by Cathy Glass
‘Does he exercise?’ Dr Jhaveri asked.
‘Not a lot. He joins in PE at school, but he doesn’t like walking.’
‘That’s because it’s uncomfortable for him, but walking is a good form of exercise. Incorporate it into his daily routine.’ I nodded. ‘So what has his social worker told you to do?’ She looked at me.
‘To keep everything as it has been and leave it to his mother to deal with once he’s home.’
‘Clearly his mother hasn’t been dealing with it so far,’ Dr Jhaveri said firmly. ‘What makes her think it will be different in the future?’
‘I don’t know.’
‘Is his mother badly overweight too?’
‘Yes.’
‘Any siblings?’
‘Three older sisters.’
‘All obese?’
I nodded.
‘I’m really shocked that no one has been advising the mother on her children’s health, especially when the social services are involved. I see families here. We have a clinic that offers advice and support, and a weekly weigh-in. Obesity is a massive problem in the Western world and we are storing up huge health problems for the next generation. Is his mother in good health?’
I shook my head. ‘She’s in hospital now, that’s why Max came to me.’
‘What’s the matter with her?’
‘She had two toes amputated – I understand it’s a result of type 2 diabetes.’
She let out a heartfelt sigh. ‘Yet she’s allowed her son to go the same way.’ Dr Jhaveri was clearly a conscientious paediatrician whose outspokenness was a result of her concern for Max. ‘I’ll speak to his social worker. Perhaps she’s not aware of the help available. I have her contact details on the letter of referral.’ She then turned to Max. ‘Hi, Max. How are you today?’
‘OK,’ he said quietly, obviously chastened by what he’d heard.
‘Pleased to have the afternoon off school?’ she asked, being friendly.
Max wasn’t sure what to say.
‘He likes school,’ I said. ‘He’s doing very well and he loves reading.’
‘That’s good. My children like reading too. So do I. Now, I’m going to examine you. I expect you had an examination at your doctor’s when he prescribed the inhaler.’ Max nodded. ‘We’ll start by looking in your ears. Can you hear all right?’
‘Yes,’ Max said.
She took an otoscope from the top drawer of her desk and looked first in one of Max’s ears and then the other. ‘That’s fine,’ she said. Returning the otoscope to the drawer, she took a wooden tongue depressor from a sealed packet and then asked Max to open his mouth wide so she could look in. ‘Thank you,’ she said. Throwing the used spatula into the bin, she picked up the ophthalmoscope from where it lay on her desk and looked in his eyes. ‘Do you have glasses for reading?’ she asked. Max shook his head.
‘And you can see the board the teacher writes on?’
‘Yes.’
‘Good. Can you read the letters on that chart?’ she asked him, referring to the Snellen wall chart. Max read all the letters without any problem.
‘Excellent.’ She returned the ophthalmoscope to the desk and, looping her stethoscope around her neck, listened to his chest and then his back. ‘His chest is clear,’ she said and made a note on the form for the medical that Jo had sent. ‘Now, let’s measure you,’ she said to Max. ‘Can you take off your shoes and stand just here for me?’ She took the few steps to the height recorder as Max leaned forward and began struggling to take off his shoes. It wasn’t that he lacked the motor skills to undo the Velcro and pull off his shoes, but the fat around his middle stopped him from leaning far enough forward. I helped him and he padded across to the doctor. She gently placed him in front of the height bar and then lowered the ruler so it was just touching his head. ‘Three feet, eleven inches,’ she said. ‘That’s average for his age.’ She went to her desk, made a note on the form and then returned to Max. ‘Now, let’s weigh you. Stand on here, please.’ Max stood on the scales. I watched and waited. I knew he was overweight, but I had no idea by how much. It came as a huge shock. ‘One hundred and nineteen pounds,’ she read out. ‘That’s eight and a half stone – more than twice the weight he should be.’ Then, as she walked to the desk to record the figure, she frowned. ‘Do you realize that’s the weight of the average fourteen-year-old? Perhaps the social worker will do something now.’
