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Son's death sparks a search for justice

By Louise Kinross

In 2013 Connor Sparrowhawk (with sister Rosie) drowned in a bath alone in a National Health Services assessment and treatment unit in Oxfordshire, England. The 18-year-old had autism, epilepsy and intellectual disability (referred to as learning disability in the UK). The NHS trust that ran the unit initially attributed his death to natural causes—but his parents called for an independent investigation that found his death preventable. Twenty months later, Connor’s mother Sara Ryan, a senior researcher and autism specialist at Oxford University, is still seeking justice for her son.

BLOOM: Tell me about Connor.

Sara Ryan: He was very quirky and quite eccentric. He had an enormously brilliant sense of humour. He loved transport—buses and coaches. He had a bit of an encyclopedic knowledge of history. He was very good with facts and figures and loved the legal system and the police. But he couldn’t leave the house on his own because he had no road sense and he couldn’t count to ten.

BLOOM: When did he go to the unit called Slade House?

Sara Ryan: He went to secondary school from 11 till he turned 18 and he was a delight really. Then when he turned 18, almost overnight, he got really anxious and very unlike himself. He was difficult to engage with, had lots of dark thoughts, and was in and out of school because he was aggressive. He began bashing his head against the wall and I was worried he was going to hurt himself or someone else. The night we admitted him he wanted to go home and they had to restrain him on the floor with four people face down and section him. In all his life with us, we’d never laid a finger on him.

BLOOM: You had concerns after he went in, specifically about him having seizures there?

Sara Ryan: He was part of a happy family and the minute he went into the unit, because he was 18, they treated him as an adult. We had to phone up to get permission from him to visit, which was very odd. They didn’t engage us at all and changed his medication. I visited and could tell he’d had a seizure because he’d bit his tongue and was very disoriented. They disputed that.

BLOOM: What happened the day of his death?

Sara Ryan: I got a call that he was unconscious and on the way to the hospital in an ambulance. When I got there the consultant said straight away that he was ventilated but there was nothing they could do. They switched off the machine while I was there. Two weeks later the NHS trust published in its board minutes that a ‘service user’ had died of natural causes.

BLOOM: At the time of his death, Connor had been in the unit for 107 days but hadn’t been assessed or treated. What were they doing?

Sara Ryan: He was there for 107 days and the psychiatrist saw him three times. The psychologist filled in some questionnaires, but they didn’t come to anything. They said they were going to do social stories with him, but they never did that. He was a school boy and they should have been taking him to school. But they gave him choices, so he’d say no and stay in his room and watch DVDs.

BLOOM: How did you get an independent investigation into his death?

Sara Ryan: Before he went into the unit I’d been blogging about our family's life with Connor. It was about all the amusing things he did. Lots of people subscribed to it and became very fond of him. When I posted one line on the day he died it went viral. And when we found out the trust was saying he died of natural causes—and was going to do an internal investigation that clearly wasn’t going to find out anything—we made a lot of noise online and eventually they capitulated.

BLOOM: What did the independent investigation find?

Sara Ryan: That it was a preventable death. The staff had the knowledge. They knew he was epileptic and I’d told them he was having seizures in there and was sensitive to medication change. They hadn’t properly assessed his epilepsy and he was left unsupervised in the bath. Twenty months later we’re still waiting for an inquest and the police are still investigating.

BLOOM: I understand the unit was later closed?

Sara Ryan: Nothing happened after Connor died and we contacted the Care Quality Commission. They were about to do an inspection there. They were so shocked by what they saw that they failed the unit on all 10 quality and safety standards and the trust decided to shut the place down. There was no battery in the defibrillator. It was dirty and there was no therapeutic environment.

BLOOM: What accountability do you want from the NHS trust?

Sara Ryan: We want the staff to be disciplined, as appropriate, and a corporate manslaughter charge brought against the trust. We want meaningful involvement at the inquest, which is provisionally set for Oct. 5. We also feel that the commissioners who were commissioning the service—which cost about $1,000 a day—have some role to play. The commissioners spend money on services that you wouldn’t let your dog stay at.

