Tango with the Social Security Administration

I have held off on my blog about government services and special needs because it always seemed to me that it could be nothing but a long rant, or a pathetic whine.

Well, I suppose the time has come for this odious task, though I hope to make it at least marginally thoughtful or at least thought provoking.

If you have a child with special needs, and if that child is at any point in his life ill enough to go to the doctor, even the most secluded and isolationist homeschooler will eventually have a run in with government services.

Ben was born at a hospital in Kalamazoo, Michigan. And as soon as he was born I got a visit from social services. I say this appreciatively. Ben was, and is, chronically ill, and he qualified for Children's Special Health Care Services (also known as the Medicaid Waiver), a state service, which can function as either primary or secondary health insurance coverage. For us, we had parental coverage already, so  CSHCS functioned as secondary, which meant that we had no copays and no 20% payments for all those many procedures Ben had in his early years. Thank God!

Michigan, I might add, is an excellent state to live in for support for offspring with special needs, and in many ways I wish we were still there.

What was odd about Michigan was that we had to renew this medicaid waiver once a year. That is reasonable, you might say, since some children, like children with Leukemia and other diseases might outgrow their diagnoses and no longer need to be on the plan. Fair enough, but what it amounted to was that once a year, I had to traipse to a doctor who would document that yes, indeed, Ben still does have Down Syndrome, and then I had to set up a meeting with the person who ran CSHCS, a great lady, Marlene, and she would renew Ben's services very efficiently.

Not so, in 2003 when we moved to Colorado. In Michigan being on CSHCS is a birth right if you are born chronically ill. In Colorado, you were put on a waiting list, and as enough kids died off --yes, I know it is brutal to say so, but such is the case--your child would move up the waiting list for your county and finally get on the medicaid waiver. We spent 3 years in Colorado before Ben was far enough up on the list to be back on the Medicaid waiver (each Medicaid program is run by the state). And once he was, we started all the surgeries that could wait that we had held off on till that time. And it was a lot. He had had surgeries in the meantime, but only the absolutely necessary ones.

Renewal of the medicaid waiver in Colorado is also an annual thing, but unlike Michigan, it is complicated, a long review process requiring multiple bureaucrats to sign off on him, and inevitably every year at some point we are denied, have to appeal, and then finally the insurance is in place for another year. You may think this reasonable, since you do not  want to render government services to the underserving, so a process of checks and evaluations seem OK,  however,  for a parent with an obviously chronically ill  child, this annual hurdle is a pain, which perhaps could be lessened by being done every 3rd year for the most obviously deserving cases. --- I am convinced that we have layers of bureaucrats administrating Mecidaid whose jobs are only to make it more difficult to obtain services.... and the existence of which basically mean that fewer deserving families in Colorado get the services they need. -- So the question is: Are we so eager to make sure that no undeserving families obtain services that we are less concerned that perhaps deserving families (like Ben for 3 years) sometimes go without?

In fact, this post was inspired by my recent tango with the Social Security Administrations, and this is just one of  numerous cute anecdotes I could tell about my run ins with county, state, and federal social services on account of my youngest son having Down's.

Ben's Medicaid is renewed every June 1st, and every April and May I have another incompetent government agency story to tell. This year, I did the renewal interview in April. The normal process is that a lady from a private contracted company comes to my house, interviews me, looks Ben over to make sure he is still alive, and then stays for 2 hours asking all sorts of invasive questions, establishing whether he still has needs that require renewal. (If you add up her drive time, and the time she spends entering all the info, Colorado spends about 6 qualified man hours per year for a kid like Ben, so probably $120 or more per year for her part of the renewal process).

In addition, every 3 years, I go through the absurd inconvenience of proving that Ben does not get any SSI (Supplemental Security Income... basically social security for the disabled whose parents are below the poverty level). Well, you would think I could just produce my 1040 to show them I am not in poverty, or that different government agencies could talk to each other and send over the information, but NO... it is mY JOB to APPLY for SSI for Ben (knowing I will be denied) and then to bring that letter of denial to Medicaid, and without that denial, Ben cannot get his Medicaid Waiver renewed.

