by Casey Watson
But her tone belied her words. She knew no such thing. This wouldn’t be a team I’d be getting much support from, I decided. Once again, as had been the case with our last child, bar John, we’d probably be on our own. Was that how it worked with our kind of specialist ‘extreme’ fostering? That Mike and I were considered so able they could throw anything at us, secure in the blind faith that we’d cope?
But before I had a chance to say something regrettable, Mike himself walked in, having come back from work. ‘Morning all!’ he said cheerily. ‘Everything okay here?’ The three of us seemed of like mind. End of conversation. We all got our heads down and ran through all the paperwork.
It was only once John and Linda were finishing up and I cleared the mugs that I could have a word with Mike on our own.
‘What’s up, love?’ he asked, once we were both in the kitchen. ‘You could cut the atmosphere in there with a knife!’
‘Oh, just more of the same. Our little madam’s been busy being one again. And it seems no one in her “team” has got the confidence to take her on. I just had a bit of a moment, that’s all. Nothing to worry about. She’ll find things rather different now, starting today. And none too soon, because that lot seem to be creating a monster.’
But once back in the living room I had cause to eat my words. Sophia and Sam had come down from upstairs now, and Sophia was visibly and genuinely distressed as she hugged both the women and said her goodbyes. I felt a pang of guilt. This was a desperate 12-year-old girl, trying to make sense of an appalling situation. Perhaps Linda had been right, and I’d been wrong. I must learn, I decided, that my usual acuity re character wasn’t quite as infallible as I thought. I also knew nothing about the emotional toll of being the victim of an incurable disease. Sophia had perhaps been right in that, too. I did have a lot to learn this afternoon. Speaking of which … ‘Look at the time,’ I said. ‘We really need to get off.’
‘Right,’ said Sam, disentangling herself from Sophia. ‘And we’d better leave you all to it. I’ll phone you in a day or so, Sophia, okay? And come to see how you’re doing in a week or so.’
I moved closer to Sophia as everyone trooped back out of the door, automatically putting an arm around her waist. She needed affection, I thought. Physical contact. Even though her manner so often seemed to suggest otherwise, the child inside needed love more than anything.
We waved them off, Sophia rubbing at her tear-stained cheeks with her other hand. Then she turned to me. ‘Where’s your son? Didn’t you say you had a teenage son?’
Her voice was completely different now. As light and sunny, suddenly, as the day was dark and cold.
‘Kieron?’ I said, shocked. ‘Yes. He’s at college today. You’ll meet him tonight. When we get back from your doctor’s –’
‘Okay!’ she said brightly. ‘Coats on then, is it? As you say, it’s a long way. Time to go!’
It was a very, very long three hours, that journey to hospital, as all three occupants of the car – Mike, myself and Sophia – retreated into their own minds and thoughts. I tried several times to start conversations with Sophia initially, all of which were mildly, but decisively, rebuffed by her lack of interest in giving me more than one-word responses. I then tuned the radio station to one I thought she might like, but this, too, was pointedly rejected. She simply pulled an MP3 player from her pocket and plugged herself into that. ‘I think that’s you told,’ whispered Mike.
She’s 12, I kept telling myself, locked alone with my anxieties. (I couldn’t talk to Mike, of course, because she wasn’t six inches from us.) She’s 12. Think back, Casey. That’s what 12-year-olds are like, even 12-year-olds with the most benign of families and backgrounds. She’s on the cusp of adolescence, too; no, that was wrong. Physically at least, she was well into it. So perhaps I was reading too much into things. She’d also been overindulged and was clearly using her disorder to manipulate the adults around her. She just needed guidance, support and that healthy dose of discipline. That, I decided, would help her immeasurably. And as a virtual orphan in the world, boy, did she need help.
But I couldn’t help but wonder at these extreme swings in behaviour: one minute full of herself, the next happy-clappy, and then, out of the blue, appearing really upset. What mood would be on offer when we arrived at the hospital, I wondered? I was beginning to realise that we just couldn’t second-guess her.
‘Happy’, as it turned out, just as soon as we got there. The sullen mask was stashed away along with the earphones for her iPod, to be replaced by what I could only describe as the sweetest, friendliest expression imaginable.