The mortality rates of people with learning disabilities in the UK are shockingly high.* Because the trust said Connor’s death was ‘natural causes’ we were concerned that learning disabled people might die regularly in hospitals and units and their deaths wouldn’t be properly investigated.

Through our campaign we had a meeting with the chief executive officer of NHS England and he agreed to commission a review into deaths since 2011 of people with learning disabilities and mental health issues in the care of the trust.

We want the law changed so that families don’t have to pay for legal representation at the inquest and we believe there should be an independent investigation if someone with a learning disability dies in a hospital or other secure setting.

BLOOM: In a report you produced, you wrote about the lack of humanity in how your family has been treated.

Sara Ryan: I think how they treated Connor was extended to us after he died. They stripped away any sense of him being part of a family and treated him as an object. Once he died they didn’t demonstrate any empathy or compassion or understanding for the pain they caused us and for all kinds of delays and obstructions and deceit really. It’s made what was such a horrific and unimaginably awful situation so much worse. For example, they had the trust’s barrister sit in at a pre-inquest review and try to argue that drowning is a natural cause of death.

BLOOM: What will your legal costs be?

Sara Ryan: Families in the UK don’t get any legal help for inquests and it will cost us almost $50,000. The NHS trust draws on public funds to arm itself with very good legal representation. We were able to raise the money we need through our social media campaign and selling postcards and other fundraising efforts, which is quite remarkable.

BLOOM: In your report you say ‘The ultimate barrier appears to be that learning disabled people are seen as less than human.’

Sara Ryan: Generally, in the way our social life is organized, our kids tend to go to special schools and leisure activities aren’t accessible, so people don’t come into contact that much with people with learning disabilities. The chance of having a job is low, so there isn’t a big community presence. When I started blogging about Connor I made him human in a way that he hadn’t been seen outside of his family and school. Even my colleagues started to chat with me about him. After the weekend they’d say ‘it was hilarious that Connor did this or that.’ They began to see that he was a quirky, funny young man. Ultimately we need to bring the human back so people can appreciate these kids as individuals like anyone else, who just have their own ways of doing and saying things.

BLOOM: You’d like to see more money allocated to community supports?

Sara Ryan: Assessment and treatment units like the one Connor was in have complicated costing arrangements and the money doesn’t tend to follow the person from the unit back to the community. Often the local authority has to find the cost of the support package. You might be able to stay in a place that costs $1,000 a day (indefinitely sometimes, a National Audit Report published last week found the average stay for someone in an assessment and treatment unit is 17 years), but when you come out the local authority hasn’t got the funding because of cuts to welfare costs. In addition, no one seems to know what good care looks like.

*A 2013 inquiry into the deaths of 247 adults and children with intellectual disability in England and Wales found women with intellectual disability died 20 years earlier on average than the general population and men with developmental disability died 13 years earlier. Over a third of the deaths could have been prevented with good health care.

Please see a talk Sara Ryan gave at a patient experience conference at the University of Oxford: How to hear voices that are seldom heard



Hope that high-fat diet will tame a little girl's seizures

By Stephanie Ly

It was a sunny and glorious Muskoka morning when our daughter, Pepper, had her first seizure. It wasn’t the first time I’d seen a seizure, but it was alarming to watch my nine-month, otherwise perfectly healthy baby girl, drop and seize.

We called 911 and had her taken to the nearest hospital. Since it was her first seizure, she was otherwise healthy and her vital signs all checked out as normal, we were sent home without further treatment.

Two seizures later that same day, she was treated with a low dose of her first anti-convulsant medication. So began a series of hospital visits and medication trials for Pepper worthy of an 80-year-old in poor health.

