Why? (Part 1)
Ryan saw his psychiatrist five days before he made his coffee. He told him that the meds were working and that they weren't working well enough. His doctor increased the dose of one of them. The pharmacy took 6 days to fill it. We'll never know for sure if that change would have helped, but I don't think so. Ryan died because his doctor relied on the self-assessment of a depressed 17 year old, believing the part that wasn't true and missing the part that was.
I knew the meds weren't working. I was watching the slow decline as Ryan became more and more withdrawn into himself. It was gradual, not the sort of thing one sees from one day to the next. It happened slowly over months. If he'd asked me, I could have told the doctor that Ryan was worse in February than he'd been when we met in September. But he didn't ask and there was no single event or conversation that prompted me to send an uninvited email. Ryan died because our medical system and the laws of Washington state discourage and even forbid meaningful collaboration between and teen's parents and his doctors.
I met his psychiatrist when Ryan did just before school started. I gave him a five page summary of Ryan's complicated medical history, a short version of the unsolved mystery that was my son's health. I offered more. I also gave him the genetic report that said SSRI's wouldn't work for Ryan. He dismissed it. I don't remember his exact words, but something about genetic testing not being useful. It's just a model, the science isn't good. I'm sure he was describing a common belief in the practice of psychiatry. I imagine that everything he did was the usual standard of care within his field. SSRIs are the drug of choice for psychiatrists in 2022. Even when the first one didn't work, that choice persisted. The next prescription was an SSRI too. Ryan put them both in his coffee. Ryan died because our medical system is so fragmented that the doctor who treated him couldn't see a way to work with the doctors who knew those treatments wouldn't work.
In the last month, his doctor added Ritalin to the second SSRI, creating the fifth attempt at medication. The idea as Ryan explained it to me was that it would help him do the things he wanted to do. Somehow it never occurred to anyone that the real problem was that Ryan didn't want. He didn't have a Christmas list or a favorite food or a plan for his future. Ryan didn't have anything to live for because his brain couldn't hold a want. Until something, likely the SSRI medication, made him want to stop living. Ryan died because the Ritalin worked.
I might have fought for what I believed my son needed. I might have sought out a different psychiatrist, though it had taken months to get into this one and I'd tried several others without success. I might have tried a different medical field, an alternative drug. When the first SSRI didn't work and the second was prescribed, I might have written to his doctor and reminding him of the genetic testing and asked him to reconsider in light of his own supporting evidence. I might have sent him weekly or every monthly updates and inserted myself uninvited into Ryan's care. Odds are I would have been written off as a helicopter parent as I had been so many times before, but that isn't why I didn't do it.
There are two reasons I didn't fight for what I believed Ryan needed. The one I find comfort in is that Ryan didn't want me to. Ryan wanted to be a normal kid in a normal school going to a normal doctor in the normal medical system, and he didn't want his mother making waves. Ryan died because I believe every person, even a child and certainly a young adult, deserves to make their own choices. Ryan died because he had taught me years ago never to use my power over another person against their will, to respect his own profound knowledge of what is best for him. As much as I wish Ryan was still here with me, I get comfort from knowing that Ryan chose what he believed was best for him. I don't believe I get to decide that he was wrong.
The second reason is harder to live with and equally true. I didn't fight for my son in the last year of his live because I was exhausted. After years of resisting mainstream medicine's dismissals, of searching for the next answer, of managing supplements and implementing therapies and driving to appointments and enticing Ryan's participation and standing up to his father's opposition, after years of mothering and fighting and growing and loving a complicated little boy, my mothering capacity was all used up. It was simply easier to let Ryan and his father and his doctor have their way. Ryan died because everything I had to give him wasn't enough to save him.
Postscript: This is a partial and one-sided story. I offer it, not because it is factual (a lot of it, we'll never know), but because it feels true to me.
Comments
Post a Comment