(Let me note here that there are so many forms of Medicaid that if you have heard anything bout Medicaid, you may already be confused, but know, just for now that Ben's medicaid is the Medicaid Waiver, which is health insurance for the chronically ill who are under 18, whose parents live above the poverty level).

So this year in May I get a letter from the state asking for the usual SSI denial letter, saying that Ben does not receive SSI. And I call the Social Security Administration, ask for the letter 3 weeks in advance of when I need it. The lady who answered the phone after a 50 minute wait (with a barking dog and a screaming toddler in the background) assures me the letter will be on its way well ahead of the May 28th deadline, so all is HAPPY.

Excepting, the letter did not arrive, and today was  May 27th. So Mamma Bear calls the Social Security Administration back. 1st call after waiting 1 hour: We can fax it to you, what is your fax number. I don't have a fax, but I will call my work, find out theirs and call you back... The person could not wait, so I had to go to the back of the line. Figured out the fax number, and then called back, sat in line for another 50 minutes. -- My new person cannot take a fax number to a fax that I am not sitting next to. I would have to go to the bottom of the line again (another 1 hour wait) AFTER I drive to a location with a fax machine and a phone from which I can call the Social Security Administration again, verify the first fax by faxing back my ID to show it is me there, and then I could get the fax I need to renew Ben's medicaid before June 1st. --- Not gonna happen that day because of Social Security Administration's hours, my needing to get Ben off the school bus, so I could potentially try again tomorrow to drive to where a fax is, call, wait, fax, wait, and finally get the letter and THEN drive to the county office with the letter a day late, and hope that Ben's Medicaid would still get renewed by June 1st.

I don't mean to make this a rant, and I don't want to continue the details of my driving to Boulder in quest of a letter that simply said that Ben does not receive SSI services... SITTING in line at a live place until it was my turn, etc, to procure my letter stating what everyone already knew... Ben gets no SSI... But let me say this...  EVERY YEAR, there is some major obstacle in the way of a perfectly reasonable and deserved renewal for a kid who will neither grow out of his Down Syndrome, nor shed his permanent physical illnesses and disabilities. WHY?

And please do not give me the answer that government is just messed up and only private companies can do this. Other countries can do this, and do it well and efficiently. Half of the process of renewing Ben's Medicaid is run by private companies. The process is messed up seriously for this reason--- In the United States we do not want to ever risk giving something to someone who does not deserve (or earn) it, and so we unnecessarily complicate the process to make absolutely sure that the undeserving is not rewarded. In the process we punish those who need the services... but they are usually so busy taking care of their special needs wards that they do not have the energy to protest and try to improve the system. When they finally get what they need, they breathe a sigh of relief. If they are lucky, they have a 6 month reprieve before the whole renewal system starts over again... that is, a reprieve in which they get monthly insurance claims denied,  hospital mis-billings, doctor's offices sending bills to collection, to say nothing of obnoxious  law clerks from collection firms who intimidate and threaten their credit ratings if they do not just cough up the money themselves immediately,

I used to pile all Ben's bills up till the end of the month and just pick a Tuesday morning when we were not interred in a hospital, and just sit and systematically go through bills from doctor's offices, hospitals, anesthesiologists, surgeons, labs, etc, all these individual billings that were all done wrong and either denied by our job-related insurance or denied by Medicaid for lack of documentation or authorization, etc.

There is nothing more intimidating than a cocky law clerk who has been trained by a collections agency to be as abrasive and threatening and unkind as anyone possibly can be. Collections agencies mercilessly bombard your cell phone, your home phone, and when you finally answer, they make you hold for one of their agents, who immediately is as unfriendly and menacing as he can possibly be, in hopes of intimidating you into paying what is not your responsibility to pay, but you're afraid not to.

Ben's has been sent to collection several times (in spite of the fact that the secondary medicaid insurance should make it impossible)  and it takes a back bone to stand up to the extortion that occurs when collections calls you up with a year old claim from a laboratory that misbilled the claim to start with.

All that to say, WHEN you have a very ill child in the hospital for months on end, Medicaid is supposed to ease that burden by picking up copays and co-insurance, but often all that happens is that it stalls payment till the claims are too old (it will not pay a claim over 12 months from the service date)... and then you are stuck not only caring for your ill child, but on your days home, negotiating medical bills that threaten to ruin your credit.