My only knowledge of the medication Pepper was first prescribed was that it was used to treat dogs with seizure disorders. No joke. I had a friend who treated his dog with the same medication after the dog suffered a stroke and began to have seizures. So why were we treating our daughter with this medication? And why, when this drug stopped working, was she prescribed another anti-convulsant? And then, yet another? And after a year, why were we still manipulating her doses with little effect? Why? Why? Why?

Epilepsy, or rather intractable epilepsy, as Pepper is known to have, is a condition where treatment fails to control seizures. Since she was nine months old, Pepper, who is about to turn three, has experienced, at most, a month’s repose from seizure activity.

Despite pharmaceutical intervention, she continues to have seizures regularly and we don’t know why. Pepper doesn’t appear, from numerous genetic tests, to have any genetic basis for her condition. Nor does she appear to have any physical cause for her seizures. She just has them. Like that. And like that, she takes medication, which doesn’t control her seizures.

The medical community doesn’t always discuss with you all the pros and cons of the medication they prescribe, though they attempt full disclosure based on their awareness. Instead, their mandate is to treat the symptoms in the most effective and, to their knowledge, safe manner available. Sometimes, in times of crisis, you are left wondering, where are my options?

First Do No Harm is a movie about a mother trying to save her son with intractable seizures. The concept of “first do no harm”—a fundamental medical precept by Hippocrates—is important to our family because for two years Pepper was given an old seizure medicine known to cause developmental delay, without doctors telling us of this connection.

Our daughter has developmental delay, so that feels like a failure on our part.

In First Do No Harm, the child is finally treated using the ketogenic diet, which is a natural alternative to medicine that we learned about at the Hospital for Sick Children.

The ketogenic diet alters the body’s metabolism to create changes in brain chemistry that prevent seizures in some people.

Pepper was admitted to Sick Kids in late May of this year to begin her own journey on the ketogenic diet. The diet itself is a low carbohydrate, high-fat diet in which the body converts fat into energy, rather than using glucose, in a process called ketosis. Ketosis is the same process that kicks in when someone is fasting, and fasting has been a traditional seizure treatment for centuries.

There are a few variations of this diet used to treat epilepsy. Pepper is following the MCT Diet, which uses Medium Chain Triglyceride oil as one of the flash points for initiating ketosis. It is a strict diet and it takes patience, vigilance and strength. Good thing we have those—in spades.

Since Pepper started the ketogenic diet, we have had major adjustments in our household. Time management has been a huge shift. Meals must be prepared in advance and with precision (we weigh and measure to the very last point of a gram). The meals are then packed with care so as not to expose the oils to light, or to spoil the fresh foods that Pepper goes to preschool with every day.

Her meals are administered, much like medication, at certain times of the day, with even spaces in between. She’s given plenty of water to keep her kidneys clean and stone-free. Her ketone levels are monitored twice daily, her blood glucose levels are checked occasionally and she is always being watched for seizures, digestive ailments, fatigue or discomfort. Since day one of her first seizure she has not gone without someone’s eyes on her, and this diet hasn't changed that aspect of our lives.

What has changed, however, is that we've seen cognitive improvement! Since the second day of her admission to hospital, Pepper went from being mostly unresponsive and in her own little world to interactive and engaged. It was something immediate and so noticeable. It gave us hope, and it still does. As for seizure control, we are still in the process of determining the diet’s efficacy and will be for a few months.

We’ve definitely seen a reduction in seizures, and Pepper has recently gone three weeks without a seizure, which has been remarkable and promising. We have hope, something we were slowly losing over time.

A typical day on the ketogenic diet starts the night before, or sometimes many nights before. Fresh food is always prepared in advance, with very few ingredients and simple foods. Pepper does not get any processed food, with the exception of a specialized drink to raise her ketones. Otherwise, she is getting a protein, a carbohydrate, a vegetable and/or a fruit and a fat at breakfast, lunch and dinner. Each of these food categories is weighed according to her meal allowance.

Preparing meals two days in advance and having things pre-chopped helps a lot, as does buying frozen fruits and veggies (it’s easier to improvise when you have a freezer full of fruits and veggies).

