Visit to The Other Parent

We have the technology. At holiday time in particular, when school is out for a substantial amount of time, many of the children of divorced parents get to spend some quality time with the other parent.

A stepmother expressed her worry about this.  She said that  Luke, 13, is very excited about spending the holidays with his mom, who lives an airplane ride away.  She said that Luke has often said how much he misses her.  Despite this, however, she also notes that his mother doesn’t call, doesn’t write, doesn’t email.  His mom is not involved in his life.

Life at 13 is difficult.  On the one hand, kids this age can smell and taste the benefits of adulthood.  If we would let them, they’d drive.  So they see attractive things on the horizon that they believe they are perfectly capable of doing.  But they can’t quite figure out how to get from here to there.  They have no idea that to become a doctor (I get this question a lot), you actually have to spend a lot of time in classrooms and do a lot of homework.  Another problem that nearly all 13-year-olds share is concrete thinking.  You tell her to call if she gets out of school late.  She doesn’t call, it’s 8pm, and you have the police out looking for her when she walks in the door and asks what all the fuss is about.  ‘Why didn’t you call?’ you ask in the calmest tone you can pretend.  She answers that she was supposed to call if school got out late.  It didn’t.  She left school right on time, then went shopping with a friend.  She followed your directions to the letter.  But she missed the forest because all she could see was the one tree.  This kind of thinking leads to parental frustration and these younger teens thinking that their parents don’t understand them at all.  Maybe they’re right.

As the child gets to this point, like a scenic overlook where they can see adulthood in the distance (but hopefully not with those awful binocular machines that always steal your 25¢  and never work right),they try to distance themselves from their parents and move closer to their peers.  This is a normal developmental stage, but it’s hard on the parents who can feel that they are losing the child.  If the parents hold on tighter, I usually see a much worse outcome in the long run.  You can’t hold back the tide, either of the ocean or of your child’s independence.  If you try, the end result is typically resentful and rebellious children who may or may not talk to you after they leave your household.  They will be independent whether or not you try to restrain them.  Why not make it work for the two of you?

Luke has concrete thinking.  So I worry that it has not occurred to him that something is wrong with this picture.  His mother isn’t in contact with him.  You, dear reader, are either a mother or have met one at some point in your life.  Does that sound right to you?  I don’t know if the problem is the mother’s alone (illness of some kind, including mental illness; substance use; shame or economics (can’t afford to call or visit, can’t write a letter, is embarrassed by meager circumstances compared with ex-spouse)), or if the father has explicitly or in some subtle way discouraged contact perhaps by intercepting letters or restricting phone use.  No matter what the reason, there’s a serious problem here.  Whatever Luke thinks life with mom--even for just a couple of weeks--is going to be like, he’s wrong.

This is the advice I gave.  We’ll see, after the holidays, what actually happened.

I suggested that his dad and stepmother give Luke a cell phone before he goes.  (If you think this is too indulgent, maybe you can find a fat bearded guy in a red suit to give it to him.)  This is really important.  It gives him a way to call you without using his mother’s phone, and without asking her permission.  It also gives you a place to call every day without leaving a message on her answering machine, without having her accuse you of interfering.  Most importantly, CALL HIM EVERY DAY.  Don’t call multiple times, don’t ask the minutia of what he did with mom as if to second-guess all of her decisions and plans.  (If that’s your goal, get help.)  The purpose is to tell him every day that you’re thinking of him, that you miss him, that you love him.  Don’t ask him anything.  Not even one question.  You are just calling to tell him that short message, not ask anything of him, nor interfere with his relationship with his mother.  He may say he doesn’t want you to call every day.  You might want to do it anyway.