Do I think the system does not work?? Yes, indeed. Almost all chronically ill or elderly in the United States are covered by Medicaid or Medicare eventually... since health insurance is absurdly tied to your job, once you are long-term sick, when you need it most, you usually lose your coverage. It is, at its root, an absurd system .

At last check, I believe that 45% or more of all medical claims in the United States end up being paid by the United States government. -- The other half is paid by private insurance, which also, in my humble experience is designed not to pay if it can help it, and so the lot of the parent or other caregiver of the individual who is chronically ill is largely to navigate a sea of paperwork to get the two parties who ostensibly should be paying the bills of the ill person to actually do that which they contractually are obligated to do.

Yes, if you are independently wealthy, of course this is not a problem. But most of us are not. And when we have the misfortune of having a chronically ill family member.... a long term situation that will not go away until the person passes away, for many, many people in the United States, the system does not work, or rather it works poorly, it is stressful, and at times it totally fails us at the absolute worst moment --- when we need it the most.

OK, I don't know if this was a rant or a whine, but honestly, this is something I have dealt with for years. Getting Medicaid renewed is an absolute pain in the posterior... getting either insurance to pay is like pulling teeth. Folks, it need not be so. Why can't the United States ever look at what other civilized countries do and perhaps learn a thing or two and give a break to the disabled that inhabit her shores? I understand not wanting to support those who should and can support themselves, but for crying out loud, the elderly, the severely disabled, the dying.... surely we can recognize that they are not free-loafers.

Labels

Ben had kind of a rough week. He was pretty much sick with sinus infection, double ear infection, bronchitis, and severe allergy problems for the past 10 days. Things are getting better though, and this morning he requested waffles with raspberries and turkey sausage (still in the frying pan as of that picture).

(And in case you wondered: Yes, he always dresses like that, even when he is home sick, unless he is so sick he cannot get out of bed.)

Ben is the type of person who likes to be neatly dressed, he keeps his room neat, he likes to put one raspberry in each square indent of his waffle, he organizes his lunch the night before school, and he lays his clothes out the night before school too.

He is a neat-nick, you may say, but then again, you may not because this blog post is about labels. Now, I am apt to offend just about everyone equally with this post, so keep in mind, this is my view of labels, not gospel, not THE_WAY_YOU_MUST_THINK, just the way I  like to think about labels.

Many people would say that I have a Down Syndrome child. I prefer not to say that. I have a child who happens to have Down Syndrome. 

Person first -- is my mantra in this case.  

That 'person first' comment usually gets me the response  that that is 'So PC'... i.e. so politically correct. The implication is that as  soon as we label something 'politically correct', we can dismiss it. Anything politically correct is necessarily something silly, over-wrought, over-sensitive, and therefore not something we need to concern ourselves with.

I disagree. Yes, it is true that some politically correct statements and sentiments may be overly sensitive to the point of being ridiculous, but that does not automatically dismiss all politically correct notions. --- For example, if it is politically correct to be kind and considerate of others, then I would proudly call myself politically correct. --- Do I still have a sense of humor? Yes, I hope so.

In the case of Down Syndrome, I know that most people see my son first and foremost, and perhaps exclusively (in some cases) as a 'Down Syndrome child'. ... and THAT is precisely the problem. If all we see is Down Syndrome, we see nothing at all. The label has obscured the person, and none of the uniqueness of Ben shines through.

It is easy to slap labels on us all. Women are moody and touchy-feely, teenagers are grumpy, the terrible twos, short-man syndnrome, and the one I always hear at work girls-are-bad-at-math.  (I dislike ALL of those labels intensely. I have known many men who are just as or MORE moody than women, my teens were not grumpy, I love two year olds and do not find the age terrible, why would we demean men who happen to be short, and worst of all... I WAS A GIRL AND I WAS NEVER BAD AT MATH!!!!!) UGH!!

One woman with a large family that I once met, introduced her tiny four year old daughter to me as, "She is my runt." Sorry, lady, but that one stuck in my mind forever. How would you like to be known as the runt of a litter of six kids.

The problem with labels are

1. they are self-fulfilling and create the problem they seek to identify. Tell your teenagers that they are always grumpy and they are likely to be so.

