I've been ruminating on a blog on this particular topic for some time. This is a very sensitive topic for me, but I'm hoping that putting this down in writing will help me to work through it.
My ex (as I've said in the past) has some very real issues with anxiety. I know that he struggles with them. Along with his anxiety comes a common issue - hypochondria. I lived with him through "cancer" scares, "heart attack" scares, and various other "scares", including mad cow disease, multiple sclerosis, SARs. He has never had cancer, a heart attack, or any other disease. Yet, I have absolutely no doubt that the symptoms he believes he is feeling are very real to him.
He has chosen to avoid any form of talk therapy all together, choosing instead a cocktail of medications to control his level of anxiety. And, truth be told, I'm reasonably certain that even if he were to pursue some type of talk therapy it would be a failure. My ex is not a good candidate for this type of behavioural therapy because he has a completely external focus. Simply put, nothing is ever his fault. Ever. In order for talk therapy (in this case, likely some sort of cognitive behavioural therapy) to be effective, one needs to be able to look inward, take responsibility for their own actions, and use their experiences to change their own thinking about the objects of their anxiety. My ex can't do that. He's never, ever wrong. And I always am. And I am forced to accept that this is the way he thinks, and find a way to deal with him the way he is.
The problem is, his hypochondria extends beyond himself. Of late, he has focussed a lot of attention on our son's asthma. Puck was diagnosed with asthma at approximately age 2 1/2. He doesn't have a very severe form and is typically able to function at almost the same level as his peers. He hasn't been hospitalized since age three, and even then, he was in and out in an afternoon. His lungs are a lot bigger now - and more mature. Now, even if he has a cold or allergy symptoms, his asthma is very easily managed if his medication is consistently provided, and increased with the onset of symptoms.
I've worked with his paediatrician and an asthma education specialist to develop an appropriate asthma action plan. The action plan requires his caregiver to observe his symptoms and increase or decrease his medication when appropriate. The asthma specialist has provided me with a wealth of documentation, a copy of the asthma plan, and has trained both myself and Puck to use his puffers correctly. I provided all of the information to my ex, but I'm confident he hasn't opened the package. I also invited him to ask any questions of myself or Puck's caregivers if he has any.
The problem is, my ex is not able to identify the symptoms on his own. And if the symptoms worsen, he panics and takes our son to the emergency room. Usually for a simple and managable cough. And despite the fact that I provide him with regular prescriptions, he doesn't take them to the pharmacist, nor does he maintain back-up puffers. And even though I've suggested to him several times that he needs to get an understanding of when and how to provide the medication, he has refused to make an appointment. He prefers to speak to an emergency room doctor when (like two weeks ago) Puck's puffer breaks on a weekend and his pharmacy has no repeats on file. And while there, the doctor identified that Puck had a worsening cough and needed his medication increased. Because my ex was completely oblivious to the symptoms. But that was my fault. Even though his symptoms had not increased while in my care. Because I apparently should have anticipated it.
Two weeks later, Puck still has the cough. And it got a little worse two days ago, because the trees are pollenating. So, in my regular e-mail, I provided a specific schedule of what medication should be provided when. With a reminder that his rescue inhaler should be used more often than I've described if he needs it.
But he can't just read and follow directions. Now, even though he's not had an asthma education or had a lengthy discussion about Puck's meds with his paediatrician, because he talked about it with an emergency room doctor who "new" Puck's paediatrician he's now an expert. This morning, he e-mailed and suggested that the emergency room doctor he saw two weeks ago said we should increase his steroid inhaler. Even though both e-mails he sent following that appointment only suggested increasing his rescue inhaler. And even though Puck is already receiving the maximum recommended paediatric dose for that inhaler.
He tells me "This doctor was knowledgeable, and new of [Puck's paediatrician] well. I want a follow-up on this topic A S A P. So I suggest you get on this please. Or I may need too take matters in my own hands, as for Pucks well being, and best interest. If this may be the case? Get back to me, as I may want too ask this doctor directly for a response, if not satisfied with yours."
(Apologies for the grammar and spelling. I didn't correct it.)
So this morning I had a choice. Do I call the doctor and say "are you sure that I'm doing the right thing?" or do I trust that I've been given the proper information and am already following the instructions I've received from his primary care physician and his asthma education specialist?
I responded to his e-mail first thing (it came overnight). That was likely a mistake. I've already received a second e-mail. I'm holding off on responding to that one. Even though it will reiterate exactly the same information as the first.
But this morning, I advised him, calmly, (again) that Puck's symptoms are perfectly normal for an asthmatic child, that I have been trained to handle them and I will not be taking him to the doctor. I advised him that Puck is already receiving the maximum recommended dose for the steroid. I reminded him that there is an asthma action plan in place, that has been approved by both Puck's primary care physician and his asthma education specialist. Any medication I've told him to supply follows that plan. I gave him a copy but if he needs another one, he can request it from the doctor. I suggested if he has any questions, he can speak to the physician. And I pleaded with him, again, to speak to the asthma education specialist and get training on identifying symptoms and when to increase or decrease the medication. And then I called Puck's doctor and advised them about the conversation, so we're all on the same page.
But this morning, I advised him, calmly, (again) that Puck's symptoms are perfectly normal for an asthmatic child, that I have been trained to handle them and I will not be taking him to the doctor. I advised him that Puck is already receiving the maximum recommended dose for the steroid. I reminded him that there is an asthma action plan in place, that has been approved by both Puck's primary care physician and his asthma education specialist. Any medication I've told him to supply follows that plan. I gave him a copy but if he needs another one, he can request it from the doctor. I suggested if he has any questions, he can speak to the physician. And I pleaded with him, again, to speak to the asthma education specialist and get training on identifying symptoms and when to increase or decrease the medication. And then I called Puck's doctor and advised them about the conversation, so we're all on the same page.
I'm sure we'll be on yellow alert until Puck's cough is gone. And it's quite possible that he'll seek emergency care again. Because he's scared. Even though I've provided the information and he has access to the specialists. Even though I always suggest to him that if he's unsure whether to increase or decrease the medication, I'm available by phone or e-mail. Because as sure as he is that he's always right, he's just as certain that the rest of the world (and especially me) are wrong.
Truthfully, sometimes I'm not even sure it's the anxiety. Sometimes I wonder if he just needs to have the interaction with me. Because he thrives on the conflict. He wants to have someone validate him. And even though he knows I won't do it, even if he knows that the children's doctor won't do it, the "stranger" in the emergency room who has no background information may agree. And even if he doesn't agree, the "magical" thinking that goes on in my ex's head can transform it into validation. Because if I'm not there to hear it, how do I know what happened. He can just make it up. As he did this time (increasing his rescue inhaler somehow transformed into increasing both).
I was aware of the hypochondria when we finalized the divorce agreement. I took steps to ensure that I was the primary caregiver and had decision making on all medical decisions. The court order says he's to call me immediately upon seeking emergency care. Immediately. Not after. Immediately. I've reminded him of all these things a few times. The parenting coordinator told him too. More than once. And all of Puck's regular caregivers understand. But I can't go to every hospital and walk-in clinic in the area to tell them. It's too much work, there's no way they could flag the file - he might still slip through. And truly, I don't want him to second guess himself because of me - in case there really is an emergency. I don't want him to waste precious time wondering if I'm going to take him to court if he does.
But I have to stop and take a breath. I have to let go of the worry. I am doing the best I can. And I have to trust that it will be enough.
Image credit: [stuffmybrainthinks.com]
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