Showing posts with label autoimmune encephalitis. Show all posts
Showing posts with label autoimmune encephalitis. Show all posts
Sunday, October 12, 2014
The big picture
12:41 PM
Acquired disabilities, autoimmune encephalitis, Parent-talk, school, stigma, wheelchair
5 comments
By Sandra Joy Stein
The
note announcing picture day came home in my son’s school folder.
“Wow,”
I thought. “Look how far we’ve come.” The fact that my son
attends school at all is quite an accomplishment. It wasn’t until
three years after the onset of his autoimmune encephalitis—where the immune system attacks the brain—that we
received medical clearance for him to participate in an educational
program outside of hospital or home. After considerable work to get
all the necessary systems in place, for the first time since his illness he was now attending a barrier-free neighbourhood
school, accompanied at all times by a nurse.
I
was occasionally thrown by how immediately his entry to school brought many ordinary experiences to our extraordinary lives. He had
homework; I received emails from the PTA; I signed permission slips
for fieldtrips. And now, it was picture day.
I
picked out an outfit, lamenting that on that particular day I did not
have the requisite time (or patience) to engage him in the choice. I
sent a back-up outfit, should vomit or drool sully my original
selection. As the wheelchair lift was raising him onto the bus, I
made a request to his nurse. I had recently seen class pictures in
which a group of currently able-bodied children stood clustered in
the centre of bleachers with the one child who uses a
wheelchair positioned to the side of the bleachers, separate from the
class.
I find these images to be unnecessarily isolating to children
who work tirelessly to participate in a world that has not been
designed for them. I suggested that if the whole class were posed in
such a way, with my son off to the side, to please ask for an
alternative arrangement. She agreed to raise the issue should it come
up.
Mid-day
I received a text message from the nurse informing me that for the
class picture they took my son out of his wheelchair and his teacher
supported his head and torso so he could sit with the rest of the
children. That made sense to me since they do take him out of the
chair to sit with the other children regularly and his head and trunk
control have improved enough over time that with a little input from
an adult, he can sit in some of the classroom chairs safely. In the
class picture, he would be right beside his peers, a full member of
the classroom community.
But
then came a second text message: “Solo pic was in his wheelchair
but they’re gonna photoshop his headrest so you can’t see it.”
I felt a lump in my throat. I had asked that he not be isolated from
his peers in the class photo, not that his individual shot omit all
traces of his illness. Who thought we would not want to see the
headrest of the chair that has become the means for our son to move
around in the world? I thought to write back immediately saying: “He
uses a wheelchair. It’s fine. Keep it in the pic.” But I often
find that taking time after my initial visceral reactions leads to
better outcomes. So I waited for my husband to come home to discuss
it with him.
My
son loves having his picture taken. At times, when his body is
behaving in ways that seem beyond his control, I hold up my cell
phone to snap a selfie of the two of us. Upon seeing our image on my
phone he often focuses, calms, and mugs for the camera. It’s a
phenomenon I cannot begin to understand, so I don’t try. I have
several pictures of the two of us, looking right at the camera,
smiling together as if someone just told us to say cheese. When I
post these pictures on Facebook, I comment that they are from the “If
you didn’t know you wouldn’t know” files because there is not a
visible trace of the three years my son has been battling his
disease.
I am admittedly more likely to post these pictures to
Facebook than the ones where the visual effects of the disease—the
deviated gaze, the open, drooling mouth, the protruding tongue, the
asymmetrical facial expressions, the blank stares—are visible. I
have justified this tendency by looking at the postings of friends’
kids whose childhoods have thus far not included disabling diseases.
We all post what we believe to be the most attractive shots of our
kids, the ones where they look happy and loving and impish and
proud…right?
But
the thought of any part of his current state being photoshopped
out of a professionally taken picture disturbed me. I told my husband
the story and he had the same reaction. Our son used to walk on his
own. He does not now. He may or may not walk again someday. In the
meantime, there is no need to photoshop any aspect of his current
state out of visual existence.
We wouldn’t want the photographers
to airbrush in a smile that his facial muscles didn’t authentically
produce or paint the missing teeth back into his mouth. In fact, we
wouldn’t want them to change a thing about his picture, as it is a
snapshot of his incredible life as it is today. There is nothing
about the physical imagery of his journey that brings us shame. Quite
the opposite, he is a powerful testament to resilience in every image
we capture of him with or without the wheelchair, the drool, and the
varying facial asymmetries. He is our son and we stand in awe of his
beauty.
I
texted the nurse that night asking if she happened to get the
photographer’s contact information so we could communicate that we
do not want any photoshopping of our son’s picture. She informed me
that they would be back to the school the following day and she would
let them know.