Pepper’s combined meals total approximately 900 calories per day. This is within range for her age. The meal sizes however, appear so small. For example, at lunch, she might get roughly the size of a tablespoon of rice, a tablespoon of chicken, a tablespoon of peas, a pad of butter and four grapes. To think that I could almost polish off a whole roast chicken to myself is eye-opening.

It’s also not easy. Most children Pepper’s age would turn their cute pouty faces away from such food restrictions. This is where her good nature and developmental delay are an advantage. She doesn’t have the cognitive awareness to protest, or to expect anything different. She just accepts what she is given.

We on the other hand, have had to adjust to many things. Our shopping list, of course, our eating schedule and finally and most challenging of them all, our routine. Finding the time after a long day’s work to prepare everything has been a challenge. But we do it.

Just as Pepper continues to smile with each meal, and with each newly acquired skill, and another day passes where she doesn’t have a seizure, and we all finally have a restful night, we adapt.

We accept that our daughter has a seizure disorder that may or may not be treated. We live day to day with the uncertainty of Pepper’s seizures. We have good days and horrible days. It’s a constant up and down of emotion.

Our biggest coping mechanism is Pepper’s smile and her laughter. It’s amazing how when I look into her eyes, and connect with her, I forget the worries outside. She has a way of healing our fear and disappointment. I can shut out the negative energy when I focus on the positive she gives me.

Follow Pepper’s story at UnSeizeTheDay. 

A therapist finds herself in parent shoes


At five days old, Lucas Puchta had an MRI.  

He was born with a port wine stain on his face, which can sometimes be a sign of Sturge-Weber syndrome, a rare disorder where an excess of blood vessels is found on the face and the brain, causing an increased risk of seizures and other symptoms. 

