The Adapted Family

I'm participating in the Define Normal Blog Hop this week where the challenge has been given to us special  needs mums to define what we consider normal in our lives and embrace the things that make us different to other families.

I was thinking about this and started remembering stuff I learned a long (very long) time ago at University when I was an undergrad studying Social Anthropology.  My interest was specifically how peoples adapt to their environment and how communities evolve to take into account the external influences of their environment.  For those of you who are curious, my dissertation was on the significance of the Potlatch Ceremony among the Kwakiutl peoples of the Pacific North West....but that is all another world away..

So I was musing on the blog hop topic, which focuses on the things we take for granted as special needs families which may be perceived as weird or odd in the wider world and I realised that what we all do is adapt, what actually is "normal" anway?  The only thing that is actually normal is a cycle on the washing machine... we have all adapted to fit our own influences that shape our family.  Things that I take for granted like putting a tube into my daughter's tummy to empty her bladder are clearly a bit away from the norm for any 7 year old, but we have adapted our lives to accept that if she is going to avoid urine infections this is what we need to do.  The normal for us is that way because our family has adapted to survive as a unit around the demands of the needs of the individuals in it.  We all do what works for our family unit, regardless of whether or not there are additional needs.

A different operating system

The quote above appeared on facebook a few weeks ago and for me it was a eureka moment, it encapsulated what life is like for a person with Autistic Spectrum Disorder, a person like my son, Theo.  In a moment I realised  what I had been struggling to articulate, that Theo is a Mac and the rest of us are PCs and we are trying to operate a Mac like you operate a PC....and if you are not familiar with these two operating systems it's like trying to manually change gear in an automatic car or speak French in Germany...you get my drift.  In other words the normal (what we perceive to be normal) rules do not apply.  When you have a child with Aspergers, many of the normal rules of parenting don't apply and you have to revisit how to parent in a way that can sometimes completely go against your instinct......

This Mother's Day I will be mostly.........

.....running a 10K race around the country lanes of the Vale of Glamorgan.  In fact over the course of 2012 I will be running 7 races of lengths between 10k and half marathon.  So why having blogged last week that I have very little spare time am I planning to spend some of it with thousands of other people pounding the streets of the UK?

When Daisy was 6 months old we already knew that her life was limited and that the future with her was uncertain, at that time she had just finished her first long stay at Great Ormond Street having been ventilated for respiratory problems, diagnosed with cardiomyopathy, found to be partially blind and extensively tested to eliminate cancer as being the cause of her pain and constant discomfort.  With no family nearby and three other children under the age of 7 to say we were struggling was an understatement.  Daisy's neonatologist referred her to our local hospice, Shooting Star Chase and from that time on we were no longer alone.

A few pics to brighten the blog!

With big brother Jules enjoying the snow

Determined to take Mickey Mouse sledging!

Opening a present from the wonderful PostPals charity

(note the Singing Hands Tshirt - her favourite item of clothing!!!)

At Shooting Star Chase for the Day - shiny and clean after a lovely bath!

Not Waving But Drowning

Yes, I am still here, I know that it's been a while since I updated but as you can guess from the title of this blog, life has just been a bit too overwhelming to find the time/motivation/energy to fire up the laptop and write about it, but I think I have my blogging mojo back and in the interests of ensuring that the world understands what it is like for families like ours it's time to pick myself up and get the words down..

