Thursday, July 7, 2016

The Reward of Caring for Foster Children

The more I see foster children in my office, the more my eyes are opened to the ugliness in the world.  Compared to them, my childhood was steeped in privilege. I ache for them to know love and security, not to worry who will tuck them in at night, or whether they will be separated from their siblings. I fight hard to hang onto my foster kids once a relationship is established.  Having the same health care provider as they grow up can lend an element of safety and stability to their unpredictable lives.  Below is one such story, of love and loss. 

The State Foster Care director asked I take on a patient who had been designated the highest care level, known as BRS (Behavioral Rehabilitation Services).  These particular children tend to have history of heavy trauma and increased adverse childhood experience (ACE) scores.  Being cared for by complete strangers as they move from home to home brings perpetual uncertainty.  Processing life forces these children to work through pain and adversity most adults do not face in a lifetime. 

I will always see a little of this one special girl in every new foster child who walks through my door.   Maleka (Arabic for Queen) was 8 years old when I first met her.  What an odd choice for a little girl with blonde hair and blue eyes, I thought to myself.  Her life story was no different than that of other BRS foster children.  There is always a primary caregiver who could not cope and was addicted to drugs, followed by an older relative who stepped in to help.  That individual gets ill, dies, or can no longer manage and yet another child is thrust into an unfamiliar world.  Each new home is always temporary.  In this particular tale, one home contained adults who were later convicted on multiple accounts of sexual molestation.  She was a victim as was her half-sibling, who was placed somewhere else in the state. 

What a start in life for this brilliant young mind, huh?  By the time she arrived in my office, she was on 8 heavy medications and carried 6 diagnoses including ADD, Oppositional Defiance Disorder, Conduct Disorder, PTSD, Reactive Attachment Disorder, and a Learning Disability.  She had been treated with every major psychiatric medication on the market and then some.  She was on 3 times the maximum dose of anti-psychotic medication and having daily accidents at school, likely due to the sedating nature of the medications.  How could she focus on schoolwork, let alone her bodily needs?  Common for children shuffled from county to county, each new physician adds to the regimen; sometimes forgetting to wean them off of others.

On that first visit, I saw her fear as plain as day.  So many people had harmed her, how could it possibly be any other way?  I took a history, completed an exam skipping uncomfortable parts for now, and decreased the sedating medication by two-thirds.  She seemed intrigued by this physician who seemed different from the others.  Unfortunately, I needed to draw blood and make sure she still had adequate liver and kidney function which destroyed any rapport built that day. 

I was honest and direct, explaining what needed to be done.  “Nope.  Take it or leave it lady.”  It took four of us to hold her down.  Her anger was apparent as she threw punches until she had little fight left.  The tears followed as I tried to reassure her to the best of my ability.  “I will never listen to you,” she hissed.  Before Maleka, when trying to comfort these hurting souls, I mostly felt lost.  She helped me find my way.

After she recovered, I said, “Your name is beautiful.  Do you know what it means?”  She shook her head indicating no.  “Would you like to find out?” I asked.  She nodded.  “It means Queen in Arabic and I think it means you are pretty special.”   She sat straight up and grinned ever so slightly before leaving.

Over the next two years, she returned many times; I always looked forward to seeing her on my schedule.  She weaned down to one medication for ADHD.  She tested into the gifted program and lost 30lbs. once she weaned off the mood stabilizers and sedating anti-psychotics.  She and I fell into a rhythm during her appointments; she always hugged me tightly on the way out the door.  It was as if she knew our relationship was only meant to be temporary. 

Out of nowhere, a long lost relative in a faraway state suddenly popped up on the radar.  The couple wanted to adopt her and her half-sibling.  I was the one who was terrified now; I cannot imagine how this little girl felt.  She was thriving in a wonderful foster home, attending a school she loved, and had a stable health care situation likely for the first time in her life.  I hated letting her go to another unknown place. She and her half-sibling were adopted by that couple and I pray she is thriving.  It has been a decade now and I imagine she will be entering college soon. 

While there will always be cruelty in the world, this story is more about triumph in the face of overwhelming adversity.  With each new foster child I wonder if there will be another who teaches me so much.  To genuinely stand with these forgotten children between their rocks and hard places is something Maleka taught me to do.  Our time together was far too short, but thank you darling child for allowing me into your heart.  Wherever you are, I wish you happiness, health, security, and love.  You deserve everything extraordinary life has to offer. 

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