Sophia wasn’t with us now. When we’d been invited into the doctor’s office, where he sat behind an enormous desk, Sophia perched on a stool to one side, he’d suggested that she might like to go off with the nurse for some fresh air. After all, as he pointed out, grinning at both her and us, she was already something of an expert on Addison’s disease and didn’t need to sit through all the boring stuff.
We’d taken the opportunity to bring up the slightly odd business of her being so adamant about seeing him alone. Wasn’t it all a bit cloak and dagger?
‘I know it seems that way, Mrs Watson,’ he’d agreed. ‘But unfortunately my hands are tied. There are certain parts of Sophia’s file that she doesn’t want disclosed, and I’m afraid that I have to respect that. All I can say is that they in no way affect her condition, nor do they hamper your ability to care for her.’
Which, frustratingly, left us none the wiser.
‘The main thing,’ Dr Wyatt explained now, his medical briefing complete, ‘is, of course, that you become attuned to the symptoms of a steroid insufficiency. Headache and/or dizziness, nausea and/or vomiting, wobbly knees, fuzzy thinking – the thing is, at all costs, to avoid a full-on emergency, so it’s always better to be safe than sorry. Increasing her steroids temporarily won’t cause her any harm, though long term they very much can. But it’s all in the literature,’ he finished up, cheerfully. ‘And you can call us any time you have concerns. Oh, but one more thing.’ He nodded towards the door now. ‘There’s also low blood sugar to look out for. It’s another common problem with Addisonians, but easily dealt with. As happened just now, give her a small bag of peanuts or something. Some of my patients swear by things like scrambled eggs, too. It’s the protein boost that helps. You’ll find she craves salt as well. Just the one thing …’ He paused again.
‘What’s that?’ Mike asked him.
‘The one thing, of course, as you’ve no doubt been told, is that Sophia’s been known to fake crises and low blood sugar. In fact, that’s probably what she did just then. For effect.’
I tried to take this in. ‘But why?’ I asked.
‘She’s a 12-year-old girl,’ the doctor said. ‘One who must take pills all the time and eat sensibly. Which must be galling. Especially when her peers can chow on what they like. But if she says she feels sick or dizzy … well, she’s learned, of course, hasn’t she? That it’s a sure route to getting attention.’
‘But how are we supposed to know if she’s faking or not?’
Dr Wyatt shook his head. ‘Please don’t stress overly,’ he said. ‘It’s just a question of making sure she follows her routine. If you make sure from the outset that she takes her pills in front of you – when she’s with you, that is – give her a healthy packed lunch and a well-balanced evening meal, there’s no reason at all why she should have problems. Oh, and get her school on board, of course. If you’re really very lucky, they might have someone on the staff who’s familiar with the condition. But if not – and it’s doubtful – then it’s really just a case of them exercising vigilance as well.’ His tone was reassuring, but I wasn’t reassured. I had no idea the condition could be manipulated like this and how much of a close eye we would have to keep on her. ‘And this could really be life-threatening – this crisis thing?’ I asked him.
He nodded. ‘They happen only very rarely,’ he said, ‘but potentially yes, one could be. The trick is to stave it off before it even looks like happening. Prevention is always so much better than cure.’
I thought grimly about the average adolescent’s mind. Being told you might do some damage to yourself in the long term never stopped armies of kids taking up smoking, trying drugs and getting drunk as skunks, did it? But for attention? Mr Wyatt seemed to read my mind. ‘The problem with Sophia,’ he said quietly, ‘is that she resents her condition and wants to prove she controls it, rather than the other way around.’
‘Or maybe she’s just manipulative,’ Mike suggested. ‘And likes to control those around her.’
Dr Wyatt nodded. He looked slightly taken aback by Mike’s comment, but I got the feeling he did understand. ‘It’s certainly true that some young people with chronic illnesses can be manipulative,’ he agreed. He then looked at his watch. Quite a lot of time had passed now. There were obviously more patients waiting. ‘But unless she tells us how she feels, I’m afraid we just don’t know,’ he finished. ‘But please do get in touch,’ he said, rising, ‘if you have further questions or need help. That’s what we’re here for …’
We were all quiet, lost in our own thoughts, during the journey back home. I was busy going through everything again in my head: the complicated nature of this new routine. I was expecting each child to be different, of course; with my first foster child, Justin, who counted major food issues among the many manifestations of how badly he’d been damaged, I’d had to create a wall chart and update it on a regular basis, detailing every aspect of all our upcoming meals. Not only did I have to write up exactly what we were having, but also when we were having it, almost to the minute. If I didn’t do this, he got terribly anxious and difficult, especially in the early days and weeks he was with us. It did improve, but it would create tension, even months down the line, if we ever deviated from it. Deciding on an impromptu take-away instead was, we soon realised, not an option.
This new routine, though, was a whole other ball game. This was medical and complex and stressful. I had to observe Sophia’s daily tablet taking, keep a track of her supplies, ring up for regular repeat prescriptions and collect them, and keep two emergency kits – one at home, and one for school trips and so on – to hand and ready for action at all times. Not such a huge amount really, but that wasn’t the point – it was just the enormity of the responsibility. I had honestly not realised until that very moment quite how serious a chronic disease like this could be.
I sighed heavily. Blow the long-term health implications for me – I was stressed and I really craved a cigarette.
I turned to Mike. ‘Could we stop at the next services?’ I asked him. ‘I need to pick up a few bits.’
‘And a cig?’ he said, grinning. ‘Course we can, love.’
We stopped at the next services – about an hour away from home – and all got out of the car. After such a long time in the car it was good to be able to stretch our legs, but Sophia, once she’d done so, climbed straight back in. ‘I don’t need to go in, do I?’ she wanted to know. ‘I’m tired. I think it’s the heat. Plus the stress of the journey.’
‘You go on, love,’ Mike said to me. ‘I’ll stay here with Sophia. Get your bits. See you back here in a bit.’
I bought the bread and milk I needed and ducked round to the corner of the building to the smoking area. I really must research this disease properly, I decided. I didn’t feel comfortable not knowing everything I could know about it. If I was going to be able to look after Sophia properly, then I needed to know when the wool was being pulled over my eyes.
I stubbed out my cigarette and walked back to the car, and the rest of the trip home passed without incident. Sophia, true to her word, seemed sleepy indeed. She didn’t stir for the rest of the journey.
Happily, for all concerned, the rest of the day went pretty well. When we got home Kieron had already arrived back from college, and their first meeting seemed a success all round. Sophia took to Kieron instantly, it seemed to me, and our evening meal felt as relaxed as it would have done usually, Sophia laughing and chatting and being generally very sweet.
But there was still something – a vague sense of unease I couldn’t shake. I’d definitely been rattled by the doctor’s revelations about Sophia having been known to fake symptoms, but not that shaken. After all, I’d spent almost all of the previous year with a much more obviously distressed and challenging child under my