Maudsley Hospital again

Today is Monday so we are back to the Maudsley this afternoon.

I am very optimistic that Waif has put on some weight. Not much, mark you, but some. She looks less ill to me, and less startlingly skeletal. I hope it is not just that I am getting used to her thinness.

This is no magic cure: Waif is still ambivalent about weight gain - she still won't eat a morsel more than is on her menu list and always opts for the smallest/ least calorific option put before her even if I know she prefers the alternative. But as long as she is making progress I will be happy that she is reducing the chances of permanent damage to her body.

At some point we will have to tell her psychiatrist about Waif's worries being alone at home, andsleeping in her own bed at night. At 13 years old I fell that she should feel more secure in her own house.

Waif is not going in to school today. Older Daughter is not well and Waif thinks it will be "easier" for her not to go in. I am easy with that - the more Waif stays home, the more food I can supervise being eaten and in the end there is no point in her doing well in all her exams only, God forbid, to die of a heart attack at 23 or to find that she is unable to have a family if and when she wants one.

My husband has taken the day off work in order to come with us to the hospital, and Older Daughter might well come too so we would have a full house again. I am sure that the sessions are more helpful if we are all there together.

Back to The Maudsley

The Waif is back to the Maudsley today after school.

The psych explained to me last visit that he is hoping to build up a rapport with Waif in the hopes of having her confide in him. He is certain that there must be some trauma or emotional disturbance that is causing Waif to be anorexic.

Waif is well aware of this goal and is immensely frustrated by it:

"I haven't got any secret worries, Mother. So how can I tell him any? Should I make something up to get him off my back?"

Sigh.

Anyway, I mentioned to the psych that Waif had drawn quite a disturbing self portrait: you can tell it is her, for she is an excellent artist, but it is full of frowns, dark shadows and crooked teeth. He wanted me to bring it along.

Now I can hardly bring it on its own (Waif would never forgive me) so I suggested to Waif that we take along her portfolio to show psych so that he can see her main interest. She said no. Hmmmmm.......... Much of her work is beautiful, colourful and fun. It is always intricate and perfect, and betrays hours of careful labour. I am not even supposed to look at most of it myself but now and again Waif will let me peep.

Perhaps I will put some pics in the car and see if I can change Waif's mind on the drive to the hospital.

Oh, she is loving her new school :-) She says it is a lot more relaxed than her old (girls only) school and that the presence of boys makes it more fun. Hmmm....chaotic, more like. The class had a plan that halfway through English one boy would shout "dead mouse" at which signal, the others would all bang down their desk lids (God help their teacher). They did it! At Waif's last school, the whole class would have been in detention. At he new school, the teacher affected not to notice. She will simply have nightmares about it, I guess..... Waif is thrilled at this concept of freedom and power. I am guessing that is no bad thing.

Oh, please cross your fingers for her to have put on some weight. I will be surprised if she has but here's hoping.

Progress

The GP yesterday agreed that the time had come for specialist support. He proposes to refer Waif to the Maudsley. He says that there is some administration involved: the surgery is in Lewisham whereas we live in Greenwich. He must refer Waif to Greenwich, knowing that they will on refer to the tertiary centre that is the Maudsley. I understand that the Greenwich psychiatrists routinely on refer to the Maudsley. He cannot however directly refer to the Maudsley even though he knows this is the right place for her, and is fully confident that Greenwich will send her there. Consequently, there may be some delay.

The GP said that I might want to explore the private health insurance route as it might be quicker. I phoned BUPA. I discover that they will happily pay large amounts for inpatient treatment at The Priory, but will pay only up to £1,000 for outpatient treatment at The Maudsley. The logic that The Maudsley approach would be cheaper for them does not seem to cut ice. I guess that's fair enough. I have been advised by my child psychiatist friend to stick with the NHS as she says the Priory admit far too readily as (she speculates, please don't sue me) that is how they make their money, and she advises that the Maudsley is the right place for Waif.

Waif also had her blood taken for testing yesterday. She is needle phobic but, bless her, still submitted to the phlebotomist with only a small amount of damage to her sister's hand whilst it was drawn - ridiculously, I could not go in with her as blood is no longer taken at our doctor's surgery nor at Lewisham Hospital but is instead taken at a few centres throughout the borough (to save money centrally at cost to all the patients instead in terms of transport, time and parking fines). Only 3 or 4 of those centres can cope with children. Only one of those has a walk-in service (otherwise the wait is over 2 weeks, seemingly, to get blood taken). That particular centre is in the residential centre of Catford with only 4 pay-and-display places for cars, all taken as the clinic has well over thirty patients queuing, so I had to sit in the car in a residential bay. I would not want to be the parent of a child needing frequent blood tests in Lewisham. I was lucky that Waif's older sister is so sensible, so nearly grown up and so present.

Neither the GP nor I are expecting the bloods to turn up anything but I can see that it must be done to rule out some physical explanation for the Waif's loss of appetite.

Perhaps due to the prompt of the doctor telling her she was too thin and might have to see a specialist, perhaps due in part to the long talk we had the night before about the dangers of under-eating, Waif ate so well yesterday :-) including shepherd's pie and cauliflower cheese for lunch, and a large steak and chips followed by honeycomb ice cream and toffee sauce for her supper. I slept well last night for the first time in days. So did Waif - she was not in my bed for the first time in weeks....she slept in the spare bed in her older sister's room........eschewing either of her own bedrooms.

Meanwhile, the school nurse phoned me yesterday wanting to know how Waif was doing - she had phoned me last term, concerned about Waif's loss of weight which had been pointed out to her by the sports teachers, and today is the first day of the new year. She wanted my permission to talk to Waif fortnightly to monitor if she was well enough to attend school. I am reluctant as Waif will hate it but felt that I was not being given more than a token choice, so I acquiesced. I shall have to forewarn Waif who will be mortified.

I am today hopeful that Waif is truly going to start eating and getting better. My cleaner is a fully qualified social and health care worker in Hungary, and she reassured me yesterday that most children with eating disorders recover rapidly.

The Maudsley Approach

I have been doing some research and an approach called the Maudsley approach seems to me to make the most sense and to have the highest success rate - 75-90% after five years if the previous course of the illness has been short. This it has been - Waif was over 42kg at the start of the year which, whilst slim, was well within te normal range for a 12 1/2 year old of her height.

The approach also manages not to treat parents like either the enemy or idiots, and instead encourages them to be part of the solution.

The Maudsley hospital is 10 mins on DLR then 1o mins on British Rail from our house so door-to-door would be feasible within 40 minutes tops, so I reckon my mission on Wednesday with the GP is now crystallising: a referral to the Specialist Adolescent Eating Disorders unit at the Maudsley. If we need to pay, we will, but hopefully the NHS or BUPA will cover us one way or the other.