Mummy's Little Helper (11 page)

I followed her around like a proverbial hawk over the next couple of days, and my eyes were truly opened to the extent of it. Not just one or two –
every
doorknob was opened with a sleeve, be it the front door or an interior door or the handle on a cupboard. The visits to the toilet – which I’d previously never really worried about that much (it was the other way round with most kids: will you
please
wash your hands!) happened not just here and there, to answer a call of nature, but at intervals that at first seemed inexplicably short, until you realised they immediately followed Abby doing
anything
that might be dirty, such as taking something from me – a tea towel, an apple or a pile of magazines. She’d do whatever I asked of her and then immediately disappear, and then return from the downstairs loo or, if more appropriate, the kitchen sink, having carefully washed and dried her hands. I also noticed that she didn’t use my fabric towels either. In the kitchen she would wash her hands, dry them on kitchen paper, then pop the kitchen towel in the kitchen bin, using the foot pedal. The same applied in the downstairs loo – I even stood outside and listened. I would hear the flush, then the sink taps, then the rattle of the toilet roll holder for a second time and, finally, a second flush, and only then would she re-emerge.

Other things were more subtle. I recalled her hair-pulling that first evening, and began taking note of any time when she started to do it, and, to my astonishment, found that she was doing it quite consciously, and that there was a definite pattern there, too. She would pull half a dozen hairs out, line them up on the chair arm beside her, then, when she’d done that, gather the strands together and roll them into a ball.

I also noticed that the switching off of lights was equally ritualistic. It wasn’t just a case of going around plunging the house into darkness. She would also switch on any light that was off, as if to check it. She’d flick it on for half a second, before switching it back off again, as if reassuring herself it really wasn’t lit. She would then pat the switch plate several times, for good measure.

In short, she was in a state and it was a state that was definitely worsening. And I wanted some guidance on how to help her. So when I got an email from Bridget, finally, on the Wednesday, I felt frustrated. The email was brief. And ironic.
Dear Casey
, it read,
apologies for being so slow to come back to you. I’ve been off with some dreadful bug – ugh! – but am now back on the case. Are you free for me to pop in for a bit of an update next Thursday?

‘Harrumph!’ I said to Mike, after I’d read it out to him. ‘She hasn’t even mentioned who she thinks should be updating who! And look –’ I pointed. ‘Next Thursday? That’s more than a week away!’

Mike squeezed my shoulder. He knew what I was like. Once I’d decided on something I was like a dog with a bone. I wanted action. Not meetings next bloody Thursday.

‘Ah, but perhaps she’s had MRSA as well,’ he quipped.

Once again, I laughed. But inside I was still harrumphing. Stuff it, I
would
call Dr Shackleton.

Dr Shackleton, our local GP, has always been a godsend. He’s been the family doctor since before Riley was born, and even though our recent house move meant we were a little bit outside his area there was no way I’d consider leaving his surgery unless physically restrained from going there.

Kids in foster care sometimes retain their own GP, and others not – it depends on the individual circumstances. This was certainly true of the children we’d had so far. Where a child was to be with us long term, it obviously made sense to get their notes transferred to him – which he was graciously accepting of – and in others, where it was short term or there was some other compelling reason, the child would continue with the practice they already had.

Dr Shackleton was also wonderful because he was such a great supporter of what Mike and I did. He’d been particularly invaluable in helping us with one of our earlier foster children, Sophia, who had a rare hormonal disorder called Addison’s disease. It had been a lifeline more than once to have him at the end of the phone.

Though I obviously couldn’t speak to him specifically about Abby’s case, I could at least get an overview of what her symptoms might mean and, most importantly, how to help her manage them. I was particularly concerned about how it was affecting her at school. She had enough to deal with without becoming even more ostracised than she already was. I called the surgery the morning after receiving Bridget’s email and was able to book a quick telephone consultation for the end of morning surgery, so I could at least talk the problems I’d seen through with him.

And he was predictably helpful.