I hardly dare to write this but it's been two months since Daisy's last emergency hospital admission.  Two months where well meaning people who don't know my world equate no hospital stays with Daisy being well.  If only this was the case, no hospital stays are because every day is a battle for us to keep her out of hospital. Not being in hospital does not mean that she is better, it means that bar a life threatening emergency there is nothing else they can do for her.  And actually the definition of life threatening emergency seems to be stretching a bit now, a couple of years ago we had to take Daisy to hospital if she spiked a temp or had positive cultures, now we judge whether this is a "manage at home" situation or a "call 999" one.  The last admission was for intravenous pain relief but since then Daisy has been on various intravenous antibiotics at home to manage various bacteria which colonise the bits of plastic in her body. Now together with the TPN drip we put up every night and which provides her nutrition into her blood stream, we also draw up at least one antibiotic - a few weeks ago it was meropenem, now it's augmentin, IV antifungals are being mentioned too.....in addition to this, because of her worsening foregut motility and severe reflux (we are not talking vomiting here, we are talking gut renching, blue in the face wretching and projectile vomiting of luminous yellow bile...) we also administer anti-reflux medication intravenously.  Drawing up an IV is not like pouring out a medicine, each iv has it's own way of being prepared - some (if we are really really lucky!) are ready mixed, most need mixing with something else - saline, water or some other solvent.  They need to be drawn up, measured, air bubbles dispersed and administered.  Sometimes as a slow push, sometimes as an infusion via a pump and always with a saline flush between each medication.  So another compromise we have had to make to keep Daisy out of hospital and with her family is to add intravenous medication into our daily routine.  But it is working and she is definitely better on IVs than she was off them.  It's just sometimes it would be nice just to be Daisy's mum, sometimes it would be nice to say "tell you what let's not bother with putting the TPN on tonight, let's go out to the park instead", sometimes it would be nice not to have to change her catheter knowing it's going to make her cry or drag her away from her toys to change her stoma bag because the contents are leaking all over her clothes and burning her already sore skin....sometime there are so many things I would like to do rather than be Daisy's nurse but this is the pact that we have made...for Daisy to be here with us, for Daisy to be enjoying life then this is how it needs to be.

It's just sometimes when I have a brief moment and allow myself the really think about the enormity of the situation I realise how unfair it is, on Daisy, on us, on her siblings.  Why does she have to have this rare, sporadic syndrome?  It's nothing to do with one of us carrying a rogue gene, or our age or race, just one of those, chance in a million (make that 28 million) occurences that could have happened to any of you.  So why then having this dodgy gene mutation does she then have to have intestinal failure meaning that she relies of chemicals and machines and plastic to live and then the final cruel blow - why does her bladder then decide that it's going to join the party too?  That's just not fair.

It's the ripple effect that's tough too - Daisy has three siblings.  These four children have one shot at childhood and while we constantly tell them there is no such thing as a normal family, a perfect life, I feel guilty at how sometimes I rely on their help as I change stoma bags and catheters and run through TPN when there is no other adult around to help me.  Ask any of my children about TPN, Hickman Lines, Mitrofanoff stomas, gastrostomies and jejenostomies and they will confidently tell you all about them, probably more confidently than a junior doctor.  They seem oblivious to the physical manifesations of Daisy's disease and see her simply as their sister and she in turn has them completely and utterly wrapped around her little finger.  Daisy rules the roost at our house, and given her larger than life personality I think she would still rule the roost despite all her medical problems.

But for all of us, while we present a facade of coping those feelings of drowning are bubbling under.  All three of my older children are receiving emotional support - one from CAMHS (child & adolescent mental health services) , two from the hospice and young carers groups.  Andy and I attend counselling sessions.  These sessions have given me time to reflect and take stock and think about me and what's important.  I felt that because I am intelligent, articulate, willing but I think above all, so desparate to have Daisy at home and keep the family together, I was being laden with more and more work and responsibility and risk to manage this.  I felt like I had been thrown into a lifeboat with a load of supplies and set adrift left to fend for myself while everyone waves from the land.  But the thing is, I am not waving, I am drowning - I am drowning under the overwhelming workload that comes with looking after a chronically sick child, trying to be there for the other children and listen to their problems, trying not to get angry with Theo's asperger's outbursts and meltdowns and reminding myself it's not him, it's the autism, drowing under the paperwork and bureaucracy that comes with my world.....and it seems to me that the more that the world thinks you are coping, the less likely it is to check if you really are.

So when I stood back after a recent long, all day appointment at Great Ormond Street and took stock of all the addtional meds and IVs that we were being asked to add in to our already packed daily routine and I had an epiphany and I realised I could just say no.  So I did.  It was not about putting Daisy at risk, it was about ensuring that overloading me (because remember it is mainly me, Andy works long long hours to keep a roof over our head) did not put Daisy at risk.  This was a really liberating feeling because suddenly the wheels of support starting to turn and a better, more manageable plan was formed, a plan that could be managed at home taking into account the workload and Daisy's needs.  Since that time I have been on a bit of a roll, realising that I don't have to do it all.  I have stood back and taken a look at my life and what is important, for me the most important thing is my family and my marriage.  Since having Daisy I have gradually acquired other projects and interests to take the place of the career that I had to give up when she was born, these things have started to take up more and more of my time away from the family and I have realised this is not what I want, so taking advice from the great Homer Simpson I have asked myself "Can't somebody else do it?" and I have discovered that I am not infallible, the world will not fall apart if I withdraw myself from a voluntary group or committee, there will always be enthusiastic souls like me who are happy to take on more than the lion's share of service to the community!