Luke is one of my patients with ADD.  So I had further advice for his stepmother.  Get a second, prepaid cell phone.  Write down the serial number and all the numbers inside the phone, and the activation instructions that came with the phone.  Then, James Bond-like, sew this brand new but nonworking cell phone into the lining of his suitcase.  Ideally, without his knowledge.  Then, after he loses the phone you gave him, he will have one right there.  All he needs to do is call you, get the activation instructions, and turn it on.  Maybe you can even do it remotely.  He’s going to lose the phone you gave him.  So get over it now, be prepared with the online tools or toll-free number to turn off the lost phone.  Don’t blame him for it!  How can you blame him from something you knew was going to happen by reading this very paragraph?  You, dear reader, have been served.

OK, for those of you a little more domestically challenged, maybe you don’t have to sew it in the lining.  But sneak it in the bottom of his bag.

I know that once he’s got a cell phone, it will be tempting for him to use all the available airtime texting his friends.  Get a plan with expensive texts and tell him you will take the cost out of his allowance.  Or turn off the text function altogether.  As the owner of the phone, you can turn this feature on again if you need it by phoning the cellular company.

Do NOT tell him to call you at all.  If he wants to, he will.  If you want him to, he won’t.  If you force him to, he’ll resent doing it.  If you don’t want to follow my advice to call him every day with a quick ‘I miss you’ message, don’t tell him you will call him every day.  Never, ever, tell children this age you will do something that you don’t actually do.  They will remember it for the rest of their lives.  More on this later.

Slow Medicine: The Telephone Paradox

When I tell other doctors that my patients have my home phone number, they simply don't believe me. I tell them that calls to my office in the evening and on weekends or holidays get automatically routed to my cellphone or home phone. There is no answering service or triage nurse.

I set this up because the job of the answering service (this is one of the selling points they use for doctors) is to minimize the number of calls they put through. They seem to be measuring their effectiveness by how impenetrable a barrier they are for the patients. When your child is sick, if you want to talk to a doctor—forget the possibility of talking to your doctor—you have to sell the person answering the phone on how desperate your situation is, but not so desperate that they tell you to go to the emergency room. I want to get those calls, and want to know what's going on with your kid.

But my colleagues don't believe it. They tell me that if they let patients call them at home, they would get calls through the night about trivial things. They would suffer and their patients wouldn't benefit. I used to work for a big group practice, and this seemed a reasonable summary of my experience, too. So nobody actually tried it.

Here's what I found. The more I gave out my home number, the fewer calls I got. When I opened my own practice, I could actually program the office phone to direct all the calls automatically. Patients didn't even need my home number, they could get me at home any time. I got almost no calls. In the last 2 years, I have been awakened by phone calls just 6 or 7 times. In each of these cases, I got out of bed, got dressed and either made a housecall then or met the family in the emergency room. So those few calls were well justified.

As I thought more about this paradox, I realized that the general population of doctors had become so convinced of the universality of their experience, that they didn't attempt to repeat my experiment. I think there's an interpretation that isn't so mysterious.

First, in my Slow Medicine practice, everybody knows me. They see the same doctor with every visit and talk to me with every phone call. This leads to a humanization of the doctor as more (and less) than a BMW with a white coat who barely makes eye contact in the five minutes he spends with you, forgetting your name. So I suspect people are more respectful of my private time, the way we all are with our own friends and family. They all know that when they call at night, they won't get an anonymous shift-worker at a call center.

Second, Slow Medicine is all about access to the doctor. Once the parent is convinced they really can get a hold of me anytime, they are more willing to try and handle minor problems on their own. The thinking, I suspect, is that if the child gets worse, they can always call then. That results in perceptive parents carefully observing their sick children. If they get worried, if it gets a little too much for them to feel comfortable with, they can always call me at that time. So parents handle a lot more on their own, I think. In this way, there is another paradox. The fewer calls I get, the more empowered and self-reliant the parents feel. They know I'm there to back them up, so they might be willing to take a few steps on their own.

I believe that the ability to get in touch with your child's personal doctor in a crisis is often very beneficial to the quality and continuity of their care. Besides, if you have confidence in your doctor, and can get your doctor on the phone, then you'll have confidence in the phone advice you get. It's logical that this confidence is itself reassuring, even without actually making the call. This paradox helps me sleep better. And maybe the parents of my patients, too.