Praying for Children at Risk

These days my work with children as a nurse practitioner in a pediatrics group practice seems to be interspersed with alternate doses full of sorrow and  laughter. My patients make me smile, occasionally laugh at their childhood innocence and escapades. They say and do things that often stay with me long after the day is done. They can surprise you at times. Giving you a hug when you least expect it, or that look of wonder when they listen to their heart through your stethoscope, or that smile from ear to ear when you give them the smallest of gifts. Tending to the little people and their older brothers and sisters, who are  straining to act like the grownups they aren't,  is replete with small glimmers of hope and a rising uneasiness about the future.

Pediatrics is like veterinary medicine. The patients in both disciplines are not in the least bit interested in telling you what's wrong with them. It's up to you to find out. The older ones are not much more communicative than the younger variety. If you get a one word answer or grunt you are doing quite well. Of course, I was once their age a long time again and although it's been a while I haven't forgotten what it was like. Then there are the parents. Struggling as best they can to raise their children. They come in worried about them when their sick, or frustrated with their behavior. Sometimes they are just going through the motions, disinterested and in a hurry to leave.

The nurse practitioner (NP) role was developed in the United States back in the 1960s to address the physician shortage in the inner cities and remote rural areas. At the time,  it was considered revolutionary, not to mention unsettling, for nurses to adopt the medical model of health care. In that model, the diagnosis is paramount and from that diagnosis one derives a plan for treatment. NPs were trained to do physical exams, order and interpret tests, to diagnose and to prescribe appropriate medications. Fortunately for their patients, NPs also brought with them the nursing model which consisted of listening to your patient as well as  his family and approaching the illness as only one aspect of a complex person. I am not saying that doctors, who are valued colleagues, don't do this, just that a great deal of their training is much too invested in disease and not the humans who suffer from it.

With a ringside seat, I get a glimpse into the lives of the children who come to our clinic. I do so because I try hard to see those kids as more than someone with a sore throat  or earache. The glimpse I get is not always the TLC (tender, loving care) that we may expect our kids should be getting. I see kids who live sad, even hopeless lives. Kids who are can't wait to leave home and who are victims of neglect, physical or sexual abuse, violent crime, substance abuse and teenage pregnancy. The children I see run the full spectrum of childhood from neonates to young adults.  None of the children I see in my practice lacks for food or basic clothing or even a roof over their head. These are easy things to obtain in our affluent societies. What many endangered kids suffer from in varying degrees is a spiritual poverty that pervades their environment. It emanates from parents who are the products of such poverty, cut adrift without a family support network, totally on their own, ill equipped to deal with the world at large let alone raise resilient children to cope with that world.

Who is responsible for this spiritual poverty? Perhaps we are all to blame. We cultivate it, we look the other way, we enable it, we are part of societies that create ever growing numbers of children who we will be hearing from in the future and who we will have to lock up in order to protect ourselves from them.  Lately, I feel like I am swimming against this inexorable tide. Feeling helpless and unable to make a difference in the lives of  the increasing number of children at risk. Perhaps my older son Nick has noticed. He recently gave me something helpful to read. It consisted of advice given to a pediatrician by Elder Fr. Porphyrios, who served for many years as a hospital chaplain:

"Listen to what I have to say to you. Every time you examine a child you should offer a fervent prayer with love:  Lord Jesus Christ have mercy on your servant.

As he said this he took a deep breath while he opened his hands. It is in this way that you should pray for every child. God has sent a precious soul into your hands. As you place your hands on them pray fervently within yourself that the grace of God will be transfused into the soul of the child. 

Do all this things spiritually and in secret. The others who are present won't understand anything. You will prescribe to them medicines which science dictates but in the final analysis Christ will heal the child."

+May all efforts on behalf of children by parents, teachers, and all the adults in their lives be blessed.+

Comments

[Margaret]

"and unable to make a difference in the lives of the increasing number of children at risk"

I can see that you cannot, perhaps, exactly know whether you make a difference. My life was immeasurably enriched by three men, father figures really, none of whom probably have any idea how important they were/are to me. On my 40th birthday, I thought of inviting them to my party and thanking them publicly. I didn't. I also wrote posts about two of them on my blog, but have not published them because I was worried about them being identified. So they still don't know. Children are very acute and will take from you what they need.

You may never know who you helped and how: all that matters is that you keep on trying, and leave the rest in the hands of God.

[Stavros]

Margaret,

Thank you for taking the time to write these words. I never quite looked at things in this way although I do believe that the way we live our lives can have far reaching benefits for others. ANY adult can make a positive difference in the life of a child. A neighbor, social worker, police officer, priest, teacher, librarian. I'm not ready to give up trying, just sad about those children whose lives will not be touched and who will never get beyond the disasters of their early lives.

One of the greatest regrets I have in my own life is not being able to tell some of the most important people in my life how important they were. Perhaps that's why I write about them.

Tell these father figures in some acceptable way before it is too late to do so. You would be giving them a very precious gift.