Lucas’ mom Lizna was told that the MRI came back clear, “so I put it behind me,” she says. “Other than being told that he had a life-time risk of developing glaucoma due to the location of the port wine stain, he was developing normally.”
At seven months of age, a resident informally told Lizna that one of Lucas’ more recent scans looked like Sturge-Weber. At nine months, just two weeks after being formally diagnosed, Lucas had his first seizure. In the next 10 months he started bumping into things on his right, developed stroke-like episodes, absence and myoclonic seizures, and lost all skills, putting him in the first percentile for his age.
What was unique about Lizna’s experience was that she'd worked for 10 years with children with disabilities, mostly as an occupational therapist. “I had fought for my families when I worked in pediatrics, but could I fight for my own? she asked herself. I didn’t know if I could do this.” Lizna explains why it was so difficult to be on the other side of the fence.
BLOOM: You said professionals didn’t listen to you.
Husnani-Puchta: ‘Wait and see’ was always the answer we would get. That was frustrating because they talked to us as if we didn’t really understand much, or didn’t do our homework. It’s not a common condition, but I felt like I had to do all the educating. Over and over again, in hospital, we were asked: ‘So what is this condition?’ I’m in a hospital and my child is having a seizure. I’m sorry, but do your homework before you come in to see the parents. You have access to his health records. Look at them.
BLOOM: Did you feel your concerns were taken seriously?
Husnani-Puchta: No. After Lucas first went on seizure medication we noticed he was bumping into obstacles on the right side of his world. He wouldn’t notice food that was placed on the right side of his tray. I said ‘I don’t think he sees on the right’ but was dismissed. I was told it could be an effect of the meds and that it was hard to know because he was so young. Three months later, in emergency due to stroke-like episodes, we were told: ‘Yes, you’re right. He does have visual field defect’ which means he only sees half of the world.
BLOOM: What was it like to see Lucas lose the skills he had?
Husnani-Puchta: I broke down. I felt I had lost my son. His body was there but his personality was gone. My son is an engaging, social boy who loves to walk and loves to interact with his environment. He had signs, he had words, and he lost all of that. He didn’t respond to questions he knew like ‘What does a lion say?’ and there was a huge regression in his motor skills.
I would send e-mails to his neurologist and neurology clinic nurse and leave messages on voice mails crying, saying ‘You have to do something. The medication isn’t working. The meds just make him more and more sleepy.’
BLOOM: I understand Lucas had an emergency video EEG that showed that the disease had progressed from the left to the right side of his brain?
Husnani-Puchta: Yes. We were finally shown all of the EEGs and MRIs and we could see how the left side of his brain was shrinking due to the seizures. I was flabbergasted. They said he was a good candidate for surgery to remove the diseased portion that was causing the seizures and disconnect the left from the right part of the brain. He had the surgery a month after this meeting, spent 10 days in hospital and then was transferred to Holland Bloorview.
BLOOM: How did he respond?
Husnani-Puchta: Amazing! I have my son back. He’s seizure-free. Every week he is showing new skills. He smiles, he laughs, he engages and he knows how to get you to laugh. He’s walking, he has words, his brain is reorganizing and creating new pathways. 
He still has the visual field defect but he’s aware now, he’s present, he’s learning that things can be behind him. At our last family team meeting, specialists from the Canadian National Institute for the Blind sat in and they were shocked at how well he was doing with his vision. 
If you’re on the third floor everyone from the kitchen staff to nurses to cleaning staff know Lucas because he has his wave and he does his fly kisses and he says ‘uh oh’ and ‘go, go, go.’
BLOOM: Lucas had his surgery at 19 months. Do you feel he got it soon enough?
Husnani-Puchta: I think if he’d gotten an MRI with contrast dye sooner, and if we were taken seriously, and if there was more awareness among the various professionals about Sturge-Weber, maybe we’d be in a different place. Maybe he wouldn’t have developed seizures or his seizures would have been controlled better. It was almost eight months before Lucas was assigned one staff neurologist. Before that we were bounced around in the department and seen by a different neurologist each time. After my emotional plea around receiving appropriate care and the lack of improvement in Lucas' seizures, the department finally assigned us to one staff neurologist.
Other countries have programs in place to increase public awareness about Sturge-Weber: programs aimed at prevention, early detection and diagnosis, professional training and funding for centres of excellence. In the U.S. they have 10 centres of excellence where the doctors focus on research and treatment and everything to do with Sturge-Weber. I think I would have been taken seriously there.
BLOOM: Has this experience made you reflect on the families you work with?
Husnani-Puchta: I don’t know what would have happened if I didn’t advocate. If I didn’t cry. If I didn’t write e-mails. I don’t think we would have had that surgery as early as we did.
Going through that process has made me realize: What do parents do when they don’t speak English? What do they do when they just accept whatever the doctor says? What happens if they wait, like they’re told to do, and they don’t knock on that door? And it’s not just about the surgery. I knew the system. I knew to put Lucas on wait lists for speech and early intervention. I knew there were preschools for kids with special needs. But professionals didn’t tell me about them. I knew they existed because of my work.
BLOOM: When you return to work as an OT, how may you approach it differently?
Husnani-Puchta: I’ll be more empathetic, because I know what they’re going through. I am going to provide them with any tips and strategies and resources I can. And because I know they can’t remember everything, I will make sure I provide the information not only verbally but in writing as well.
BLOOM: How can we build empathy in professionals who don’t have first-hand experience parenting a child with special needs?
Husnani-Puchta: Actually listen. There has to be a course on listening. Because so often the follow-up questions we got indicated that professionals weren’t listening. I would list so many concerning things about my son and the response would be: “So how’s he doing otherwise?” It was like they didn’t hear anything I had just said. And they don’t read between the lines.
BLOOM: Did you feel that you understood your families before you had Lucas?
Husnani-Puchta: I thought I was empathetic but my level of empathy wasn’t where it is now. When a family is dealing with multiple issues in one child, as well as managing appointments, paperwork, funding, communicating with all team members and let's not forget about advocating, it’s a full-time job.
It’s so hard to do everything and get it done right and follow through with programming goals at home. I can see why families are so exhausted. When parents don’t do their homework it’s not that they don’t want to, or that they’re not complying.
I was exhausted mentally dealing with Lucas’ safety, with making sure I put on his helmet, with timing how long his seizures lasted, with deciding whether to give Ativan and/or whether to go to the emergency room, and on top of that was all the therapy stuff I could to be doing with him at home. 
But he’s not even present, I’d think, he’s not here. Why should I be following through with recommendations for his vision, speech, cognitive and motor development? I didn’t want to be his therapist. I wanted to be his mom.
BLOOM: I understand you want to create better awareness of what families go through?
Husnani-Puchta: I do have a passion to raise awareness and I am willing to talk to any parent, regardless of disability, to share with them the resources I know of. Because even when I knew my resources, I still had difficulties. 
For example, funding through Special Services at Home has been frozen since I began working as an OT. Yet most online information includes this as a possible funding avenue for children with special needs, giving false hope in my opinion. And the income cap for Assistance for Children with Severe Disabilities hasn’t changed in a decade, even given inflation in a city like Toronto. 
We were denied care for Lucas through Community Care Access Centre and not notified when he didn’t qualify for services. It was frustrating falling through the cracks of our health-care system and experiencing this firsthand.
I’ve got a Facebook group for Lucas and I try to post as much as I can. If just one family can learn from our experience navigating the Canadian health-care system, I’ll have done what I wanted to do.
BLOOM: What most helped you cope during Lucas’ illness?
Husnani-Puchta: I think finding a similar family to talk to. I found support groups a bit overwhelming, but through social media I was able to connect with another mom in Ontario whose child has Sturge-Weber and went through the same surgery as Lucas. We talked for an hour-and-a-half. I always asked to be connected to other parents at the hospital, but no one ever followed up.
BLOOM: I understand you have plans to create practical information for other families whose kids have Sturge-Weber?
Husnani-Puchta: There’s excellent information online about Sturge-Weber in the U.S., but nothing about the Canadian experience. Another parent and I would like to create resources for families in Ontario and then move across Canada. Our children are affected in so many areas. As an OT, I was fortunate to have worked in pediatrics. I knew about these resources. But most families are not in my shoes.