2. they obscure the person. (I forever remember nothing about that tiny 4 year old than the fact that her mother called her a runt.)

Aftter Ben was born, people were telling me that at least I had 3 healthy normal kids before I had Ben, as if  I had 'one to spare' by having 4, so it's OK Ben has Down's. After all, he is not my only kid, and I have two healthy strong sons before him, so it's good he is a boy, since I had boys to spare. What I particularly don't like about that attitude is that it is all about me and what *I get*, never mind the individual kids and their lives.  

(Kinda the same way that people thought it OK when my first son entered the Navy, since I had one healthy normal son left who was a still civilian,. When both my older healthy sons ended up at the Naval Academy, people thought I had made too much of a sacrifice. After all, I could not possibly spare both to the US Navy.  Again, a very 'me'-centered attitude that assumes that I can spread my kids out sort of evenly as I please. Sacrifice one for the military, one for the church, one to make the money, one to stay close to me at home in Colorado, etc. It is absurd, and it assumes kids are mine to do with as I choose, not persons in their own right who make their own decisions about their futures, one at a time, independently.) 

When we label kids we set expectations for them, and some of those expectations can scar them for life. No, we don't necessarily do so every time we slap a label on someone, but we might.  As parents, we curse and bless with our mouths, and we might to well to think about what we say: This is my messy one, this one is stingy, this one is shy, this one is a picky eater, this one is my runt, she is my funny looking one, that's my fat one, this one is the brain of the family, and that one is our musical child.

I wonder if our need to label is caused by our own desire for order in sorting out this chaotic universe. If I decide that Joanne is just messy, then I understand her and accept that. Or do I? Do I more so resent the fact and bringing it up and slapping the label on allows me to vent it on occasion. At any rate, I have her figured out. Next. 

Labels also have the aspect that if they stick, they can become a trap that a kid may not be able to move beyond. Being stubborn, fat, messy, a picky eater, a runt, the asthmatic one, ... if that stays with a kid, he may just accept that, and never try to move beyond it. --- And truly, some things kids don't outgrow. For example, being short, as I have always been, can be an issue if it is constantly pointed out. I cannot really outlive being short, but the question is, even so, is that the one and only thing I want people to remember about me. 

Heck, even if  my label is something ostensibly 'good' like being the brain of the family, it can be hurtful. Not only is the brain label an impossible legacy to live up to, but it also diminishes all the other kids in the famkily, almost as if they now have to accept that the position 'brain' has been taken, so they need no longer vie for intellectual achievements.

At any rate, for Down's labels could be of the nature of 

"They are always so happy"

"They have the stubborn gene associated with that third chromosome"

And then one that was too often applied in this family, "He doesn't eat, he just collects food on his plate." Or, "He is so generous."

Let me take those in order:

1. Happy

No, Ben is not always so happy. Most adolscents with Down's struggle with depression because of social isolation, and Ben is no exception. He THINKS he needs to be happy and when he is sad, he tends to answer that he is happy because he conceptually struggles to deal with negative emotions, almost as if he thinks if he just stays happy all will be well, but the moment he admits that he is not happy, his world will crumble. No, he is not always happy and contented. -- In public, yes, he is outgoing, friendly and appears happy because he is (if I may say so myself) well raised, polite, and he does not vent his emotions in public. (for better or for worse.)

2. Stubborn

This one really gets my ire. Kids with Down's are no more stubborn than anyone else in the world. What they are... most of the time... is compliant, easy going, and you can (if you are the type) manipulate them into agreeing to many things, including giving you their last dollar or their last piece of candy,  or their new iPod. Now, once in a while you cross a boundary with a person with Down's and then he or she will dig his or her heels in and say no. Is that stubborn? Well, it appears so to us, perhaps, because the person will not budge an inch. The person with Down Syndrome, however, does not have the verbal skills to articulate precisely why he or she will not do or say whatever it is you desire him or her to do or say, and so the person (you or I) who did not get what (you or I) wanted, labels the person with Down's stubborn. I am  sorry but not only is that a selfish cop out, it is also a refusal to respect another person's no. If a person tells you no, odds are that the person has a reason, and slapping a label on the person is a means of disrespecting his or her refusal of your (or my) request. Shame on us!!  I suppose any person who does not do what I want him or her to do is 'stubborn'???  :P