Thanks again.

[drmom]

Steve, I enjoying popping into your blog every so often to hear what you're thinking. Practicing here in Michigan, I often forget how challenging the families in Maine are. I was reminded with a "Maine moment", a family that was the anomaly here, but would have been the norm in Maine. An 18 month old and 9 year old brought in by the 24 year old mom (different dads for the kids of course) for evaluation of a pit-bull bite on the face of the younger. The fault, of course, was with the 18 month old because "he's naughty and takes after his namesake". Turns out, this poor toddler is named after his uncle, mom's younger brother, who at age 17 attempted suicide with a shot-gun, failed, and now lives at home in a vegetative state at age 21. Where do you start? With the current issue of the infected bite? The future issue of a dangerous dog no one wants to part with? The developmental issue of a "naughty" 18 month old? Can we even hope this child will see his 18th birthday, and if so, not be a father a few times over or in jail? It was a reminder to me of the hard cases you see on nearly every visit in Maine. All you can do is take a deep breath, be thankful for your blessings, pray for these kids and ask that they see Christ in your attitude and care. Now, if we could only get Medicaid to reimburse for intercession!!

[Stavros]

Hi Meg,

I think you have boiled down my concerns into a very representative vignette. It is so frustrating when we are unable to help families break the cycle that keeps repeating itself from generation to generation. These problems are not exclusive to the poor. I see an increasing number of dysfunctional families who are well off financially. It's not about money, ethnic identity or class. It's about people whose kids are raising themselves with few if any worthy role models to emulate.

Perhaps I sound harsh, judgmental or too focused on the failings of others instead of my own. We all make mistakes as parents. What concerns me is that I see too many parents nowadays who lack the one basic attribute essential for parenting: loving their children more than themselves.

There are, of course, many great parents, like you and Margaret, raising great kids, even in trying times. I just wish that all our kids could have the kind of childhood they all deserve. It's a daunting task and government, unfortunately, offers few solutions.

[Margaret]

I, too, wish that all our children could have the kind of childhood they deserve, but, you know what, sometimes - against all the odds, those that didn't/don't have what they needed (that love you describe) go on in the next generation to be the parents the most dedicated to giving their own children the childhood those children deserve even though they never knew it themselves. I don't know how that happens or where that sacrificial love comes from, having grown out of nothing - a small miracle - and they still have to carry their own legacy around, but I see lots of examples close to me.

Is Meg's vignette really typical of your practice?

[Stavros]

Margaret,

Saying this is "typical" in Maine or any other state would be ignoring the majority of families that are doing a good job raising well adjusted, happy kids. Unfortunately, it happens often enough to give one pause, not to mention, engendering a feeling of helplessness and frustration.

I would agree with you that many children are amazingly resilient and overcome less than optimal childhoods. Many do go on to live productive, even exemplary lives and raise their children with all the love and attention they didn't get. I am not sure what the scientific literature has to say about the subject. Based solely on anecdotal evidence I would venture to say that many are not able to heal the scars inflicted by their childhoods in chaotic, dysfunctional families. Even loving adoptive/foster parents cannot undo the damage inflicted on the psyche at a young age. Many go on to raise their own children in much the same manner that they were raised. This is the cycle I was talking about previously which is so difficult to break. The prevalence of serious psychopathology in parents also does not bode well for future outcomes among their offspring.

I am not despondent about the future, just concerned about how we can turn things around.

[Margaret]

Stavros,

I fear you are right - about the long term damage. I just find it so hard to accept (that no change is possible).

I've probably mentioned this book before, and I'm sure you have similar books in the US, but it described some of the people I meet in my work, and it does not end happily: Stuart, A Life Backwards, by Alexander Masters. It confirms you view, if you like.

Good review here:

http://www.newstatesman.com/200504250049

For all that it is depressing, I still like to imagine points along Stuart's path at which intervention could have made a difference.

[Stavros]

Margaret,

Thanks for the link. I couldn't agree more with the reviewer. It's interesting to note that he and his brother have had decidedly different outcomes in their lives and they are both the products of the same upbringing.

I share his views of the welfare system. Reading about Stuart I was reminded of a homeless man who was brought into the Emergency Department of a busy hospital where I worked as a staff nurse. He was found living under a bridge in sub zero weather. He was malnourished, dehydrated and hypothermic. I spent a good part of the shift giving him IV fluids, getting him warm and fed. After a number of phonecalls I was able to get him a bed in a local shelter, arranged transportation and thought I had talked him into spending the night there. He changed his mind abruptly, walked out into the frigid night and disappeared.

There is an interesting reality show here in the US called: "intervention." It's all about people with addictions or eating disorders and a concerted attempt by family members and professionals to help them change. It seldom ends with everyone living happily ever after. What always impresses me about the show is that even when people hit rock bottom they are not amenable to change.

That does not relieve the rest of us from doing what we can to help. There is, as you rightly point out, always hope. We have to love them even when they don't love themselves, but I think, in many cases, it needs to be a "tough" love.