A pediatrician reflects on a foster care child

October 31, 2016

By Niran S. Al-Agba, MD

I care for foster children in my practice. I ache for these children to know love and security, not to worry who will tuck them in at night, or whether they will be separated from their siblings. I fight hard to hang onto my foster kids once we establish a good relationship, because having the same health care provider for them as they grow will provide safety and stability to their unpredictable lives.

Ten years ago the state foster care director asked that I take a patient who had been designated the highest care level, known as BRS (Behavioral Rehabilitation Services). These children tend to have histories of heavy trauma and severe adverse childhood experience (ACE) scores. They have been fostered by complete strangers and move from home to home, which brings perpetual uncertainty. Processing life, these children work through pain and adversity most adults do not face in a lifetime.

One special girl who walked through my door was Maleka (Arabic for “queen”), an 8-year-old when I first met her. Her life story was no different than that of other BRS foster children. She had a primary caregiver who could not cope and was addicted to drugs. Then an older relative steps in to help. That individual gets ill, dies, or can no longer manage, and the child again is thrust into an unfamiliar world. Each new home is always temporary. In Maleka’s case, one adult in her home was convicted of multiple counts of sexual molestation. Maleka had been a victim, as was her half-sibling who had been placed elsewhere in the state.

Maleka was on eight strong medications and carried six diagnoses, including ADD, oppositional defiance disorder, conduct disorder, PTSD, reactive attachment disorder, and a learning disability. She had been treated with every major psychiatric medication on the market and was on three times the maximum dose of anti-psychotic medication. She was having daily wetting accidents at school, likely due to the sedating nature of the medications. How could she focus on schoolwork, let alone her bodily needs? As is common for children shuffled from county to county, home to home, Maleka was seen by different physicians who added to the drug regimen, failing to wean off other drugs.

On that first visit, I saw her fear in her eyes.  I took a history, completed an exam skipping uncomfortable parts, and decreased the sedating medication by two-thirds. Unfortunately, I needed to draw blood and make sure she still had adequate liver and kidney functions–which destroyed any rapport I was building that day.

I was honest and direct, explaining what needed to be done. “Nope,” she said. “Take it or leave it, lady.” It took four of us to hold her down. Her anger was apparent, as she threw punches until she had little fight left. The tears followed as I tried to reassure her to the best of my ability.  “I will never listen to you,” she hissed.

After she recovered, I said, “Your name is beautiful. Do you know what it means?” She shook her head indicating no. “Would you like to find out?” I asked. She nodded. “It means queen in Arabic, and I think it means you are pretty special.”  She sat straight up and grinned ever so slightly before leaving.

Over the next two years, she returned many times; I always looked forward to seeing her on my schedule.  She weaned down to one medication for ADHD. She tested into the gifted program at school and lost the 30 pounds she needed to lose, once she was weaned off the mood stabilizers and sedating anti-psychotics. She and I fell into a rhythm during her appointments; she always hugged me tightly on the way out the door.

It was as if she knew our relationship was only meant to be temporary.

And she was right. Out of nowhere, a long lost relative in another state emerged. The relative and her spouse wanted to adopt Maleka and her half-sibling.  I was the one who was terrified now; I could not imagine how this little girl felt. She had been thriving in a wonderful foster home, attending a school she loved, and had a stable health care situation likely for the first time in her life. I hated letting her go to another unknown place.

She and her half-sibling were adopted by that couple, and I pray she is thriving. It has been a decade now, and I imagine she will be entering college soon.

With each new foster child I wonder if there will be another who teaches me so much. To genuinely stand with these forgotten children between their rocks and hard places is something Maleka taught me to do. Our time together was far too short, but thank you darling child for allowing me into your heart. Wherever you are, I wish you happiness, health, security, and love.  You deserve everything extraordinary life has to offer.

Dr. Al-Agba is a practicing pediatrician in Silverdale, WA. This piece was originally published on her blog, MommyDoc, July 7, 2016.