Mummy's Little Helper

by Casey Watson

  ‘MRSA?’ It was obviously going to be a morning of medical acronyms. And this was no nicer than the last two. ‘Oh dear.’

  ‘Quite. Oh dear is right.’

  ‘But isn’t that the one you get when you’re in hospital? I didn’t think you tended to get it otherwise. Nasty bug to get. Are they sure?’

  ‘Apparently. I think the mum was in for something and has been ill with it, or something. But you know what these things are like – the usual sharp intake of breath, the mass terror of contagion, the usual “step away from that plague child!” response. Can you imagine what the average nursery school would have been like during the plague?’

  ‘Er, empty? Aww, poor little thing. Are they very sick?’

  ‘Bearing up, as far as I can tell. Possibly even on the mend now. But there’s been another one picked up today with sickness and diarrhoea symptoms, so everyone’s panicking that it’s going to spread, of course. It’s an emotive word, MRSA, isn’t it? A bit like “nits”. Everyone’s stressing their little one might have caught it as well now – and yes, Mum, Levi is absolutely fine, before you ask, and it’s not a child he’s particularly close to or anything. But I just thought it made more sense to postpone Jackson’s party than to have everyone cry off at the last minute – or, more pertinently, think I’m being a deeply irresponsible mum.’

  Riley was right, of course. It was the sensible thing to do. The days when mums liked to hold chickenpox and measles parties so all the kids could get it over with were long gone. And Jackson wouldn’t give a hoot. He’d only be one. This wasn’t a party he’d even remember.

  ‘It might be better in any case,’ I agreed. ‘Give the chance for the weather to warm up a bit. And, actually, putting it back a couple of weeks means we could hold it on Abby’s birthday itself, come to think of it. If you don’t mind us doing it on the Friday, that is.’ And with Abby’s current problems, I also thought, but didn’t say, it might just be one less thing for her to get stressed about right now. ‘But now I’d better get off the phone anyway. I’m waiting on a call from John Fulshaw.’

  ‘Okay,’ Riley said. ‘But listen – just be sure to disinfect the phone now we’ve spoken to me. You know what these virulent new superbugs are like …’

  ‘God,’ I groaned, thinking how ironic her joke was under the current circumstances. ‘Don’t you start!’

  ‘I know hardly anything about Sarah’s current medical condition, to be honest,’ John admitted, once he’d called back half an hour later and I’d given him a run-down on what Chelsea had told me about the clinical trial and the possible plans for Sarah to remain in hospital long term.

  ‘Do you think Bridget does?’ I asked him. ‘I’m very conscious that Chelsea thought I knew. It sounds serious, doesn’t it? And if she’s got to go into some residential rehabilitation programme as well … Well, it will obviously change things, won’t it? Have you had any sort of update on the situation with finding relatives? What about those second cousins she mentioned? Any news there?’ As I spoke it occurred to me that I’d had almost nothing in the way of updates either. Which was unusual in itself. Why not? Usually, there were more meetings than you knew what to do with. But then, Abby wasn’t usual, in that she wasn’t in my usual category. The kids we had mostly required loads of meetings, to plan strategies for coping with the extreme things they did, and in some cases, just to keep them from absconding, not to mention falling foul of the law.

  ‘I’m also conscious,’ I went on, ‘that if that is what’s going to happen, then Abby needs to be prepared for things properly.’

  I explained about the school’s worries and how I wanted to know what action John thought I should take. ‘And I was wondering if I should go and see the school, or whether it’s Bridget who should be speaking to them. In conjunction with Sarah, even. Though, as of this moment, we don’t know what “it” even is, do we? Not definitively. I mean, normally, I’d just get on with it, and call Dr Shackleton, but do you think Bridget would want to take Abby to her own GP?’

  ‘I’d better speak to her,’ John said. ‘I see no reason why you couldn’t give him a call and get some general advice, I suppose, but before you make an appointment with the school or start thinking about strategies, let’s see what Bridget has to say, yes? You’re right. This is an unusual situation, in that no one here is trying to exclude Sarah from proceedings, are they? And we also know how it is with all these various protocols. Don’t want you to be seen as stepping on any social service toes, eh?’