I have not given everything up though, I have made room in my life for something that is just for me, long distance running.  I have run on and off since I was twelve, I ran a marathon at 13.  I may not be fast but I have the mental and physical stamina which ensures that I can run and run.  And recently this is what I have been doing, I plug in my music and run, morning, evening, it does not matter, running is my prozac, it's my time out away from everything where I can meditate to the repetitive rhythm and escape into music and thoughts.  Running keeps me physically and mentally strong to keep going, because I have realised that life with Daisy is not a sprint, it's not a marathon, it's an ultra marathon, iron man, triathlon, decathlon endurance event and she, and the rest of the family, needs me to be up to the challenge.

So I have regained my mojo and with it normal (maybe a bit more streamlined and focussed) service has resumed.

It could be you

So how did I come to this point in my life where I made a shift from wage slave to benefit scrounger?

Up until November 2004 I had a full time marketing career, I had degree and a master's under my belt together with professional qualifications and memberships. I had travelled the world with work, managed multi-million pound budgets and had either worked for or manged the accounts of some heavy weight, blue chip companies.  The role I was in by November 2004 was supposed to be my "slowing down, being more close to home" job - I was head of Marketing and Student Support for a Further Education College.  The plan had been to take some maternity leave then return on a part-time basis, in time for the college's busiest time of the year, Student Enrolment.

I loved working, I loved the sense of identity and purpose it gave me, I loved being part of a team and being appreciated for a job well done.  I enjoyed dressing in "corporate" clothes, receiving my pay slip at the end of the month (even though a huge chunk of it always seemed to go on childcare!), putting my education and training into practice but most importantly it was great to leave it all behind at the end of the day and go home (well, when I wasn't travelling).  I was not ashamed to admit that going to work was a bit of a cop out, I was not cut out to be a stay at home mum.

I had a stereotypical view of people who claimed benefits  - I wanted to show my children that you could have it all, career and family and that an education was worth pursuing as it led to wonderful rewards.  I knew nothing of the world of disability, illness, hospices - except for once a year when Comic Relief and Children in Need was on the TV, at which point I would get my credit card out a pledge some money and think nothing more of it.

So November 2004, when I was 29 weeks pregnant with our fourth (and much wanted) child and second daughter, I had no idea how my world was going to change so dramatically and so permanently.  Being my fourth child I had a good idea when things did not feel right in pregnancy, I was being monitored for polyhydroamnios and I was now looking like a woman who was full term with twins, I was huge.  I wandered into my ante-natal clinic which happened to be on the way home from work and that's when my life changed.  I was admitted straight away. given steroids to strengthen the baby's lungs, and had several amnioreduction procedures to try and minimise the risk of pre-term labour.  As it was Daisy was delivered by c-section (a normal labour was deemed too risky as all three previous ones had been very long - and very natural!) at 33 weeks, three days before Christmas.  I spent Christmas in hospital, Daisy was in intensive care and poor Andy was at home 7,5 & 2 year old children.  I remember shuffling into the neonatal unit on Boxing day, clutching my meagre bottle of expressed milk to see the staff gathered around a TV watching coverage of the asian tsunami - and I wondered what had happened to the world, to my world...

Needless to say, despite optimistic plans and strategies I never did return to work and with a heavy heart I handed in my notice so that the college could get on with recruiting a replacement.  The world as I knew it had changed; after two months in neonates, Daisy did come home for a few (very fraught) weeks before being rushed up to Great Ormond Street Hospital at four months old for investigations for a possible tumour. She ended up staying there for three months during which time she visited intensive care with respiratory failure, had the first four of many general anaesthetics, was diagnosed with heart problems, a severe visual impairment and failure to thrive.  They did not find a tumour and we know know in hindsight the agony she was in and the symptoms she displayed were down to rare nerve disorder, probably completely separate to her overall diagnosis of Costello Syndrome,  in her gastro-intestinal system which meant that every drop of milk we were trying to force into her caused her huge pain.

We soldiered on for a few years, we embraced the diagnosis of Costello Syndrome, we even manage to attend the syndrome conference in Portland, Oregon.  I thought of ways I could get back to work in between the hospital stays, when we were lulled into a false sense of security as we managed a few months out of hospital and on a reasonably even keel.  We struggled financially on one income, but always in the back of my mind I thought this was a temporary situation and I thought that Daisy, like the other children with Costello Syndrome we had met would eventually stabilise enough for me to freelance occasionally or go back to college to train as a teacher.  I even started an application for a part time teacher training course..