‘I think you’re spot on,’ he agreed. ‘This sounds very much like stress-related OCD. And the good news is that very often it’s only temporary, particularly when it manifests in children. It can run in families, and it tends to afflict the already anxious – it’s often a trigger such as you’ve described that tips the person over into a place where they can no longer manage those anxieties, after which it’s particularly good at feeding off itself – it’s the enemy within, so to speak. And from what you describe that’s what seems to be happening here. Though, on a more positive note, you may well find it begins to settle down once she gets more used to her new living arrangements.’

Which were completely up in the air, truth be told. Who knew what was going to happen to her? No one, right now, it seemed. But once we did – well, that was at least encouraging. ‘That’s reassuring to hear,’ I said. ‘Because right now it seems to be going the other way. She’s been with us over a month now, and though I reasoned it might be partly because it’s only now I’ve really started noticing, the compulsions seem to be getting worse daily.’ And that was, literally, what seemed to be happening. I’d now caught her several times tapping her fingers on all the door frames – as if she couldn’t walk through one before doing so. ‘I keep reassuring her,’ I told him. ‘I don’t try to stop her doing what she needs to do – far from it. If she needs to polish the doorknobs, or tap things, or wear her special “bandages”, then I’ve let her …’

‘Ah,’ said Dr Shackleton, ‘that’s exactly what you shouldn’t do.’

Now I was confused. Wouldn’t stopping her make her even more anxious? ‘But I thought drawing attention to a behaviour was the last thing I should be doing,’ I said. ‘Isn’t that tantamount to reinforcing it?’

‘In many cases, yes, obviously. But there’s a subtle difference here. With errant toddlers and attention-seeking teenagers, of course that’s true. In cases like that, you’re absolutely right. You
are
reinforcing a behaviour, which, in the case of an undesirable, attention-seeking behaviour – such as a tantrum or a rant – is obviously the last thing you want to do. Reinforce the good, don’t reward the bad with attention, and so on. But this is different. With compulsions – which are essentially rituals employed to minimise feelings of acute fear or anxiety, as opposed to being used to get the child’s own way – the trick is to
confront
them. You’ll have heard the expression ‘feel the fear and do it anyway’, no doubt?’

‘One of my mottos, as it happens.’

‘Well, that’s what it’s all about. And it’s the opposite of what an anxious OCD sufferer does. They feel the fear and “run away” from what frightens them. And the “running away” of course – which is what they’re doing when they adopt all these little tics – just makes the fear feel bigger next time. So it might start with tapping something once, and then escalate to several times, or be augmented by additional rituals, till in the end it becomes so elaborate and frequent that it’s almost impossible to function. You see what I’m saying?’

‘Yes, I get that.’

‘Well, OCD is an extreme form of that. What happens to the OCD sufferer is that, under stress that perhaps rational fear gets blown up into something so big as to be difficult to manage. So, in this case, say Abby has this fear of getting sick. Perfectly understandable given what you describe of her childhood environment, but now she has to deal with the additional stress of having to leave her mother and go and live with strangers – losing all her reassuring routines and rituals behind in the process – so now she feels the fear and finds it unbearable. Hence the obsessions and compulsions. In simple terms, she can’t avoid her current circumstances, so she has found ways to reduce her anxiety about them, by endless hand washing, germ obliteration and so on.

‘Of course, there’s a lot more to it than that,’ he went on. ‘The other main thing that happens is that the brain finds all sorts of clever ways to alleviate anxiety – and that’s where repetitive tics come in – the light switch flicking and hair pulling you mentioned. Patients often can’t explain why they do some of these things, except to report that it makes them feel better. Again, it’s just a way of controlling their fears. If I turn round on the spot three times – to pick something at random – the horrible feelings of dread in my head go away.’

This was beginning to make sense to me now. ‘Ah, I get it. So I shouldn’t be indulging them, then. I should be trying to stop them. Intervening.’