‘Follow me,’ she commanded, though in the nicest of manners. ‘I know this place like the back of my hand! Casey,’ she turned to me, ‘you are so going to love my doctor. He’s called Dr Wyatt, and he’s absolutely gorgeous.’ She was so excited, she was practically squealing.
‘Right behind you, love,’ said Mike, as we both hurried along in her wake.
Less inclined to stampede down the corridor than Sophia was, we kept her in sight but still failed to keep up, and by the time we reached the correct clinic’s reception she was already charming the receptionist.
‘Ah, you must be Mr and Mrs Watson,’ the young woman said. ‘I’m Wendy, by the way. Me and Sophie go back a long way, don’t we, honey? Do take a seat. Dr Wyatt will be with you very shortly.’
Mike and I sat down on the leather sofa we’d been assigned to, leaving our young charge gaily chatting to the receptionist. But we didn’t have to wait for very long. After only about thirty seconds a man emerged from behind a door, and promptly bellowed ‘Sophie!’ as if greeting a dear friend who’d been thought lost at sea and had unexpectedly fetched up. I noted that he, like Wendy, hadn’t called her Sophia. They were obviously all very close. Very close.
Sophia’s response was equally enthusiastic. ‘Oh, it’s so nice to see you!’ she cried, leaping upon him, and so forcefully that I thought she might topple him over, or, even worse, jump up into his arms and swing her legs round him. Thankfully, neither happened, but most astonishing to my mind was that the doctor didn’t even seem to flinch. ‘Nice to see you too!’ he said, when she finally put him down. ‘I’m Steve Wyatt,’ he then said to us, coming to shake our hands. ‘Paediatric endocrinologist. Very nice to meet you both as well.’
Mike and I began to rise, but he flapped a hand to indicate we should stay where we were. ‘No, no. You can sit a while longer,’ he explained. ‘Sophia likes to have her consultation in private – just myself and her nurse, if that’s okay?’
He could probably tell from our expressions that this seemed a little irregular – after all, we were in loco parentis. ‘I know it seems a little strange,’ he added, rather less confidently, ‘but it’s what Sophia wants and we have to accept her wishes. But it should only take around fifteen minutes and then of course you can come in so we can go through the management and so on. Okay?’
‘Well, if that’s the way it has to be …’ Mike answered. ‘Is that okay with you, Sophia?’
‘Well, I do like to see my doctor in private,’ she nodded, and then they turned around and went back into the room.
‘How bizarre,’ I said to Mike, once we were alone. ‘We should have insisted on being allowed in with her, shouldn’t we? Don’t you think? It feels all wrong not to be in there. How odd.’
Mike shrugged. ‘What’s new? Everything seems bizarre about this child. Run of the mill, she isn’t. Why should this be any different?’
‘But why the “private” thing? What’s he privy to that we’re not allowed to know about? I mean, I understand the whole business of patient confidentiality. But she’s a child. And she’s in care. And it’s our job to care for her. So if there are things we should know and which are important and no one’s telling us …’
Mike squeezed my knee. ‘Don’t fret, love. We’ll be in there soon enough. And we can ask. Perhaps we’ll get a chance to have a word with the doctor on our own at some poi
nt. In the meantime, I need a coffee. The heat in this place is making me sleepy … You want one?’
‘Do bears live in the woods?’ I asked him, grinning.
While Mike wandered off in search of a vending machine, I idly flicked through the magazine I’d brought with me. But only a couple of minutes later the doctor’s door flew open and a stressed-looking nurse came rushing out, clutching a purse. I was then shocked to see her rushing back, only half a minute afterwards, now holding a bottle of water and a bag of peanuts. Blimey, I thought, poor love. Talk about NHS cutbacks – were their tea breaks now measured in seconds, or what? Mike ambled up with our coffees soon after, and I was just about to share my little witticism with him when he said, ‘You see that?’, nodding towards Dr Wyatt’s consulting room. ‘That was apparently for Sophia. Had a bit of a turn, by all accounts. Brain fog, the woman called it. Needed an immediate protein boost.’
