Wednesday, September 10, 2008

A Little More Bearable

A few weeks ago, there was a child at work who was supposed to discharge to a therapeutic foster home. He was very excited about it, and when the day came, was literally all packed up and ready to go, with his shoes and jacket on, bags at his side, and discharge gift in his hand. For multiple complicated reasons, during this moment, it was decided that he would not be leaving that day after all. In fact, we weren't sure if he was going to leave any time soon. Understandably, we knew that this was going to break his heart, and I had to tell him...

I managed to buy some time while we worked out a few details, but the time came when I had to tell him he wasn't leaving that day, and I wasn't sure when he would be leaving. How do you tell a child that he can't leave residential treatment after all, because the adults messed up? Of course, there were appropriate clinical reasons that he was not leaving, but for a child who has been told that he gets to go, it doesn't make sense, and it's not fair. Nothing I could say was going to make it OK, or even better.

I had planned to break the news to him after Ross had a visit with another child. When I walked onto the unit to visit the other child, the child who wasn't leaving was sitting in the hall, talking with a staff member. When he saw me walk by with Ross, he jumped up and ran towards us, excitedly pleading, "Can I pet the dog?!"

I asked him to please sit down quietly, so that Ross could come over to visit him. He quickly sat back down and waited anxiously for us to walk the 10 feet back to him. Ross approached, and with permission climbed into the child's lap. Ross laid his head in the child's lap, and licked his hands and face. The boy petted Ross, while examining him and his equipment. I showed him the tatoos in his ears, and he noticed that the tatoo had the same letters and numbers as the ID plate on his collar. He tried to tickle Ross' feet, and was amazed at how Ross laid there perfectly still, not at all bothered by the tickling. As he examined his feet, I showed him Ross' dew claw and explained how it is his "thumb."

While he was petting Ross, I broke the news to him. I informed him that the adults still had to figure some things out, and that we would let him know when we had more information, but for now, he was staying. I told him that I understood that he was angry, and that I would have been too.

As I tried my hardest to say anything reassuring that I could, he interrupted me to calmly state, "Ross makes me feel relaxed." I knew then that Ross had just saved the day! The child's calm demeanor had nothing to do with my attempts to break the news softly, it had everything to do with Ross' gentle touch. (So much for those 10 years of higher education...)

A few days later, we had a meeting to decide this child's treatment plan. It was decided that he would stay, and enter a new program. He was anxiously awaiting the decision that the adults were making about his life. We decided that we would tell him as a group, including two different therapists, his father, and care coordinator. We also decided that Ross should be there, hopefully to save the day once again.

The rest of the group arrived to meet with him before I got there with Ross. They had started to tell him, and he got up and left the room. As I entered the building, he was on his way out of the room. I told him that Ross was there to visit with him, and without any hesitation, he turned around and went back in the room with the group. He sat down, and Ross cuddled up next to him, laying his head in his lap, as if to say, "I know you hurt." The boy sat and listened to the adults as they told him he had to stay and work on his behavior some more. He calmly sat and stroked Ross, and made no more attempts to leave.

A few days ago, a couple of professionals came to interview this child for his new program. Not usually being the one to make these arrangements, I forgot to prepare him for the visitors. Once they arrived, I had to go get him from school. I knew that he would not want to go talk to strangers, so I took Ross with me. The boy was outside with staff, as he had been having a difficult day at school. When he saw us, he excitedly asked if Ross was there for him. I informed him that he had some visitors, and that Ross came to take him to the visitors. Without looking back at the staff, he immediately began walking with me. Although we were not part of the meeting, we stuck around for a while so that Ross could ease him into the interview. Ross cuddled with him, and after a few minutes began to snore loudly (he sometimes does this even while awake). I took the snoring as an opportunity to excuse myself and Ross, telling the child that Ross needed to go back to the office for his nap. He was compliant with us leaving. I later found out that he basically quit talking after Ross left the room.

The other day, the psychiatrist and I had to interview this boy for the new program that he was entering. He has a history of yelling and swearing at the psychiatrist who was part of the interview. I requested to bring Ross, and he was gladly welcomed. Staff brought the child to the office, and he was very resistant to being there. I informed him that Ross came to visit him while we ask him some questions, and he compliantly followed Ross into the office. They resumed their usual position: child sitting, dog's head in his lap. The boy was very quiet, and avoided answering questions as much as possible. He spent the entire time looking at Ross as he gently stroked his soft black fur, sometimes mumbling answers so quietly I could not hear them. Ignoring the psychiatrist's questions, he whispered and signaled to me, "Are his eyes closed?" After a very short interview, instead of leaving the room, he moved out from under Ross and kneeled in front of him, trying to tickle his feet. I had him show the psychiatrist Ross' tattoo and tell him about his dew claws (or "thumbs"). The boy perked up immediately. He started to make eye contact, and his voice was suddenly audible. He told the psychiatrist all about Ross.

First thing the next morning, before either Ross or I were even really awake, he asked when he could see Ross :)

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