‘Exactly. To accept tics as being “normal” is reinforcing them, obviously. It’s like saying “Go ahead – you’re right to be afraid of the thing that scares you” because that’s what it’s about. An irrational obsession. So, generally speaking, you need to be doing the opposite. Not in a traumatising way, obviously – just gently encouraging her to confront her fears and so shrink them down to a rational size. It’s a bit like managing phobias. First she needs to be exposed to the things that frighten her, so she breaks that cycle of fear and avoidance. Second, she needs to be distracted from ritual tics – gently steered away from doing them. In both cases it’s all about her re-learning the associations she’s made – having it reinforced instead that if she touches a door handle or a chair back she’s not going to die, and that if she doesn’t perform her tics then nothing bad is going to happen to either her or her loved ones – in this case, her mother. Again, I’m grossly over-simplifying, but that’s the gist of it. That help?’

‘Immeasurably,’ I said. ‘Wow, I’m certainly learning in this job, eh?’

‘Life is short, the art long, as we medics are wont to say. Another useful mantra for you, Casey!’

I felt much better having spoken to Dr Shackleton. And now I was armed with more information about the logic of the disorder – and, in its own perverse way, it
was
logical – I felt better equipped to help Abby start to manage it. Once I’d spoken to Bridget, of course (and we had a clearer sense of what might happen in the longer term), maybe some professional intervention might be appropriate, in the form of a course of cognitive behavioural therapy, to help her deal with it. Or maybe all would be well, and she and Sarah would go home and, magically, the symptoms would disappear. But I wasn’t holding my breath, and right now she needed support, so in the meantime I could practise my own small interventions – or ERP routine, as Dr Shackleton had called it: exposure and ritual prevention.

For poor Abby, though, this must have felt like another great weight on her shoulders, which were already buckling under the strain.

‘You know what?’ I said to her, the afternoon after I’d spoken to Dr Shackleton. ‘I’m starving. And Mike’s working late, so tea’s going to be
ages
away yet. So how about we go and choose a cake from the cake counter?’

We were in the supermarket, straight after school, which had already thrown her somewhat. Her ritual – as I now realised it to be – hadn’t varied since she’d come to us. She would come in, go into the downstairs loo, wash her hands, straight upstairs, change out of her uniform, then wash her hands again upstairs, then come down again, at which point I’d make her a snack. The only times that hadn’t happened were when we’d gone to the hospital, when I’d taken something for her to eat on the way there. And, of course, now I realised that on neither occasion had she eaten it. I’d naturally put it down to the emotion of seeing her mum, but now I realised it was actually more complicated than that.

She shook her head now. ‘I’m not hungry. I mean, you get one if you want to.’

‘But surely you must be,’ I urged, heading towards the bakery anyway. ‘You’ve had nothing since lunchtime.’ And she’d probably eaten very little of that, either, it occurred to me. And I doubted she’d be monitored that closely over lunch – the older juniors generally didn’t tend to be.

‘Really,’ she persisted. ‘I’m fine, Casey, honest. But you get one if you want one.’

I pulled a sad face. ‘Oh,
please
,’ I said. We’d reached the counter by now. ‘I’ll feel like
such
a greedy pig if you don’t have one as well. Just a little fairy cake or something? Or a cookie? They look nice. Or an iced bun perhaps?’

I was being horribly manipulative, and I knew it. Poor Abby would be torn now between doing as I had asked and the stress of the situation, and I knew how much of a tussle must be going on in her head. Other kids would just refuse point blank to do something they didn’t want to, but I knew for Abby, who wasn’t used to being disobedient or contrary, this would be a real poser. I just hoped her urge to do what was asked of her would win out.

I leaned towards the trolley, which I’d made her push for me, citing a blister I’d got scrubbing the garden furniture. Like a school chair, or a public door handle, it might have been previously pushed by anyone, and having to touch it was already upsetting her equilibrium. ‘Sweetheart,’ I said gently. ‘Go on. Please. For me? I worry about you, you know. I’m sure you’re not eating enough. And I’ll feel awful if we go to visit Mummy on Friday and she starts worrying that you’ve been losing weight.
Awful
.’