‘Oh, my God,’ I said, panicked. ‘Should we go in?’
Mike shook his head. ‘Apparently not. I did ask her at the machine. But she said she’d fetch us in once they’d sorted things out.’
I took the coffee from him. ‘I don’t know about you,’ I said, ‘but this Addison’s thing scares me. It’s clearly a serious illness and we know nothing about it. Nothing. How on earth are we going to cope when it’s just her and us?’ I meant it, as well. Just how would we cope? I had no confidence that half an hour with Dr Wyatt was going to help much. This was obviously something that could come on and be life threatening at any moment, and for the third time in as many days I repeated the same mantra – that I mustn’t fret, that it was short term, that we wouldn’t have her long … but how dreadful, I thought guiltily, to be wishing a kid away when she’d only been with us five minutes!
Mike, who could read my mind – well, most of the time, anyway – put a reassuring arm around my shoulder. ‘Stop worrying, love, eh? Think about it logically. They wouldn’t have trusted us to care for her if they didn’t think we could cope, would they? Let’s just see what the doctor says and take it from there. And remember what they say about women and teabags …’
I laughed. He was right, as I’d proved to myself often. You really didn’t know how strong you were till they put you in hot water. And becoming a foster carer, above all, had proved to me that I was one hell of a lot stronger and more capable than I could ever have thought.
I sipped my coffee, awaited our summons and tried to think positively about things. But I didn’t know then, though I very soon would, just how hot this water was going to turn out to be …
Chapter 4
Addison’s, clearly, was a very frightening disease. Despite Dr Wyatt’s cheerful, matter-of-fact manner, this wasn’t something Mike and I could listen to lightly.
Our all-you-need-to-know lesson wasn’t long, but it was complex, so I was grateful that the doctor passed us various leaflets and brochures as he spoke, which we could take away to digest more fully later, along with a big box of medication, which included the steroid injection paraphernalia I’d read about and which scared me. I hated everything about injections.
But the reality of the disease hit home straight away. Sophia’s Addison’s disease meant her adrenal glands no longer functioned, which had implications for all sorts of bodily processes. The two vital hormones she needed – cortisol and aldosterone – had to be replaced by taking daily medication – several times a day – and though it seemed this was usually sufficient to manage it, all sorts of things could affect how much she needed, including eating patterns, how well she was and how much stress she was under. If she didn’t get those hormones, via the tablets she was taking, she would die – it was as stark a fact as that. She had, therefore, to be mindful of taking her tablets at all times; an onerous responsibility for anyone, let alone a child – and when you factored in the appalling circumstances of this particular child’s life … well, it was a pretty sobering thing to even think about.
On a practical level, it was all about discipline. She had to eat regularly, and follow a diet that, though not that restrictive generally, prohibited the sort of random snacking on junk that other children of her age so often tended towards. Her medication did, as Jean had said, mean she could easily put on weight, something that would make her condition even harder to manage, as well as having negative psychological effects.
The worst-case scenario, the doctor pointed out, would be the onset of an ‘Addisonian crisis’, as it was called. If she had one of them, as a result of either a high temperature or other stress, it really was a life-and-death situation. Hence the injection kit he’d given us. I could only hope we’d never have to use it.
It was a hell of a lot to take in at one sitting, but we needed to try to get our heads around it all because, as Sophia’s carers, for however short a time, we had to have the means and knowledge to be able to put it into action.
Sophia wasn’t with us now. When we’d been invited into the doctor’s office, where he sat behind an enormous desk, Sophia perched on a stool to one side, he’d suggested that she might like to go off with the nurse for some fresh air. After all, as he pointed out, grinning at both her and us, she was already something of an expert on Addison’s disease and didn’t need to sit through all the boring stuff.
We’d taken the opportunity to bring up the slightly odd business of her being so adamant about seeing him alone. Wasn’t it all a bit cloak and dagger?
‘I know it seems that way, Mrs Watson,’ he’d agreed. ‘But unfortunately my hands are tied. There are certain parts of Sophia’s file that she doesn’t want disclosed, and I’m afraid that I have to respect that. All I can say is that they in no way affect her condition, nor do they hamper your ability to care for her.’
