February 28, 2010

Medication Mix-up

Don't make a bad situation worse.

It's Monday morning. David is in bed and will most likely be there for a while. We had a big mix up last night. We are certain that he took a dose of methylin (a long acting stimulant medication for ADHD) when he should have taken trazodone (sleep and anxiety medication). He was already in bed when he became very disoriented and confused. While the methylin doesn't have this sort of effect on him during the day, I witnessed a wild-eyed agitation that could not be the result of trazodone. In the kitchen, I found the methylin bottle sitting apart from the rest. I counted the pills and it came up short - by one. How could this have happened? Well, for one thing, the two medications look alike - round, white pills of a nearly identical size. They come in the same size and color container from the same pharmacy. While I always check the label to make sure that I am getting the right one, David just grabbed one, opened it up, saw that it looked like the right one, and swallowed it down. The methylin is a new medication for his ADHD and looks different than the previous one. This would not have happened with the old medication.

So, there we were...! We had stayed up to watch the closing ceremonies of the Olympics. He had spent a good portion of that time playing a demo of a game that we vetoed because of it's questionable imagery. He was on the computer doing one thing or another until bedtime, a practice that stirs up his brain instead of calming it down. And, finally, he took the stimulant medication instead of the sleep one. End result? David is going to be up all night. And, probably, so will I.

I struggled greatly to keep my own composure because, quite frankly, I was angry. I was angry that my own sleep was now going to be compromised. David's anxiety can be overwhelming for him. He's phobic, with scary sights and sounds being the core component of his phobia. So, I was angry that I didn't monitor what he doing on the computer and angry that he didn't monitor himself. I was angry that he didn't stop for one second and make sure of what he was doing with the medication. Mostly I was tired at the end of a long weekend and frustrated by the impending situation. 

My first challenge was to decide what to do with myself. I could not allow my feelings about this situation overwhelm me and then propel me to make a bad situation worse. How could I make it worse? By making my feelings and my frustration the focus of the situation. By hammering on David for making such a stupid mistake. By letting him take full responsibility for the sleepless night I was about have. By leaving him to deal with the consequences of his actions while I go on my way to get my sleep. The possibilities for self centered thinking were nearly endless.

Truth is, David was not responsible for the mistake. ADHD is a disorder of brain function. The main components of the disorder are distractability, impulsiveness and the inability to attend. He does not choose to operate the way he does and the grief and frustration that he feels over the manifestations his disorder are profound. No good will come out of making him responsible for things that are simply out of his control.

After a moment of silence, a deep breath, and a long, hard look at the suffering child in front of me, I sideline my own feelings and fatigue and start to think win-win. I set up David on the living room couch with the tv remote. He can watch the rerun of the closing ceremonies. I get Otis to keep him company. I gently quiet him as he makes his 50th apology for being such a bone head and tell him not to worry. It was a mistake anyone could have made if they were not reading labels and we would initial the caps of his medicine bottles so he wouldn't make the mistake again. I reassure him that I am in the next room if he needs me. He becomes calm and I begin to turn my attention to getting some badly needed sleep.

Win-win thinking entails beginning with the end in mind. In the end, I want to get some sleep (David may not be able to until the meds wear off). I want a strategy to ensure that no medication mix up occurs again. Mostly I want David's self esteem to incur no further damage in this situation. ADHD is a killer of self esteem. I am his coach. My job is to find the errors of execution and figure out ways to fix them. If they can't be fixed, then I figure out how to get around them. Effective coaches build up, not tear down. As his mom, teacher, coach and one who loves him with all of her heart, my first responsibility is to do no harm. Dr. Laura Markham expressed this concept in heartwarming detail in her article Stop, Drop and Listen.

It is morning. I got my sleep and am now enjoying some some quiet time to myself while David gets his sleep. He will not wake up and remember that I was angry. He will remember that we solved the problem.


Best regards,


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