Again, we had a turning point in our life with Daisy - September 2008, when after a difficult summer as she  struggled with pain and weight gain and only a week into starting school (and Theo just starting high school) she became unwell and we had to rush her to A&E for what we thought would be another few days of vomiting, fluids and then she would pick up.  But she did not pick up, she got worse and worse and eventually on being transferred to GOS and having upper and lower scopes she was found to have severe and agressive inflammatory bowel disease, we know now probably caused by the severed dysmotility and repeated attempts to feed her, and in November 2008 she started TPN and left hospital nearly 12 months after first being taken to A&E.

With TPN and Daisy's subsequent deterioration our lives, already changed, changed immeasurably.  There was not turning back, no hope for recovery, no part time work or college course.  During one of our long hospital stays Andy was made redundant and the unthinkable happened - we were both out of work, with four children, one of whom was needing 24 hour care.  Tax credits to supplement the carers allowance and Disabilyt Living Allowance were an essential part of our lives.

Andy and I would have driven eachother mad being at home together all day, so now he runs a very successful consultancy business.  This allows him some flexibility to fit around Daisy's medical needs, but most of the time I go to hospital appointments, clinics, procedures on my own as he has to work.  My full time job is Daisy and the three other children.  And it seems to me that with each year my job description keeps expanding and yet I receive minimal remuneration for it - I am now qualified to access a central line (many nurses will not/are not able to do this), I can catheterise a mitrofanoff stoma, change a stoma bag, replace a jejenostomy and gastrostomy button, I am fairly proficient in makaton sign language, I can administer intravenous antibiotics, make judgements on types of pain relief analgesia required.  And when I am not doing all those things I am checking stock levels of all the equipment and ancilliaries needed to run our mini hospital room, washing copious amounts of bedding after nights Daisy has spent vomiting or with a leaking stoma bag, cleaning, tidying, lugging heavy wheelchairs into the back of a car followed by lifting a 20kg child and various bags and attachments!  I did not anticipate the new languages I would have to learn - carefully choosing my words when I make requests of social services versus healthcare because using a word such as "respite" with the wrong person may just come back with the answer "that's someone elses budget".  I have had to become au fait with the world of statements and special education, and not just for Daisy - just incase I become too complacement I have another child with additional needs that can take me away from the day job of just being a mum - Asperger's and everything that comes with that syndrome has taken over our lives also.

I am a different person to the career woman I was 7 years ago, I have been to the edge I guess and seen another world and it really does put things into perspective.  I value what I do immensely, this is the most important, rewarding, bone-achingly tiring job I have ever had to do.  It's manual labour, intellectually challenging, goalpost moving, unrelenting, 24/7 slog.  This is not just about being a mum plus, this is about being a nurse, an advocate, a housekeeper, politician and diplomat......I get thanks and appreciation from my family and friends,  I know I am contributing to society, I am an essential component in the social and health care system, without me doing what I do the cost to the taxpayer would be huge as Daisy would need full time, funded specialist medical care in a residential setting. 

My reward is to see my children achieve and grow, I truly believe that the reason Daisy continues to live to fight another day is down to the skills and effort Andy and I have put in to make that happen.  But does our society value what I do?  I am dependent on tax credits and carers allowance, all £55.55 per week of it.  Andy works, sometimes I envy him that opportunity to escape into the corporate world and switch off.  I would love to put my new skills to use, now I google part time nursing degrees and daydream about becoming a Gastrointestinal Nurse Specialist......

This is why I write this blog, so that hopefully by sharing a bit of our lives people will understand our world and look beyond theirs.  We all walk such a fine line, we are all just a faulty gene, a birth defect, an accident or a chance happening away from entering a world like mine.

It's still about one day at a time

So, it's New Year's Eve and already the stream of texts and emails are coming through from friends and family over the world, full of good wishes for 2012, hope that things will improve....as you all know, I am always optimisitc, glass half full but also profoundly realistic.  Andy and I chatted about our hopes for 2012 earlier today and we both agreed that actually, our philosophy of one day at a time still holds true today, new year's eve, it's just a date, a number, our hope remains for stability, and time...whether it's tomorrow, next week, month or year.....