No man's land


Elizabeth Aquino (left) is a Los Angeles writer and a fierce advocate for her daughter Sophie (right), who she writes about on her blog: A moon, worn as if it had been a shell. In this essay, she recalls the moment when she recognized that neurologists and science had no practical answers for treating her baby’s severe seizures. At the time, she lived in New York. The essay appeared in the Dec. 2008 online issue of Exceptional Parent Magazine. Thank you Elizabeth!

No man’s land
By Elizabeth Aquino

Fourteen years ago, when my daughter Sophie was diagnosed with a severe seizure disorder of unknown origin, I didn’t own a computer. When the doctor explained what was wrong with Sophie, I listened carefully but didn’t even take notes. I’m a smart, organized person and I trusted that she would tell me everything I needed to know.

“You shouldn’t really read anything about infantile spasms,” she advised. “It’s all very depressing.”

One day after leaving the hospital, I made my way to the Barnes and Noble on Broadway and 84th Street. It was a spectacularly new and huge bookstore and had already squeezed out the more intimate and beloved independent booksellers in my neighbourhood. But the immensity of the store, coupled with the bright lights and gleaming escalators, were reassuring. Surely I would find some answers in these slick stacks of newness.

I made my way to the children’s health section and promptly fell upon a book entitled “Seizures and Epilepsy in Childhood” by Dr. John Freeman. I flipped to the index and read “infantile spasms, page 108.” I turned to page 108 and crouched down on the gray carpeting to read.

“Only 10 to 20 percent of children with infantile spasms will have normal mental function; the vast majority will have moderate to severe mental retardation. This is the only (emphasis theirs) seizure type where one can predict such a poor outlook.”