Chapter Eleven
Stressed
Dr Jhaveri didn’t say anything further about Max’s weight and continued the medical by asking him to lie on the couch so she could examine him. She placed a step-stool by the couch and helped Max clamber up and onto it, and then lie down. Movements that would have been completed easily by a child of normal weight were cumbersome for Max, who lacked agility. She felt the glands in his neck and then undid his shirt and the top of his trousers so she could feel his stomach. As she ran the palm of her hand over his stomach, gently pressing the flesh to feel his internal organs, the fat rippled.
‘Do you do a poo each day?’ she asked him. It was a standard question asked by most doctors giving a child a medical.
He nodded seriously. ‘It’s OK, love,’ I said. ‘You’re doing very well.’
Once Dr Jhaveri had finished the examination she helped Max into a sitting position and then off the couch. He waddled back to me, tucking his shirt in, and we sat side by side again as the doctor wrote on the forms. Coming to the end, she set down her pen and looked at me. ‘Do you have any concerns about Max’s health?’
‘There are a couple of things I wanted to mention. His mother thinks he may have an allergy, as he comes out in a rash sometimes. I haven’t seen the rash and as far as I know there has been no diagnosis.’
‘It could be an allergy, although it could also be from sweating. Overweight people sweat more. Does he bath or shower regularly?’
‘He does now,’ I said.
‘If the rash appears while he is living with you, take him to your doctor to get it checked. He’ll need to see the rash to make a diagnosis.’
I nodded. ‘The other thing is his snoring. It’s very loud and continues intermittently for most of the night.’
‘Does it wake him?’
‘No. Just everyone else.’
She smiled. ‘Some children do snore and they grow out of it. It can be a sign of enlarged tonsils or adenoids, but his tonsils looked fine when I examined him. Has he been referred to the hospital?’
‘Not as far as I know. I’m sure I would have been told if he had.’
‘The most likely cause of his snoring is that he’s overweight and unfit. Fatty tissue around the neck and poor muscle tone contribute to snoring – in children and adults. Once he starts to lose weight and is healthier and taking more exercise, I’m sure the snoring will improve. But obviously, if you have any concerns, see his doctor.’
‘I will. Thank you.’
‘I’ll give you some diet and exercise sheets for him to follow, although a lot of it is common sense.’ She stood and crossed to a metal filing cabinet up against one wall and, opening the second drawer, took out some printed sheets. ‘Plenty of vegetables, lean meat and fish,’ she said, handing the sheets to me. ‘Carbohydrates are a necessary part of a balanced diet, but go easy on the pasta, bread and potatoes. And generally limit the size of his portions. He might complain he’s hungry to begin with until his stomach shrinks back to a normal size. Exercise should be light to start with – walking, swimming, a little skipping. Play hopscotch – make it fun. His stamina will gradually increase. Hopefully his mother will continue what you begin.’
‘I hope so too,’ I said, folding the sheets and tucking them into my bag.
She smiled at Max. ‘Nice to meet you, young man,’ she said, bringing the appointment to a close. ‘Do as Cathy says and we’ll have you fit and healthy very soon.’ Max managed a small smile.
I thanked the doctor and we left. I felt she had spoken a lot of good sense, but I won
dered what Jo and Caz would make of it. I also wondered what I was supposed to do: implement the suggestions she’d made, which is what I would have done had Max been my child, or follow Jo’s instructions to keep everything as it was. I knew I needed to take advice, so I’d phone Jill first thing tomorrow.
‘Am I still having cola tonight?’ Max asked as we got into the car. I guessed he’d heard most of what the doctor had said and had understood the implications.
‘Yes. The doctor said a fizzy drink occasionally is OK but not every day. It’s about moderation; for example, just having one sweet, not the whole bag.’ Although, of course, when Max was at the hospital I had no control over what he ate, and it would be asking an awful lot of a six-year-old who was used to eating as many sweets as he liked to self-moderate.
‘Am I going to lose weight?’ Max asked as I began the drive home.
‘Would you like to?’
‘Yes. I don’t want to have toes like Mummy. They’re horrible, red and smelly with yellow stuff coming out.’