  We both laughed, of course – stepped-on toes were a constant worry in my line of work – but little did I know that John’s words would be coming back to haunt me, and would wipe the smile right off my face.

  It’s reassuringly straightforward, I think, the way the human mind works. While you’re oblivious to something, you obviously don’t look for it, but once something’s pointed out to you, suddenly it’s so there – you can’t seem to miss it if you try.

  Like being a schoolgirl, in a playground, perhaps, and your friend points out a boy she tells you fancies you. One minute you’re barely aware of his existence, the next, he seems to be everywhere you go. I remembered that sort of thing happening to me more than once when I was younger. Once you know something, you can’t un-know it, and it sticks in your mind.

  By the time Abby returned from school, I had trawled, if not the entire internet, at least my memories of the time she’d been with us, and found Mr Elliot’s concerns to be well founded. Things I’d previously attributed to force of habit, due to her circumstances (the making of endless lists, the hygiene issues, the need to turn lights off, the terror of illness), I could now see might equally be part of a pattern of an increasingly over-the-top anxiety response.

  I had decided to say nothing to Abby about the incident in school that morning – that should maybe wait until I knew who was going to do what. For the same reason I’d also held off on calling Dr Shackleton. I would do as John suggested and wait for Bridget to guide me – but I had taken the school’s worries on board, and had resolved to keep a closer eye on Abby. And, of course, as soon as I did that it all became clear. The poor child was really struggling with day-to-day living to such an extent that I couldn’t believe I’d missed it.

  I followed her around like a proverbial hawk over the next couple of days, and my eyes were truly opened to the extent of it. Not just one or two – every doorknob was opened with a sleeve, be it the front door or an interior door or the handle on a cupboard. The visits to the toilet – which I’d previously never really worried about that much (it was the other way round with most kids: will you please wash your hands!) happened not just here and there, to answer a call of nature, but at intervals that at first seemed inexplicably short, until you realised they immediately followed Abby doing anything that might be dirty, such as taking something from me – a tea towel, an apple or a pile of magazines. She’d do whatever I asked of her and then immediately disappear, and then return from the downstairs loo or, if more appropriate, the kitchen sink, having carefully washed and dried her hands. I also noticed that she didn’t use my fabric towels either. In the kitchen she would wash her hands, dry them on kitchen paper, then pop the kitchen towel in the kitchen bin, using the foot pedal. The same applied in the downstairs loo – I even stood outside and listened. I would hear the flush, then the sink taps, then the rattle of the toilet roll holder for a second time and, finally, a second flush, and only then would she re-emerge.

  Other things were more subtle. I recalled her hair-pulling that first evening, and began taking note of any time when she started to do it, and, to my astonishment, found that she was doing it quite consciously, and that there was a definite pattern there, too. She would pull half a dozen hairs out, line them up on the chair arm beside her, then, when she’d done that, gather the strands together and roll them into a ball.

  I also noticed that the switching off of lights was equally ritualistic. It wasn’t just a case of going around plunging
the house into darkness. She would also switch on any light that was off, as if to check it. She’d flick it on for half a second, before switching it back off again, as if reassuring herself it really wasn’t lit. She would then pat the switch plate several times, for good measure.

  In short, she was in a state and it was a state that was definitely worsening. And I wanted some guidance on how to help her. So when I got an email from Bridget, finally, on the Wednesday, I felt frustrated. The email was brief. And ironic. Dear Casey, it read, apologies for being so slow to come back to you. I’ve been off with some dreadful bug – ugh! – but am now back on the case. Are you free for me to pop in for a bit of an update next Thursday?

  ‘Harrumph!’ I said to Mike, after I’d read it out to him. ‘She hasn’t even mentioned who she thinks should be updating who! And look –’ I pointed. ‘Next Thursday? That’s more than a week away!’

  Mike squeezed my shoulder. He knew what I was like. Once I’d decided on something I was like a dog with a bone. I wanted action. Not meetings next bloody Thursday.