3. Collector of food

The label in our family was 'food collector' for Ben. I fought that label for years. Yes, he piles a lot on his plate, yes, he does not eat it all. But collector is not the point. Not only is it hurtful to make this comment, half in jest, half in resentment and irritation, it is inaccurate. Ben likes to pile food, which is not the same as liking to collect it. He likes to pour and scoop, and he does not have a good sense of how much to take. Not that he is greedy and wants to leave none for others. He would give it all away a second later, if asked for it. He simply does not have the ability to combine the thoughts of 'how much can I really eat' with the thought of 'is there going to be anything left for anyone else' with the thought of 'am I being modest and selfless here'. His taking and taking is a quality of living in the moment and loving what he is doing... and it has nothing to do with collection, selfishness, or greed.

4. Generous

Yes, I do believe that most of the time Ben acts very generously, ready to give the shirt off his back if someone asks for it. This is a quality and a vice at the same time. Ben has little sense of planning for the future (excepting in the rote behaviors I explained above where he makes his school lunch the night before and lays out his clothes the night before). But he does not have the ability to think, I have $30, I need $10 for bowling and a snack on Friday, I need $10 for a present for Kirsten's birthday, and that leaves me with $10. I think I will save it for whatever might come up next. Such elaborate planning is beyond a person with an IQ of 45.  If you are near him and you need $10 and you ask him for his $10, he will give it to you, plain and simple. He has never been in need of $10 and so it does not occur to him not to give it to you if you need it. Is that a virtue? I suppose it is a virtue of a mind that is not too complex, but it is also a vice. I cannot let him take his iPad in public because my guess is it would disappear somewhere, as did the old cell phone he was given that he took to school for a season.

So, to conclude on labels. As you might have suspected, I don't like them. That is not to say that I don't use them too on occasion, but persistent, emotionally laden labels that obscure the personhood, I find dangerous. Hence, my son is not a Down Syndrome person, but a person... who happens to have Down's, the same way I am a person, who happens to be female, and who happens to have a bunch of other labels that could be pasted on (mom, author, perfectionist [some say], professor, short, blonde, knitter, cat-lover). Any one label surely cannot sum up a person. Not even a collection of labels can. So let's treat them like sugar or medicine, and use them sparingly. 

And if you disagree, that is fine. And if you think in horror that you once said to someone in my hearing that I had a Down Syndrome son, please do not sweat it. I have heard it a million times, and I don't knee jerk and break out in hives. It is not that big of a deal. It is not how I prefer to introduce him or speak of him, but Down Syndrome is a part of his life, not the defining part, but definitely an influential part.

I Could not Do What You are Doing . --- Are you kidding?? Neither can I!!!

A certain number of people have told me that off and on, and it is a kindness and a kind compliment, and I certainly take it as such... but let me say this. Take me back before September 1996 before Ben was born. Give me a run down of those next 18 years with Ben (and God only knows what lies ahead of us yet here in 2014), tell me this will be my future life... and I would have run away faster than Jonah ran from God. And likely some sea creature would have swallowed me up and spit me out on some foreign shores to face my problems :)

There is NO way, absolutely NO WAY apart from having Ben and his health and mental issues thrust upon me ignorantly, that you would have ever gotten me to say that "Oh, sure, I can handle this. Not a problem."

Ben was born after (get this!!) 50+ hours of labor. I went into labor on September 6th at 2 pm, a Friday afternoon. I remember that first pang distinctly. Kids with Down's tend to be slightly early, and he was 36 weeks and a little more. Ben was born at 1 am on September 9th. It was not grueling labor, it was all very uneven, did not go anywhere and because of his heart condition, he was a c-section Baby.