I grimaced at the description. ‘You won’t,’ I reassured him. ‘We’ll make sure you stay healthy.’
‘Shall I tell my mummy she has to lose weight?’
‘I think she already knows, love.’
But did she? I wondered as I drove. Do people with life-threatening conditions that are a result of poor lifestyle choices acknowledge the link, or are cause and effect too far apart? Like heavy drinkers with liver damage, for example, who literally drink themselves to death. Or smokers, who are aware of their increased chance of developing lung cancer, but never find the willpower to give up, believing it won’t happen to them and citing the person who’s smoked sixty cigarettes a day all their life and is in their nineties. Was Caz aware that being obese was killing her, and if she was, why didn’t she do something about it? Easy for me to say, having never had a big weight problem. And judging from Max’s comments about his dad liking big women, I didn’t think he was going to give Caz much support if she did embark on a diet and fitness programme.
My parents had collected Adrian from school and were home just before us. I introduced them to Max and then made us all a cold drink, which we took into the garden. Mum and Dad made a point of including Max, talking to him about what he was interested in, as they did with all the children I fostered. I left them in the garden while I made dinner. My parents knew we were eating early, as Max would be going to visit his mother in hospital. Mum suggested Adrian and Paula could stay with them while I took Max, which met with much enthusiasm from my children. When I served dinner I gave Max a similar-sized portion to Adrian’s and Paula’s and one glass of cola, followed by one helping of Mum’s delicious trifle with a little fresh cream. The trifle was so rich that none of my family wanted a second helping, and I didn’t offer Max one.
Once Max was changed and ready to go he came with me to say goodbye, holding the bag of sweets and the box of fresh cherries I’d bought for him to take. Although I would be limiting Max’s portions of food at home, I didn’t think it wise to stop the sweets until I’d spoken to Jo, as Caz had specifically asked that Max take them to the hospital.
‘Are those for your mother?’ my father asked pleasantly.
‘Yes,’ Max said. ‘She likes sweets.’
‘Give her our best wishes,’ Dad said. ‘We hope she’s better soon.’
Max smiled and we said goodbye. I felt considerably relieved that Adrian and Paula could stay with their grandparents, rather than passing another evening whiling away their time in the hospital café. We left them in the living room, about to play a game of cards, with the patio doors open on a lovely evening and Toscha sitting on the step, watching the world go by.
At the hospital it was Summer who noticed that Adrian and Paula weren’t with me and waiting in their usual place by the door of the ward. ‘Where are your kids?’ she asked me.
‘At home with their nana and grandpa,’ I said.
‘That’s nice,’ she said. ‘We don’t have a nana or grandpa. They died.’
‘I’m sorry,’ I said. But I was pleased Summer was talking to me, despite her mother looking daggers at her.
Max put the sweets and cherries on the bed with the three other bags of sweets like a ritualistic offering. ‘Cathy’s parents said they hope you get better soon,’ he remembered to say. I smiled.
‘That’s cute,’ Summer said, while Caz just humphed.
‘Watch out for the stones in the cherries,’ I warned, mainly for Max’s benefit. ‘Have a nice evening.’ And I left.
Upstairs in the café I bought a coffee and settled at a table, then realized I should have brought something with me to read. The time passed incredibly slowly without the children, although for a while I struck up conversation with an elderly lady who’d just visited her husband and was now waiting for her son to collect her and give her a lift home.
I returned to the ward at seven o’clock and as usual the bed was littered with sweet wrappers. Only Summer was there, sitting in the chair, her elder sisters having been allowed to go early. I thought Max was looking uncomfortable – sheepish – as if he had done something wrong.
‘OK?’ I asked him.
He nodded.
‘I’ll be speaking to his social worker first thing tomorrow,’ Caz said, glowering at me. ‘I’ll get that paediatrician sacked. The rude cow!’
‘Give it a rest, Mum,’ Summer said, nibbling the tip of her little finger.
‘And you can shut up,’ Caz said, turning on her. ‘It’s not you she had a go at.’