  ‘Ah, but perhaps she’s had MRSA as well,’ he quipped.

  Once again, I laughed. But inside I was still harrumphing. Stuff it, I would call Dr Shackleton.

  Chapter 11

  Dr Shackleton, our local GP, has always been a godsend. He’s been the family doctor since before Riley was born, and even though our recent house move meant we were a little bit outside his area there was no way I’d consider leaving his surgery unless physically restrained from going there.

  Kids in foster care sometimes retain their own GP, and others not – it depends on the individual circumstances. This was certainly true of the children we’d had so far. Where a child was to be with us long term, it obviously made sense to get their notes transferred to him – which he was graciously accepting of – and in others, where it was short term or there was some other compelling reason, the child would continue with the practice they already had.

  Dr Shackleton was also wonderful because he was such a great supporter of what Mike and I did. He’d been particularly invaluable in helping us with one of our earlier foster children, Sophia, who had a rare hormonal disorder called Addison’s disease. It had been a lifeline more than once to have him at the end of the phone.

  Though I obviously couldn’t speak to him specifically about Abby’s case, I could at least get an overview of what her symptoms might mean and, most importantly, how to help her manage them. I was particularly concerned about how it was affecting her at school. She had enough to deal with without becoming even more ostracised than she already was. I called the surgery the morning after receiving Bridget’s email and was able to book a quick telephone consultation for the end of morning surgery, so I could at least talk the problems I’d seen through with him.

  And he was predictably helpful.

  ‘I think you’re spot on,’ he agreed. ‘This sounds very much like stress-related OCD. And the good news is that very often it’s only temporary, particularly when it manifests in children. It can run in families, and it tends to afflict the already anxious – it’s often a trigger such as you’ve described that tips the person over into a place where they can no longer manage those anxieties, after which it’s particularly good at feeding off itself – it’s the enemy within, so to speak. And from what you describe that’s what seems to be happening here. Though, on a more positive note, you may well find it begins to settle down once she gets more used to her new living arrangements.’

  Which were completely up in the air, truth be told. Who knew what was going to happen to her? No one, right now, it seemed. But once we did – well, that was at least encouraging. ‘That’s reassuring to hear,’ I said. ‘Because right now it seems to be going the other way. She’s been with us over a month now, and though I reasoned it might be partly because it’s only now I’ve really started noticing, the compulsions seem to be getting worse daily.’ And that was, literally, what seemed to be happening. I’d now caught her several times tapping her fingers on all the door frames – as if she couldn’t walk through one before doing so. ‘I keep reassuring her,’ I told him. ‘I don’t try to stop her doing what she needs to do – far from it. If she needs to polish the doorknobs, or tap things, or wear her special “bandages”, then I’ve let her …’

  ‘Ah,’ said Dr Shackleton, ‘that’s exactly what you shouldn’t do.’

  Now I was confused. Wouldn’t stopping her make her even more anxious? ‘But I thought drawing attention to a behaviour was the last thing I should be doing,’ I said. ‘Isn’t that tantamount to reinforcing it?’

  ‘In many cases, yes, obviously. But there’s a subtle difference here. With errant toddlers and attention-seeking teenagers, of course that’s true. In cases like that, you’re absolutely right. You are reinforcing a behaviour, which, in the case of an undesirable, attention-seeking behaviour – such as a tantrum or a rant – is obviously the last thing you want to do. Reinforce the good, don’t reward the bad with attention, and so on. But this is different. With compulsions – which are essentially rituals employed to minimise feelings of acute fear or anxiety, as opposed to being used to get the child’s own way – the trick is to confront them. You’ll have heard the expression ‘feel the fear and do it anyway’, no doubt?’

  ‘One of my mottos, as it happens.’

  ‘Well, that’s what it’s all about. And it’s the opposite of what an anxious OCD sufferer does. They feel the fear and “run away” from what frightens them. And the “running away” of course – which is what they’re doing when they adopt all these little tics – just makes the fear feel bigger next time. So it might start with tapping something once, and then escalate to several times, or be augmented by additional rituals, till in the end it becomes so elaborate and frequent that it’s almost impossible to function. You see what I’m saying?’