I reread the lines, this time with my finger tracing the words. My lips moved, repeating the sentences over and over. A woman excused herself and reached around me for a book about colic. On the other side of the bookshelf, toddlers raced around their strollers and nannies, city babies at play. I swallowed and continued reading, the letters black and pulsating, a perverse seduction. This was knowledge.

About six months later, Sophie has already been on six drugs. Her seizures continue unabated and her development has plateaued. She’s nine-months-old and spends most of her day moaning. A new doctor assures us it’s plain irritability. A “side effect,” he says, “that you’ll have to figure out your tolerance for.” He recommends a new drug not yet approved by the FDA but available by fax through a pharmacy in London.

“Wow,” I think, “Europeans are always so much more sophisticated. We’ll try it.”

He writes us a prescription and gives us the fax number for the pharmacy in London. I imagine a small place on a cobble-stoned street, where the pharmacist still mixes drugs. I’m in Atlanta with Sophie, visiting my parents for the Christmas holidays.

The London pharmacy sends me the drug in individual foil packets. Each packet is a single dose, but for an adult. I have to gently shake the contents onto the counter and split it in half with a knife. It doesn’t seem so accurate, so I use a credit card, wielding it like the cocaine users I watched in college. The amount I give her could fit in a quarter teaspoon, fine white granules that appear smaller than sugar or salt. I lick my finger and place it in the powder and then gingerly on my tongue. It’s incredibly bitter so I spit it out. I have never been a drug user so am fascinated that such a minuscule amount can actually stop seizures. We add the drug to Sophie’s other two, a cocktail of the non-FDA-approved. And then we wait to see if it’ll work.

On the third night, Sophie doesn’t sleep. Screaming, she flails her hands and arches her back. She’s a wreck. It goes on all night for several nights. Sometimes, she quiets unexpectedly and collapses, exhausted, in her crib. I go downstairs and walk into the dimly lit living room where my mother sits, shadowed, in an armchair. She has insomnia. I kneel down next to her, lay my head in her lap and weep. She brushes the hair back from my face and says nothing.

When the wailing begins again, I climb the stairs and go to Sophie. I pick her up and walk with her, clutched to my chest but unable to cry anymore. I whisper into her ear and to the air around us, “Enough. This is enough. We will stop this.”

The next morning, I call the neurologist back in New York. I tell him that Sophie has been acting psychotic (if a baby can act psychotic). I tell him that her seizures have not shown any improvement, that she screams for most of the night, and that she appears very uncomfortable. The neurologist says little.

“Do you think that maybe the two drugs that are not FDA-approved are interacting with each other?” I say. “I mean, how many babies do you know on that particular combination?”

There’s silence. I picture the neurologist with his hand on his chin, stroking it like my third-grade math teacher Mrs. St. Andre did when she was thinking.

“Hmmm,” he says, “that’s a very interesting idea.”

For a second, I can’t breathe. His voice has travelled two thousand miles into my ear but his words are black blocks in a cartoon bubble in front of me.

I think, Shit. I have a good idea. I have a bachelor’s degree in English and French literature and he’s a neurologist, but I have a good idea. Shit. We are in no man’s land.

That moment I realized with stunning clarity that we were on our own in the care of our daughter and that no amount of scientific knowledge or experience would serve as comfort. In the space of a sentence, I felt I was shoulder to shoulder with the great minds of neurology. It felt like a crap shoot, and the only power I had was to stop.

I stopped that drug and began weaning it from Sophie’s body that day. I began to look and listen for alternatives and eventually found my way to an osteopath in southern California who worked primarily with brain-injured children. We would continue to work with neurologists over the years, open to new drugs and willing to try treatments, but I would never regain a sense of trust that the land we were traversing was known to anyone.

Today, when I get on my computer and 'google' any term I want, I am far from the frightened reader in the Barnes and Noble on Broadway. The words are plucked from some no man’s land and assemble themselves on the screen in front of me. For a while I pretend that I have a bit more knowledge than before and that it’s so accessible, right at my fingertips.