I am discharging all my pediatric patients. There aren’t that many. Chapel Hill doesn’t actually believe in Attention Deficit Hyperactivity Disorder or Child and Adolescent Psychiatry for that matter. Evidently, the over diagnosing and drugging of America’s children decried by the national media never hit Chapel Hill.
I see lots of high school students, usually girls, who have suffered from ADHD for years, decades really, but have never been treated. Boys eventually get treatment because they misbehave. Well behaved girls get left behind. They spend years working and learning and studying and knowing things the night before the test that just disappear during the test because of deficits in short term and working memory. They get called lazy or unmotivated but not correctly diagnosed and treated. Sometimes they don’t come to me until Junior year when the work load is so unbearable that they give up completely or become suicidal. Sometimes they come after three automobile accidents and their parents insurance gets cancelled. Eventually they come but often not in childhood.
In New York, I had a six month waiting list almost from the day I opened my private practice. They believed up there and they wanted answers. So it was an adjustment to learn the biases against Child and Adolescent Psychiatrists here. Once at a soccer game a family practitioner asked me what kind of doctor I was and when I told him responded with, “Can I have some Adderall for my eight year old, he won’t practice his cello. Isn’t that what these parents say to you?” Wow, was all I could think knowing there was a back story there. Turning away, I watched my first cousin once removed score a goal instead of responding.
The ones I do have are amazing. Pediatric patients that is. Wondrous formations of God’s incredible creative powers. His refusal to be placed in any box, not when it comes to manifestations of humanity on Earth. “Dr. Burns, I’m so glad to see that you are suuportating cancer,” he looks at me with sure confidence, intelligence shines out of his eyes, even on the first day we met. He was two and raced through the halls, nearly knocking himself and the other patients over in his rush to get where he was going. Usually this was to the Hess truck or the legos, to build a tower for me to wonder over and reflect once and again at his genius. His mind racing so far ahead of his ability to enunciate that he could barely speak. So many thoughts rushing over themselves that they fell together and tripped his tongue.
It was love at first sight, for me if not for him. And it wasn’t for him, as the techs came to the room and tried to get his blood pressure. He would have nothing to do with them or that. He was a moving target and to stay with him you had to move. His parents were symbols of patience and grace. They loved him more than I did and it was evident. And so we started our seven year path of understanding, unfolding the secrets of his mind and maximizing his many strengths together.
That ended yesterday. “Dr. Burns, I’m so glad to see you’re supportating cancer. I learned about it in school that when you want to supportate others, you cut your hair. Good for you. But I told Mom, I want to go see Dr. Burns because I need to de-stress. My stress and worry is worse on Wednesday because I have to go to school and then baseball and then I have church choir and when I get home, I only have time to eat and go to bed. There is no time for homework on Wednesdays. And that is my stress. And if I don’t do my homework then I worry and stress more and I act out and cry and misbehave and don’t do what I’m told and then I am really worried and stressed. I need to de-stress badly.” And so we talked as we have since he was two. If you listen hard and help him to listen and slow down and stop interrupting, he does. It takes a long time but he can do it. He told me that going to aftercare and playing with his best friend instead of doing his homework made his heart really happy when he was doing it but not later when he was behind and tired and worried about not finishing. He said that he didn’t mind working in school but that working after school was just too much especially with two other activities that he liked and didn’t want to give up. He admitted that if he just sat down as soon as he got to aftercare and finished his homework that things went smoother but that the temptation to play was often overpowering. And on and on he talked until he absolutely came up with his own de-stress plan while I just sat there and asked questions and helped him think. He’s only nine but truly master of his own destiny. Truly in a way most remarkable that I’ve never experienced in other children.
And so as the session came to an end and we were finishing our last game of UNO which I am happy to say I won, but can’t we play one more you always win and I want to, I had to tell him that I wasn’t just supporting cancer that I had it too. “Oh, that’s too bad, I was hoping, really sure that you only like to supportate it.” Then I told him how I was going to receive many special treatments and that they would make me well eventually but in the meantime my hair would fall out and I might be too sick to see him. That he had a pediatrician and he could write his prescriptions. And he said I don’t know what a pediatrician is and I don’t want to see them I want to see you. And I said well who do you see when you have a sore throat or stomachache and then he said my doctor. And I said how about you see her in August right before school starts and then come see me in December, before or after Christmas, depending on how I’m doing. And he said “no, I want to see you next week. I still need de-stressing.”
So I wrote his teacher a note that said, “Please excuse Lawrence from homework on Wednesdays.” And that made him pretty happy. But he immediately started negotiating, “How about I get to choose between Tuesday and Wednesday because sometimes Tuesdays are worse too.” And knowing how quickly we get stuck in the quagmire of his bargaining, I just answered, “We’re going to let your mother and teacher, the adults decided the details because they know more than I do.”
It was time for him to leave. Seven years of love, treatment, evaluation and shaping and educating his parents and his parents educating me and all of us the informing his teachers but most of all Lawrence, his determination to be good and do well shining over all our efforts, even when he was learning to write letter by letter, shaping lines and figures that did not follow any pattern, he persevered. And we did to.
“Know what Dr. Burns?” “No, what, Lawrence?” I answered. “You know the saying slower than Christmas?” “Yes, I do.” I answered. “Well this year Christmas is going to be extra slow because I’m going to be waiting to see you and Santa Clause. It’s going to take a really long time this year, isn’t it?” And what could I say but “Yes Lawrence, a very long time indeed.” I cried when he hugged me goodbye and told me that he’d miss me. “We can speak on the phone if you want and your mother will call to see how I am,” I whispered in his ear. I told my husband there are some things I would cry about even if I didn’t have cancer. Saying goodbye to Lawrence is one of them.