The
next day I received a text from her: “Spoke to photographer. He is
leaving headrest in.”
I
noted how the attention I was able to give to this issue served as
yet another indication of just how far we had come. I was not at this
moment suctioning the trache he used to have. I wasn’t watching
the alarming ICU monitor while a medical team ran in to resuscitate
him. I was not making an impossibly hard decision about medications
or surgeries. I was asking that the wheelchair headrest captured in
my son’s school picture not be photoshopped out, the health
equivalent of a first-world problem.
Sandra Joy Stein is an education and leadership consultant, writer and poet who lives in New York City.
Tuesday, May 27, 2014
The trove of other mothers
2:12 PM
Acquired disabilities, art, autoimmune encephalitis, Coping and Emotions, mothers, Parent-talk, poetry
9 comments
Sandra
Stein’s life was upended when her healthy toddler fell ill with an autoimmune
encephalitis, a condition in which the immune system attacks the brain, and was
hospitalized for 15 months. In this poem, Sandra invokes and honours the many
other mothers she has met in hospitals and in cyberspace who every day are
caring for children with complex medical needs.The trove of other mothers
By Sandra Joy Stein
I.
Cradling her son
As his body thrashed
Legs like iron rods.
Try to bend them, honey,
Tell your legs what to do,
They’re your legs.
It will pass, she said, again.
It always passes.
After minutes or hours—she was never sure,
He calmed. Curled. Gazed into the void.
She gazed too.
A giant tear startled her, when it fell on her arm.
Was that his tear or hers?
She preferred not to cry while holding him.
Then another tear, this time most definitely hers
And another.
And another.
He was limp, motionless, breathing, heavy in her arms.
She surrendered.
More tears. Her arm now wet.
He fell asleep. So peaceful. So beautiful. If you didn’t know, you wouldn’t know, she thought. She loved to stare at him while sleeping.
Rest, she said, her palm to his cheek. You rest.
She called out—no, not to some doctor or deity—she called out to the trove of other mothers who at this very moment were, like her, cradling sick babies, and grown babies, and limp and lifeless but very much alive babies.
II.
From behind shadows and tucked away spaces and homes-made-hospitals and hospitals-made-homes
Their forms emerged
Weathered hands, kinked necks, crooked backs, heavy eyes, furrowed brows.
They looked right at her in a way that no one had since…
We see you.
We feel you.
We know you.
We are you.
Like a somber gospel choir they swayed and sang,
No, sister, you have not failed
No, sister, this is not fair
No, sister, you are not alone
Never alone. Never alone.
III.
She blinked back to her sleeping son.
Her arm, now dry, she dug
deeper, yet again.
Friday, October 18, 2013
'Nothing is permanent'
10:17 AM
Acquired disabilities, autoimmune encephalitis, Brain injury, Coping and Emotions
14 comments
By Sandra Joy Stein
When my son was two years old, he played like most toddlers I’ve known. He built block towers and yelled in frustration when they toppled down. He climbed every structure at our neighborhood park and protested when it was time to leave. He complained when a beloved toy stopped working, broke, or the batteries ran dry. I decided, half-jokingly, that I would try to teach him the Buddhist Law of Impermanence—the notion central to Buddhist teaching that things change and nothing lasts forever. I suggested to my husband and other parents, with a strong dash of humour, that this law would ease our children’s sense of loss or disappointment, which would only intensify as their lives progressed. I do not claim to be a master of Buddhist thought, but it did occur to me that if our children were to know and accept the Law of Impermanence at a young age, it would increase their chances of living happy lives.
When an autoimmune
encephalitis rendered my formerly healthy son severely neurologically
compromised at two-and-a-half years old, my lighthearted lessons to him became
my son’s own profound teachings to me. In two weeks he went from crafting percussion
instruments out of anything he could get his hands on to thrashing around in a
hospital crib. He went from exclaiming excitedly “Mommy! An upside-down M is a
W!” to being non-verbal. He went from riding a two-wheeler with training wheels
for miles at a time to being non-ambulatory and tube-fed. We lived in hospitals
for 15 months before being discharged to home with near-round-the-clock
nursing care, a wheelchair, a supine stander, a bath chair, and a rigorous
home-based therapy schedule. Our former lives a distant memory, it was clear:
things had changed.
The type of encephalitis
my son has (anti-NMDA receptor autoimmune encephalitis) actually has a good
prognosis, with early studies showing the vast majority of those affected
making substantial recoveries, some even after several years. Although my son
has not yet “turned it around” or “woken up from this,” as his neurologists are
wont to say, several of his symptoms (dyskinesias, hypertonia, spasticity) come
and go. As soon as we think we’ve adequately addressed some type of pain,
discomfort, or spasm, we are on to some new challenge in the bodily
consequences of a brain in atypical flux. Many folks with this disease report
sudden status changes, moving from perfectly healthy to critically ill and then
non-ambulatory to walking and non-verbal to talking. We do not know what to
expect every single day. We have to make decisions for the moment we’re in with
some regard for the consequences of those decisions on an unpredictable future.