  ‘Yes, I get that.’

  ‘Well, OCD is an extreme form of that. What happens to the OCD sufferer is that, under stress that perhaps rational fear gets blown up into something so big as to be difficult to manage. So, in this case, say Abby has this fear of getting sick. Perfectly understandable given what you describe of her childhood environment, but now she has to deal with the additional stress of having to leave her mother and go and live with strangers – losing all her reassuring routines and rituals behind in the process – so now she feels the fear and finds it unbearable. Hence the obsessions and compulsions. In simple terms, she can’t avoid her current circumstances, so she has found ways to reduce her anxiety about them, by endless hand washing, germ obliteration and so on.

  ‘Of course, there’s a lot more to it than that,’ he went on. ‘The other main thing that happens is that the brain finds all sorts of clever ways to alleviate anxiety – and that’s where repetitive tics come in – the light switch flicking and hair pulling you mentioned. Patients often can’t explain why they do some of these things, except to report that it makes them feel better. Again, it’s just a way of controlling their fears. If I turn round on the spot three times – to pick something at random – the horrible feelings of dread in my head go away.’

  This was beginning to make sense to me now. ‘Ah, I get it. So I shouldn’t be indulging them, then. I should be trying to stop them. Intervening.’

  ‘Exactly. To accept tics as being “normal” is reinforcing them, obviously. It’s like saying “Go ahead – you’re right to be afraid of the thing that scares you” because that’s what it’s about. An irrational obsession. So, generally speaking, you need to be doing the opposite. Not in a traumatising way, obviously – just gently encouraging her to confront her fears and so shrink them down to a rational size. It’s a bit like managing phobias. First she needs to be exposed to the things that frighten her, so she breaks that cycle of fear and avoidance. Second, she needs to be distracted from ritual tics – gently steered away from doing them. In both cases it’s all about her re-learning the associations she’s made – having it reinforced inste
ad that if she touches a door handle or a chair back she’s not going to die, and that if she doesn’t perform her tics then nothing bad is going to happen to either her or her loved ones – in this case, her mother. Again, I’m grossly over-simplifying, but that’s the gist of it. That help?’

  ‘Immeasurably,’ I said. ‘Wow, I’m certainly learning in this job, eh?’

  ‘Life is short, the art long, as we medics are wont to say. Another useful mantra for you, Casey!’

  I felt much better having spoken to Dr Shackleton. And now I was armed with more information about the logic of the disorder – and, in its own perverse way, it was logical – I felt better equipped to help Abby start to manage it. Once I’d spoken to Bridget, of course (and we had a clearer sense of what might happen in the longer term), maybe some professional intervention might be appropriate, in the form of a course of cognitive behavioural therapy, to help her deal with it. Or maybe all would be well, and she and Sarah would go home and, magically, the symptoms would disappear. But I wasn’t holding my breath, and right now she needed support, so in the meantime I could practise my own small interventions – or ERP routine, as Dr Shackleton had called it: exposure and ritual prevention.

  For poor Abby, though, this must have felt like another great weight on her shoulders, which were already buckling under the strain.

  ‘You know what?’ I said to her, the afternoon after I’d spoken to Dr Shackleton. ‘I’m starving. And Mike’s working late, so tea’s going to be ages away yet. So how about we go and choose a cake from the cake counter?’

  We were in the supermarket, straight after school, which had already thrown her somewhat. Her ritual – as I now realised it to be – hadn’t varied since she’d come to us. She would come in, go into the downstairs loo, wash her hands, straight upstairs, change out of her uniform, then wash her hands again upstairs, then come down again, at which point I’d make her a snack. The only times that hadn’t happened were when we’d gone to the hospital, when I’d taken something for her to eat on the way there. And, of course, now I realised that on neither occasion had she eaten it. I’d naturally put it down to the emotion of seeing her mum, but now I realised it was actually more complicated than that.