Which, frustratingly, left us none the wiser.
‘The main thing,’ Dr Wyatt explained now, his medical briefing complete, ‘is, of course, that you become attuned to the symptoms of a steroid insufficiency. Headache and/or dizziness, nausea and/or vomiting, wobbly knees, fuzzy thinking – the thing is, at all costs, to avoid a full-on emergency, so it’s always better to be safe than sorry. Increasing her steroids temporarily won’t cause her any harm, though long term they very much can. But it’s all in the literature,’ he finished up, cheerfully. ‘And you can call us any time you have concerns. Oh, but one more thing.’ He nodded towards the door now. ‘There’s also low blood sugar to look out for. It’s another common problem with Addisonians, but easily dealt with. As happened just now, give her a small bag of peanuts or something. Some of my patients swear by things like scrambled eggs, too. It’s the protein boost that helps. You’ll find she craves salt as well. Just the one thing …’ He paused again.
‘What’s that?’ Mike asked him.
‘The one thing, of course, as you’ve no doubt been told, is that Sophia’s been known to fake crises and low blood sugar. In fact, that’s probably what she did just then. For effect.’
I tried to take this in. ‘But why?’ I asked.
‘She’s a 12-year-old girl,’ the doctor said. ‘One who must take pills all the time and eat sensibly. Which must be galling. Especially when her peers can chow on what they like. But if she says she feels sick or dizzy … well, she’s learned, of course, hasn’t she? That it’s a sure route to getting attention.’
‘But how are we supposed to know if she’s faking or not?’
Dr Wyatt shook his head. ‘Please don’t stress overly,’ he said. ‘It’s just a question of making sure she follows her routine. If you make sure from the outset that she takes her pills in front of you – when she’s with you, that is – give her a healthy packed lunch and a well-balanced evening meal, there’s no reason at all why she should have problems. Oh, and get her school on board, of course. If you’re really very lucky, they might have someone on the staff who’s familiar with the condition. But if not – and it’s doubtful – then it’s really just a case of them exercising vigilance as well.’ His tone was reassuring, but I wasn’t reassur
ed. I had no idea the condition could be manipulated like this and how much of a close eye we would have to keep on her. ‘And this could really be life-threatening – this crisis thing?’ I asked him.
He nodded. ‘They happen only very rarely,’ he said, ‘but potentially yes, one could be. The trick is to stave it off before it even looks like happening. Prevention is always so much better than cure.’
I thought grimly about the average adolescent’s mind. Being told you might do some damage to yourself in the long term never stopped armies of kids taking up smoking, trying drugs and getting drunk as skunks, did it? But for attention? Mr Wyatt seemed to read my mind. ‘The problem with Sophia,’ he said quietly, ‘is that she resents her condition and wants to prove she controls it, rather than the other way around.’
‘Or maybe she’s just manipulative,’ Mike suggested. ‘And likes to control those around her.’
Dr Wyatt nodded. He looked slightly taken aback by Mike’s comment, but I got the feeling he did understand. ‘It’s certainly true that some young people with chronic illnesses can be manipulative,’ he agreed. He then looked at his watch. Quite a lot of time had passed now. There were obviously more patients waiting. ‘But unless she tells us how she feels, I’m afraid we just don’t know,’ he finished. ‘But please do get in touch,’ he said, rising, ‘if you have further questions or need help. That’s what we’re here for …’
We were all quiet, lost in our own thoughts, during the journey back home. I was busy going through everything again in my head: the complicated nature of this new routine. I was expecting each child to be different, of course; with my first foster child, Justin, who counted major food issues among the many manifestations of how badly he’d been damaged, I’d had to create a wall chart and update it on a regular basis, detailing every aspect of all our upcoming meals. Not only did I have to write up exactly what we were having, but also when we were having it, almost to the minute. If I didn’t do this, he got terribly anxious and difficult, especially in the early days and weeks he was with us. It did improve, but it would create tension, even months down the line, if we ever deviated from it. Deciding on an impromptu take-away instead was, we soon realised, not an option.