  And soon enough those days turn into weeks and then years and you will realize you did survive the storm. You learned how to navigate those rough waters and you mastered the art of sailing through them. It wasn't pretty a lot of the time and you didn't come through the storm the same person as when you got caught in it, but that turns out to be a good thing. And you'll feel pride in yourself and the unimaginably hard work it took to get you there.

All of this to say that Tess had another wheelchair fitting this week. I remember pretty vividly the absolute devastation I felt when I first heard the word "wheelchair" in regards to Tess. It felt like I had been sucker punched. Like all the air was just sucked out of me. I didn't want her to look different than the other kids and I most certainly did not want her to have to have a wheelchair.

After I put it off for as long as I could without admitting the real reasons I was putting off to the people who said she needed it, I  ultimately picked out the one that looked the most like a baby carriage (since Tess was still small enough not to need a "real" wheelchair just yet). I hated that chair with a vengeance. Even though it was the least wheelchiar-y looking, it was bulky and ugly and obviously made for a child who had special needs. A wheelchair to me meant no hope of her ever walking. It was a symbol of everything I was grieving as I was trying to grope my way through the loss of the baby I thought I was going to have.

A few years later Tess had grown enough to need another wheelchair. This time the process was much easier. I was years into the Special Needs world at that point and was starting to leave the grief behind most days and only see the good stuff thanks in large part to some really good friends I'd made because of Tessie (shout out to Buh and Kellie!). They came into my life at a time when my faith in God was really being tested and, without judgement or preaching at me, helped bring me closer to God again, and I am so thankful for that.

At any rate,  I picked out a pink chair for Tessie and asked that they embroider her name on the seat back. When the chair came, I still had a pang of, "I can't believe this is my life.", but for the most part, it was just nice to see her in a properly fitted chair. I wasn't happy about it but I wasn't particularly unhappy about it either. More emotionless over the whole thing.

This past week I went into Tessie's new school where I was met with her PT, her teacher, her aide, and the representative from the durable medical equipment company that we use. This visit was actually fun and full of laughs. I was practical in my decisions of what we needed in a chair (it had to be able to roll easily across more than just pavement unlike her current one, and needed the best possible safety features for van transport).

Then I looked at Tessie and told her it was time for her to choose her wheelchair colors. She got to pick the color for the edging on the seat back and bottom as well as the frame. After giving her several color choices my little diva decided to pimp her ride with pink edging and an orange frame. I was cracking up at just the thought of what this thing is going to look like. The representative (who has done ALL of Tess's chairs and has known us since she was 2 or so) looked at me and said, "Please don't put those two colors together! Do you have any idea what this will look like?! Let me just make it all pink for her!". I laughed at him and said, "Nope! Tessie gets to choose what she wants in her ride and that's what she chose so make it happen for her!". He was shaking his head and chuckling as wrapped up the wheelchair fitting and I told Tess to have a good day at school then left and drove home; still chuckling to myself over her color choices.

But here's the real news: I didn't, even for a second, feel bad about this new wheelchair. It didn't even cross my mind to feel sad or mad or any of the other emotions I have felt in the past. I was just proud of Tessie for being so adamant about her color picks. And, I have to admit, control freak that I am, I am pretty proud of myself for not trying to get Tess to change her color choices or, like I would have in years past (and I'm not necessarily proud of this), simply vetoing her choice and getting the colors I wanted.

Yup, I've come a long way, baby!


Side Note: I use the word "you" at the beginning of this post a lot. Obviously the experience of having a child with special needs is different for everyone and I'm not trying to assume that mine is the same as everyone else's though I do think many of us go through a lot of those emotions.