I had wondered if Max would tell his mother some of what Dr Jhaveri had said, and apparently he had.
‘Yes, discuss it with Jo,’ I said amicably to Caz. ‘That’s for the best.’ She was clearly annoyed and I wasn’t going to enter into what was likely to be a heated discussion in front of Max.
He looked quite relieved that he was going and I thought Summer would have liked to leave too, but I didn’t offer her a lift home, as I knew Caz liked her to stay until the end. I was sure Summer would have asked for a lift if she’d been allowed to leave early.
Max kissed his mother’s cheek and then came to my side.
‘Goodnight then,’ I said.
‘Night,’ Summer replied. Caz elbowed her a warning.
As we left the ward Max slipped his hand into mine. ‘I shouldn’t have told Mum what the doctor said, should I?’ he asked.
‘It’s not your fault. You can tell your mother what you like. Once she’s had a chat with Jo I am sure she’ll feel better about what the doctor said.’ Or maybe she wouldn’t, but I didn’t want Max feeling guilty. So many children who come into care have secrets that they have been warned (sometimes threatened) by their parents not to divulge to the foster carer or social worker. It’s confusing and worrying for the child, who constantly has to juggle what they can and can’t say. I would therefore never tell a child not to tell their parents something, even if it might be the more diplomatic option. Caz was upset by what the paediatrician had said, but it was in her and her family’s best interests to hear it and hopefully heed it. It was just a pity it had come from Max.
Once home, my parents stayed for a while and then said goodbye, as it was time for the children’s bath and bedtime routine. I hadn’t really seen much of them, but we’d get together again soon, and Adrian and Paula had clearly enjoyed spending time with their nana and grandpa. After they’d gone and before I took Max up to bed, he asked if there was any trifle left, meaning could he have some more. I said there was but we’d have it for pudding tomorrow, which he accepted.
The following morning, when I went to wake Max for school, he was already awake, not reading but sitting up in bed and looking worried.
‘Are you OK, love?’ I asked.
‘I’ve got a tummy ache,’ he said, giving his stomach a rub.
‘Oh dear, I wonder what’s caused that,’ I sympathized. ‘Get up slowly and see how you feel when you’ve had a drink and some breakfast.’ I’ve
found in the past, as I’m sure many parents have, that children can sometimes complain of minor pains and discomforts, which quickly pass off once they’re up and about.
‘Can’t I stay here?’ he asked, forcing a grimace as if in pain.
‘Is it that bad?’ He nodded. But he didn’t look ill. He wasn’t pale and when I felt his forehead it didn’t feel as though he had a temperature. Then, from years of looking after children, I asked, ‘Are you worrying about anything?’
A moment’s hesitation and a small nod.
‘Would it have anything to do with sports day this afternoon?’
Another small nod.
‘What is it that’s bothering you?’ I asked, sitting on the bed. ‘I thought you were OK about participating after Mrs Marshall spoke to you.’
‘I don’t want you to take a photograph,’ he said. ‘You said you’d bring your camera and take a photo for me to keep, but I don’t want one.’
‘All right,’ I said. ‘I won’t take a photograph unless you want me to. I suggested it because I thought it would be a nice thing for you to keep. I usually take photographs of special events for Adrian and Paula and the other children I’ve fostered.’
‘But they weren’t fat like me.’
‘Oh, love,’ I said, taking his hand in mine. ‘Is that why you don’t want a photograph?’
‘Yes.’ His eyes filled and my heart clenched. ‘I look funny in my shorts,’ he said. ‘I don’t want to remember it. You can take a picture of me when I’m not fat.’
‘I understand, but no one in your class has said anything to you, have they?’
‘No, but they look. We have to have a class photo on sports day, but I stand at the back so just my head is showing. Don’t tell Mrs Marshall, she doesn’t know.’
I’m sure she does, I thought but didn’t say. She was sensitive and perceptive. ‘All right, love, I won’t take my camera if you’re sure. We’ll just buy the class photograph.’
He perked up a little. ‘You can take pictures of the other kids you foster that are cute and beautiful.’