Nope, it's not a blizzard... but it's enough to keep us home today.
I'm trying not to be too gleeful... (M was looking forward to seeing the pdoc)... but it's hard.
I do feel like I should explain about the pdoc..
.
She isn't a bad person or a bad physician... She's actually one of the best in the area, she's known for her kindness, genuine caring for her patients, respect for their parents, and her incredible expertise with meds. She is literally one of the top child psychiatrists around... (I've heard her described, by another pdoc, as being the absolute best in town).
So... what's the problem?
She is incredibly overworked right now, and her current professional responsibilities limit, to a large degree, her involvement with M. This is a relatively new situation (since summer of 2006), which began after she finished the research project she'd been working on for years and moved back into clinical work. She sees M (and R) privately, they are part of just a handful of patients she's kept through the moves from clinical work, to research, then back to clinical work. The position she has right now (medical director for a small inpatient/day treatment unit for kids who are diagnosed with both developmental disabilities and mental illness) involves stabilizing and caring for an endless stream of the toughest, most complicated kids... every kid she sees is in crisis. She keeps them just long enough to get them stable enough to be discharged to the care of other, less experienced, pdocs, before starting with the next child/family in crisis. She treats the kids other pdocs don't know what to do with.
I admire what she's doing, and how much she's trying to make a difference, but it doesn't leave much time for M. I know she cares about him, but the situation is what it is... nothing that's likely to change anytime soon. (I keep hoping she'll decide to move back into doing research, she was much more available then.)
Finding a new pdoc would be extremely difficult, and we'd almost certainly end up accessing services through the county, which means a much lower level of expertise, a ton of bureaucracy to deal with, and a definite lack of continuity of care... I have thought seriously about trying to find a new pdoc but when I weigh the pros and cons it seems in M's best interests, for a variety of reasons, not to take that step until I have to (when he's an adult).
I can't figure out what the pdoc was thinking in terms of my friend's child. The only thing that makes sense is that she saw the child deteriorating, and knew she was leaving out of town for a couple of weeks and was hesitant to leave knowing the child might tank while she was gone. I don't think she had any idea (too busy to check?!) that the only open beds were in a substandard facility. For this pdoc, nothing is more important than safety, and she truly believes in traditional mental health care... She'd think nothing of keeping a child in the hospital over a holiday (or inpatient for months!), if she had any concerns about the family being able to keep the child safe at home.
Honestly, we've put her in a position that compromises that concern about safety many times since she took over M's care. I've had to convince her that we could keep him safe at home, during crises that... with any other kid... would involve a lengthy inpatient stay. She's been flexible with us, I believe, because she trusts me to always be honest with her and to do whatever it takes to maintain safety at home... even when that means staying with M day and night, or modifying our home in such a way that minimizes safety concerns. (That's why I couldn't lie to her about the car broken down, other appointments, etc. I've promised her that I'll always be straight with her...)
Yes, "Mama" I have talked to her (many times) about how it feels like she's "checked out" on us, and how that impacts my ability to trust her. Each time I bring it up she seems to feel terrible, apologizes to me, tells me how committed she is to M's care, and makes a "plan" of some kind to stay in closer touch. Unfortunately, the "plans" only last a day or two, sometimes a week, before a new crisis on the unit takes her away again.
Jo, I really like your idea about suggesting the pdoc and I talk on the phone during M's appointment time today. I'm going to email the pdoc (cancelling the appointment! :) and will ask if she'd like to call instead.
So... the situation isn't quite as black and white as I've probably made it sound. This blog is a place for me to express my frustration, to vent... and I'm sure I don't always present a balanced, objective view of things.
Thanks everyone for the blizzard prayers... it's a winter wonderland at my house today, and we'll be spending the afternoon sledding instead of driving into the city for a pdoc appointment.
WOOHOO!!!!!!!
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