This spot of emotional blackmail seemed to clinch it. She mumbled an okay and shyly pointed to the pile of hot cross buns, and within ten minutes we’d gone through the checkout with our bits of shopping, and I suggested we munch our cakes once we’d returned to the car. That way, I’d calculated, there would be no chance for her to fly off and do what she desperately wanted to – wash her hands. And as I’d told her not to bring her backpack – telling her we’d be there and back in no time – she didn’t even have recourse to the little bottle of anti-bacterial gel I’d recently discovered she kept in there.

‘How nice was
that
?’ I enthused, once I’d chomped my way through an uncharacteristically-decadent-for-four p.m. éclair. Abby had finished her bun as well – as I’d suspected, she’d been ravenous – but now wore an expression of great anxiety about what to do next. I switched the engine on, to forestall any requests to pop back and use the toilets, and as I reversed out of the parking space and swung the car round to leave the car park I marvelled on what a complex and powerful thing the human psyche was. How much of her day was governed, I wondered, by trying to organise every tiny detail so she could minimise such awful stress? It must have been so debilitating. No wonder she found school so challenging. Ditto living with us and losing so much of that control. One major factor in her previous living arrangements, I realised, would have been that she could give in to these compulsions and organise her life to do so. Her mother – probably preoccupied with her own debilitating illness – had quite possibly not even noticed.

I glanced across at Abby. She was sitting with one hand in her lap now, the other once again plucking single strands of hair from her scalp. ‘You know, sweetheart,’ I said, deciding this might be a good place to broach it, ‘nothing bad is going to happen because you haven’t washed your hands.’

The effect was instant. Her hand flew away from her temple and the hairs she’d pulled out so far were brushed from her lap. ‘I don’t …’ she began. ‘I mean … um … erm … what do you mean, Casey?’

‘I mean,’ I said, joining the crawling early rush-hour traffic – there was a reason I didn’t generally do a supermarket run after school – ‘that I understand how you worry about things, sweetie. Germs and so on. Getting sick. I absolutely understand why you might be worried about that. And yes, you’re right – the world is just full of germs, isn’t it? Just like it’s full of people. But, trust me, the chances of catching a bad one – one that’ll make you poorly – are really tiny, you know.
Tiny
. Tinier even than winning the lottery. I mean, it’s obviously sensible to wash your hands before your tea – that’s just good hygiene. But sometimes you have to relax and trust that nothing bad will happen. I’ve eaten that many cakes, from that many different bakeries down the years, and look at me!’ I patted my stomach. ‘The only harm that’s come to me has been the harm to my waistline …’ Which, to my relief, at least raised a suspicion of a smile. ‘So that’s what you have to do,’ I said. ‘You have to tell yourself that
nothing bad will happen
. And keep saying it to yourself till the other bit of you
believes
it. Maybe try that for me, hmm?’

Abby didn’t look convinced, even though she did nod her acknowledgement, and once we were home she bolted straight for the loo, as I’d expected. This time I didn’t try to stop her. But neither did I let up on my subtle pressure to challenge her obsessions. On the contrary. Over the next couple of days I gently stepped it up. Not overtly – it seemed too much too soon to start actually interrogating her about things like flicking the light switches and patting the door frames – but in the sense that I tried to make it just that little more difficult for her to give in to them. I began making it harder for her to avoid touching door handles, for instance, having noticed, as with the hair, that it mattered to her that we
didn’t
notice when she did things like covering her hand with her sleeve to open them. If we were around, and she had no choice, she would always try to compensate – by immediately going off ‘to the loo’ to wash her hands. So I’d have her open a door for me, saying my hands were full or something, and then herd her off into another room on some pretext or other, so that she would have to wait for another hand-washing opportunity. I would similarly tend to hover around light switches, and forestall her in flicking them on and off. One thing, I thought wryly, would be a big dip in the electricity bills. The Watson house had never been such a bastion of green living.