His apgars were 4 and then 6 at 5 minutes. He immediately was put on oxygen, whisked into the NICU and stayed there for (I am losing count of these details) I think 23 days. He was of course not eating because with his cleft lip and palate he could form no suction by which to take in nourishment, so he had a naso-gastric tube inserted through his nose into his stomach, and it stayed there till he was 8 months old when we had a permanent G tube placed surgically (that is another story). I need to back up on that. The naso- gastric tube was taped to the side of his face. He often pulled it out and I learned to be a pro at inserting it  into his stomach and listening with a stethoscope at his stomach for the woosh when I pushed air in :) Also the latex tube hardens with the stomach acid, so it needs to be replaced regularly. Ben was syringe fed around the clock every 2-3 hours for the first 3 months of his life. (Yes, I slept in 1 hour shifts, then up to pump breast milk, fortify it with formula, pump it into Ben, then sleep... etc.)  How did I do it? I HAVE NO IDEA.

I had 3 older kids ages 18 months, 3 years, and 6 years old. That time until 3 months when Ben had his first open heart surgery is rather foggy. And somehow I still got up in the morning, dealt with the other kids, drove to appointments.

The week Ben got home from the hospital my daughter Kirsten who was 3 decided to have a major allergic reaction to something, and no matter what we did to treat her it would not go away. She was speckled in little red dots from head to toe, the worst rash I have ever seen, and we spent weeks trying to clear her up, so in addition to Ben going to Cardiology, new born visits, gastroenterology, sick fever visits, nutrition visits, endocrinology visits, ear nose throat, plastic surgeon (for cleft stuff) as well as orthodontics for his cleft palate... I had to cart a 3 year old who looked like she had a bad case of measles to dermatology.  Kirsten eventually cleared up by being put in all cotton, special diet, no contact with any surface that was not 100% natural cotton etc, and life settled down with her, which was good because Ben continued to be an interesting challenge. He had a heart monitor at night (my request so I could sleep soundly unless it beeped or UNTIL the alarm woke me up for the next feeding) He developed some interesting food intolerances resulting in intestinal bleedings and ended up tolerating only baby formulas that were broken down to their constituent amino acid forms. Did you know that amino acids really really stink?? I mean baby formula does not smell that great but amino acids are awful. Who cares, it all goes in the tube and down in his stomach, he never has to taste it, so no harm done.  The tube from his nose down was another interesting challenge because it left his sphincter muscle  always open from the stomach to the esophagus (we paid for that issue 2 years later with a fundoplication procedure) and he quickly developed acid reflux and refluxed himself into a couple of lying down aspiration pneumonias as well as a bright red lower esophagus . We paid dearly for that ng tube later, and always wondered why nobody talked to us about placing a permanent G tube in his stomach much earlier to lessen his reflux issues. But never mind, it was so busy, probably everyone thought someone else had talked to me about this issue.

Ben's morning meds were such a dose that quite frankly he was full just with the mini syringes of digoxin, lasix, aldactone, propulsid, ... I forget the others, but at one point I remember counting 15 little syringes I had to pull up for him in the morning. And quite often they came back the way they were sent down as Ben must have been so nauseated by the meds he could not keep it down. And after meds filling him up somewhat, he was not able to keep down any formula I syringed into him via the ng tube either. Those were precarious days, always on the brink of hospital admission, and quite often in the hospital.

I honestly don't know how we got him to 3 months and open heart surgery. I think back and I remember meds, I remember being busy, I don't remember the other kids much, though they were there, but I don't remember being stressed either. It was more of a , OK if this is what we have to do. This is what we will do. And I was hyper conscious that a calm me meant  calm kids and calm baby. So lots of laughs. NO expectations of any day, other than the prayer for survival for all.

From the time Ben was discharged from NICU till he went for his first open heart surgery, we went to cardiology at least weekly, many days daily. Ben was born with a heart with no walls, and the valves (tricuspid and mitral valves) were fused together into one dysfunctional valve. So he basically had one big heart chamber which simultaneously squeezed blood in all directions to his body at the same time, rather than our ordered normal hearts which differentiate oxygenated blood from blood returning to the heart that needs to go to the lungs to become oxygenated. HIs heart was highly inefficient. I think it is a small miracle that any person can live with a heart like that.

As a result, he was rather bluish and his oxygen saturations were poor all the time. The surgeons always waited till 3 months if they could, to operate on these hearts because the outcomes would be better if the heart was bigger. And so, also with Ben, in spite of his fluid gain in all his limbs (He looked fat but it was all water) and his poor functioning, no energy to swallow, hardly any energy to cry, he got to wait for 3 months for this all important surgery.

