Today the kids both had the day off school, but their doctors were at work. It was a perfect day to get in some of those needed appointments. We started at the dentist early this morning (no cavities, thank you), had a little break and then made our way into the city where the psychiatrist’s office is.
Both Blake and Big Brother are currently taking medications. I know that medications are a controversial issue for some, and, believe me, I never aspired to have two teenagers on psychotropic meds. However, in our situation, even with lots of therapy, it became a quality of life issue.
I feel very blessed to have found a psychiatrist who does more than a quick check-in with the boys and write a prescription. In fact, he is the person who I was first referred to seven-plus years ago when we realized Blake had OCD. He is the first person who explained to me how OCD works and about Cognitive Behavior Therapy and Exposure with Response Prevention. He sent us to a psychologist, telling me that medication was something to consider only if therapy did not adequately address the issues. I am grateful to him for his tutelage.
Today he spent his half hour with each of my boys. Blake went first today. I waited in the waiting room with Big Brother. Twenty minutes into the meeting, Dr. X stepped out and asked me to join them. He usually does this when something has come up that he has concerns over. Today was no different. When I entered the room, Blake lay on the sofa with his head half-plastered into a large decorative pillow. The trash can sat at his feet with tissues inside. I wondered whether he had been crying or just had a runny nose.
“So, as is usually the case, medication is an issue,” Dr. X began. “Blake wants to decrease his dosage, which I would not do without your permission.”
Blake rolled his face around in the pillow, clearly ready to be done here. Dr. X was fully aware of what was going on.
“Blake, I know you’ve had enough today and it’s okay if you want to check out. Just listen in enough to let me know if I get anything wrong. As I was saying, the issue of a medication decrease came up, but there’s also the issue of Blake’s hands and face…”
Blake’s hands are noticeably chapped, raw and cracked. Clearly, he’s been washing more, and the dry weather we’ve been having lately is not helping the matter. He has been washing his face raw, too – and once it started hurting, he could not get out of the cycle of rubbing and washing to try to make it feel better (of course that exacerbates the problem). Blake wants us to believe that these issues are just about the weather. He insists he doesn’t wash too much.
“Blake tells me he thinks he washes about 15 times per day,” Dr. X says.
(I realize that this is a great underestimation because I watched him wash 8 times in just the first 15 minutes when we got home from this very appointment. I know Dr. X knows that it is more than this, and saying so will only create a fight, as Blake is on the defensive.)
“Yeah, I really don’t have any idea,” Blake says. “It’s probably around that.”
“My colleague is an excellent allergist and she recommends this over-the-counter cream to help with eczema. Besides soothing, it actually has restorative properties. In the meantime, Blake needs to work on monitoring his own washing and decreasing it – resisting what OCD is asking him to do.”
“Okay,” I say, “so this is between Blake and you?” I ask. I’m not ready to jump in and be hand washing monitor when Blake so clearly wants nothing to do with any of this ‘resisting OCD’ stuff.
“This is between Blake and Blake,” Dr. X says. “And about wanting to decrease his meds….”
“I just want to get on that path,” Blake chimes in.
“I don’t think with the washing the way it is, or at this time of year, that this is the best time to decrease anything. I think it is important to get the washing under control,” Dr. X says.
“Blake, maybe this is a good time for you to really track and document how OCD is affecting you and how you are effectively managing it. You know, track ways you decrease the OCD behavior. That will give Dr. X solid information to know when it is time to decrease your medication,” I suggest. I know that Blake is nowhere near ready for a medication decrease and it is his job to be accountable about how OCD is really affecting him, as well as what he is doing to defeat it.
Dr. X writes the prescription as usual. Same dosage. No change. Blake groans and rolls around some more on the sofa.
“It’s just to hard to talk about this stuff. I don’t want to.”
“I know,” Dr. X says. “We’re done for today.”
Blake’s defenses are high. He wants to talk to no one about his OCD. He is in a zone where he would like to pretend it doesn’t exist. Yet, it does. We return to the waiting room, where he takes my smart phone and starts to play a game. Big Brother goes in for his turn, and I’m about to get called in once again.