I have never had such an
abject lesson in the Law of Impermanence than from my son on his journey
through this illness. Everything I ever worked for, saved for, and hoped for
changed in a way that laid plain the centrality of the notion that nothing is
permanent. I realized that despite my attempts at understanding this concept, and
even thoughts of teaching them to my then-healthy son, I had no real grasp of the
true nature of impermanence until now. Parts of the teachings were brutal, like living for months in the ICU where, due to severe dysautonomia—a potentially life-threatening
symptom of this disease—my son’s heart and breathing would randomly and
unexpectedly stop, then resume, often requiring emergency resuscitation. We lived
moment-to-moment, never knowing what the day would bring, while bearing witness
to 11 families as they lost their children to freak accidents, random (and
not-so-random) violence and disease.
Nothing, nothing is permanent.
For a time I found it impossibly hard
to be so uncertain of what would happen next. Would he live to see the next
day? Would he ever get better? I struggled with the non-linearity of his
symptoms and agonized over my sense that he had hit the nadir of his course in
this disease (which we were told by several doctors) only to realize that his
condition would in fact get worse. As he grew more stable I began to worry
about the next phases of his illness, wondered about the effectiveness of rehab
and feared the potential for relapse, even prior to approaching any semblance
of recovery. I wanted to know when I could reasonably expect improvement and
whether my son would walk again, talk again, eat again, laugh again, smile
again and play again. I wanted to prepare myself for all of the possible
outcomes as if one of them would be the permanent, static conclusion to this
total upheaval of our lives. All the possibilities and my inability to prepare
for them were a kind of emotional torture. A wise friend suggested that I not
try to solve any problems that I didn’t actually yet have. It was time to
embrace the notion of impermanence as a mechanism to preserve what might still
have remained of my sanity.
It is not an easy lesson to fully
absorb and it scrapes against both practical strategies for getting through the
day and all the lessons on futuristic thinking taught to me by my parents,
professors and profession—to plan, save, schedule, anticipate, predict. When
asked if I can attend an event, make an appointment, or get together with a
friend, I go through the motions of planning with the knowledge that I do not
know whether I will be able to show up. In reality, nobody knows whether they
will be able to show up to anything in the future. Because of my son’s teachings,
I just happen to know profoundly that I don’t know.
I now approach impermanence as a
discipline, like one might approach meditation or yoga (neither at which I am
particularly skilled). If I can adjust my orientation to the present moment,
take stock of it, and interrupt any tendencies to escape it, I am able to
accept the uncertainties inherent in all of our lives, uncertainties that most
folks (myself included) prefer to ignore. Without
permanence there is no "outcome" of my son’s disease, no before and
after, just my son in the moment he is, on his extraordinarily difficult journey.
His symptoms change so readily—sometimes his head is oriented to the right, his
gaze fixed, his teeth grinding loudly and sometimes his head is in midline, his
eyes focused and his jaw at ease. Some days he smiles, most days he does not.
Some days he moves his legs. Most days he does not.
While so much has changed
and continues to change about my son from a physical standpoint, his essence
feels totally intact. He was always compassionate, always a deep thinker,
always asking me what I was thankful for, all day every day from what I thought
to be a surprising young age. And when I answered "I'm thankful for
you!" he would respond "Awww, that's so sweet." He is still that
being, locked inside a body he cannot at the moment control.
He has changed the way I
interact with everyone and given me a greater ability to see beauty in all
forms of humans, particularly those who we think of as disfigured or deformed.
I walk through the world differently because of him—I am aware of much more and
afraid of much less. I stare down my fear every day and walk that fine line of
accepting his current condition and working to maximize his potential for what
might be, all while striving to stay firm in the here and now.
Despite my earlier hubris
at thinking I could teach my son a Buddhist principle that I had not fully
grasped myself, my son is the one who has taught me how to surrender to the
fact of impermanence, and how to live fully in the moment. He has taught me how
to hang up the phone with the dysfunctional medical supply company (or any of
the other pitifully dysfunctional systems that we rely on to get through the
day) and to see that he is, at the moment, stable, breathing and peaceful, or
thrashing, screaming and in distress. At our most difficult moments, I find
great comfort in telling both of us, “It won’t always be like this.” What it
will be like, I cannot tell.
Sandra Joy Stein is an education and leadership consultant, writer and poet who lives in New York City.