During that time he was mostly tired from this poorly functioning heart which took all his energies away, and he mostly slept, and if he were awake and had the energy he mostly cried because of his red esophagus that really hurt him rather badly. Any time we needed an echocardiogram to make sure his heart was not getting worse (and that was about once a week) he had to be sedated because he would scream so badly with the cold gel and the transponder  moving around on his chest that they could not see anything on the echo, otherwise. My older kids were as home in the cardiology waiting room as they were at home in our living room, it seemed. And the kind people in the office always played movies for the older kids so the procedures were not too odious for them to get through.

Open heart surgery, what can I say. It was Ben's first surgery, because he was too frail to have any of the other things he needed done, until the heart was stable. We had already had our  daughter Kirsten in a minor operation before, ditto for our son Nikolas, and I had had 4 c-sections, so we were veterans... or so we thought.

But no. Open heart surgery is above and beyond. Come the day before. Do tons of blood work, talk to a million specialists. Be told all the terrible things that can go wrong. Get canceled either because your kid is too this or that, and reschedule, or get canceled and rescheduled because a kid is born with hypo-plastic left heart the night before-- a syndrome that cannot wait, while my kid could wait.

When you finally surrender your kid to open heart surgery, you wait an eternity. I think we turned Ben over at 6 am, and I think he came out around 2 pm... or at least, we were allowed to see him again at 2 pm-- in the cardio-thoracic intensive care unit, where he is on a ventilator, hooked up with what seems like a million leads, and completely unresponsive to anyone. It is a rather heart wrenching sight to see a kid in that condition, let alone your own baby, but you get used to it.  And you hang there for another 5-10 days before your kid finally goes home, but back up. Cardio-thoracic intensive care was at that point at CS Mott, one big room or two, where there was a nurse for every 2 patients, unless your kid needed more intensive care. Result--- any time any kid was in crisis, the whole unit shut down and all parents were kicked out, so I spent a lot of time not allowed to see my kid even when he was doing OK. (I am not saying this resentfully, believe me, I felt for the parents who had a kid who was struggling,but the arrangement was difficult to live with.)

The first big step is getting your kid off the ventilator and letting him breathe on his own. The first try with Ben did not work, and they had to put him back on the ventilator.  It is stressful to witness this and be so helpless. You just sit and pray. Those first 3 days after open heart surgery are tenuous, you want to fast forward, but of course you can't and time moves like frozen molasses. I want to add here that at the time I was not an experienced hospital parent as I became later. I did not realize how long it takes for a specialist to show up, or how normal it is for things ordered to show up HOURS after they were asked for. It took me all of school year 1996-1997 fall and spring to develop my hospital patience and having my hospital bag ready at all times, where you bring all sorts of things to entertain yourself while your kid is on a ventilator: computer, book (and yes, I was one of the few people with a big clunky cell phone back then. Big enough to serve, also as an instrument of self defense, if needed :). This is when I got back in to the habit of knitting, a hobby I had dropped in 1990 when Nikolas was born, and ever since Nick there had been a baby to lay claim to my lap, so no knitting had really been possible. Well, with Ben in ICU on a vent, and mamma in a rocker next to his bed, why not knit? So I took up sock knitting because they are small and portable, and I have been knitting socks ever since.

Well, we survived (both Ben and me and the whole family) open heart surgery, and I won't bore everyone with the details, but we came home  from the hospital just before Christmas 1996, and Ben screamed and screamed day in and day out, and did not settle down and all through Christmas 1996 into the new year we were at the cardiologist's or in the ER or in the hospital with this kiddo who just did not seem to come out of that surgery as well as every one had thought he ought. He had pericarditis (inflammation of the area around the heart) and then as that settled, the fevers started spiking and the diagnosis was endocarditis (and infection inside the heart) and then pneumonia from all of the above and who knows what else, and ended up with a second open heart surgery to repair a heart which was damaged because of the infection.

In short, complications, the sort only 5% coming out from that procedure tend to have. But Ben with his cleft lip and palate, kidney reflux, GI reflux, chronic ear infections, gastro intestinal intolerances, etc seemed to go with the 5% always, never with the 95% who fared well. The joke became 'what else can be wrong with this kid?" ... a morbid joke, to be sure, but you either laugh or cry, and my solution is that laughter is the preferred path.