As it is, Daisy is in hospital.  Yesterday she woke up in severe pain and despite the overwhelming cocktail of drugs we have at our disposal at home we could not get ontop of it and more worryingly her breathing was becoming laboured when she did fall asleep.  So it was time to visit our local hospital, and such a relief to have some great registrars on duty who made our visit less stressful.  Daisy needed intranous morphine and fluid resuscitation and today is tired but better.  In fact we have brought her out on home leave in the hope that we can manage her pain at home but will return if it gets worse.  Hopefully if she can get through the night without an escalation in her pain management requirements then she can be discharged.  It is really worrying how bad her pain became yesterday and how quickly and we just hope that this is not the shape of things to come.  We are due to go to Great Ormond Street in a couple of days so maybe they will have an idea why she is continuing to get such bad pain or at least we can tweak her pain management plan to avoid it getting to the point where she needs to be in hospital.

As it is New Year's Eve I have been reflecting on 2011 and what it has thrown at us.  It has been the year of surgery and bladder issues for Daisy and facing facts and some pretty tough conversations for us, her parents.  Daisy now ends the year with an ileostomy stoma which continues to have high output and episodes where is completely shuts down (goes into pseudo-obstruction), she has a surgically formed jejenostomy through which she receives her medication, her gastrostomy is now permanently on free drainage with a bag attached as her stomach does not empty and her reflux and reverse motility is worsening, she has a mitrofanoff stoma and we are now able to change her catheters daily at home through this, and of course she has her hickman line, a central line which goes into a main vein into her heart through which she receives her nutrition (TPN).   She is on permanent antibiotics and anti-fungal medications because of the bugs which are colonised in her body, these treatments keep the bugs dampened down to a level where they do not overwhelm her causing sepsis, but we live with this fear permanently, especially as she becomes resistant to antiobitics as a result of long term usage.  And of course there is the cocktail of pain meds she is on - enough to fell an elephant but sometimes only enough to take the edge off the pain for Daisy.  From a medical point of view things have deteriorated hugely - her TPN requirements are going up not down and now we are faced with the situation where there is no more surgery or treatment that is going to make things better, just symptom management and our hope for time and stability.

But Daisy's cognitive development is outstanding, she signs constantly and when she is well and confident this is backed up with lots of talking.  She is completely in love with her siblings and if you mention any of their names she signs brother or sister and then signs "love".  She is also obsessed with telling people if they are boys or girls having worked on this in school which is always amusing when strangers, such as the man who came to read the electricity meters, come to the house and they are greeted with shouts of "boy!" and the associated sign!

I have to keep focussing on the positives - she is still with us, this has been a year when we have said goodbye to others close to our family, she is still fighting, our determination to keep her at home is unwavering.  We just cannot dwell on what 2012 will bring, we  could not have predicted what 2011 brought our family and I just have to be grateful that we have ended the year as we started it, as a family of six - we have more battlescars, we have increase our medical knowledge, we have come to embrace the rollercoaster of Asperger syndrome, we have ridden the storms, plummetted the depths of our emotions and yet we still seem to be standing. The only thing I ask for next year is time....more time together, time away from hospital, time for me, time to be a couple, time to be a family.  But I am aware that we have already been so blessed, with seven years with Daisy, and thinking of this is what reminds me that the cup will always be half full, against all the odds, she has given us seven years of joy and love....I think I will leave it at that and continue to take things one day at a time.....

Thank you to all my wonderful friends who continue to give me such strength and support, so many of you I have never met, some of you have only come into my life since having Daisy, but to know that all over the world there are people who are thinking of us and rooting for us really keeps me going....I feel the love, thank you.

Happy Days!

Despite everything going on Daisy is determined to live life to the full - here is a selection of pictures of Daisy having fun on her birthday and in the run up to Christmas.  We are off to our hospice ShootingStarChase later today after a quick visit to Hampton Court Ice Skating Rink.  Daisy continues to defy the odds and she is currently on intravenous antibiotics as well as her usual cocktail of drugs but nothing is going to stop her having fun this Christmas!

Happy Christmas to all of our friends and supporters! xxx

Daisy was an Angel in the School Nativity

With big brother Theo at the Shooting Star Chase Hospice Christmas Party

Spending her Birthday Money at the Oxford Street Disney Store!

Meeting Santa at the Wetlands Centre in Barnes

Birthday Party with Godparents & friends at Bloomsbury Bowling!