Ben and I became best friends with a number of doctors, from cardiology to pediatrics to GI to urology to the nutritionist, and had the fun experience of having the nurses fight over who got Ben, when he was re admitted and re admitted and re admitted onto the floors both at CS Mott's and also at our local Bronson hospital in Kalamazoo.

I have fond memories of sitting up late in hospital rooms, chatting with our favorite nurses, having doctors save Ben's room for last on the round and then sitting down to chat about everything and anything and of course about Ben late into the night, sometimes past midnight, if the doc was there anyways on call all night. I remember being in the hospital for Easter, Mother's Day, Thanksgiving, Christmas, and having different people popping in with flowers, chocolate, gifts, jokes (and I am not talking family and friends here, though they did it too, I am talking doctors and nurses).

One of the best experiences of having a really sick kid like what was the camaraderie, the sense of being part of a team, where every last person was doing his or her best to help Ben survive (and survival was 4-5 times really the issue--- would he get through the surgery, or get over the infection?) I remember living off of crackers and little else one time because I forgot my wallet at home. Somehow a doctor found out and he insisted on giving me a $  50 bill and refused repayment... just so I could get something to eat until my family would show up again.  -- At one point at CS Mott's I was so run down and sick myself, Ben's one doctor took a look at me and prescribed an antibiotic. I had no time to go off campus and home to see my own doctor 100 miles away.  -- I have had people clear broom closets and set up a cot so I could sleep there. One nurse let me sleep next to be in the ICU for a couple of nights because I had nowhere to go (a no no). I have also, of course, slept many a night in  a Ronald McDonald House when they had an available room, and whenever I go through McDonald's to this day, if I have cash, I do a donation to the  Ronald McDonald house.

I met many wonderful parents in crisis while in the hospital with Ben. During my longest stint in 1998 in the spring, a dear lady and I were like best friends all that spring as her daughter was in forever as well, and we would roll our babies in strollers out into the indoor play land in the middle of the cardio floor and sit and chat for hours while our babies slept in their strollers.

Apart from making Ben well, and supporting him again and again as he sported an infection or needed yet another procedure (he had over 20 procedures his first 2 years), the hospitals (Bronson and CS Mott's) were wonderful places where I learned patience as well as  a strange solidarity with fellow parents with suffering kids. A few parents were bitter, angry and touchy (and I understand why), but most of us were positive, hopeful, supported and grateful.

Ben had a lot of brushes with 'bad luck', a couple of honest mistakes, and one situation I would term malpractice. But I would say this. Yes, the 'honest mistake' was life threatening, but..... Basically they were placing a feeding tube in his  stomach and they missed the stomach, which generally does not happen, but it happened to Ben. As a result, for about 12 hours we were feeding him formula straight into the cavity that holds the stomach and all the lower organs. Once they figured out what was happening (he was already inpatient for other reasons) he went straight into the operating room, and I was told very honestly that they did not know if he would survive. I wasn't even angry or suit-happy. All I wanted to do was to pray that Ben would survive. The surgeon who made the mistake did not do anything that anyone else wouldn't do. Nobody knew that Ben's unusual canal for placing the tube would act strangely and collapse as it did. It was not the surgeon's fault. And more to the point, in my grieved and bewildered state I recognized that he owned his mistake and did not try to paw it off on other circumstances.

To wrap up. The hospital years were strange, intense, scary at times, but they were also immensely positive in other ways. I learned so much about myself, my own lack of patience, and about what really matters when lives are on the line. I look back at those years with fondness and many wonderful memories with doctors, nurses, and fellow parents of patients. There were moments of tears and fears, but the people that surrounded me (and I was usually alone 100 miles from home) were professional but also human and supportive and caring, and funny, and real, and sometimes angry and frustrated. It was a very real time. I wouldn't trade it.

But to those who say (and they are many!) they could not do what I am doing or what I did: Seriously, neither can I. There is something very real about the urgency of a situation one cannot help. You are thrust in it. You do it. Because you must. Not because you are particularly gifted. Not because you can. But because it IS.