The Pharmacist

I studied my daughter closely during her pre-teen years, watching for signs – but of what I was unsure; normality perhaps, or was that unkind? Her transition to Rockcliffe Academy worried me more than it did Rachel, as did her unusual behaviour. Her insular character and preference for her own company presented problems, and Rachel’s attitude could often be interpreted as rude. She had little time for our friends, and if any came to the house to visit, she could barely bring herself to be polite, with her demeanour nothing short of surly. I generally passed this off as shyness, making excuses I knew were not valid. My frequent attempts to explain social niceties to Rachel went over her head, and generally, my efforts were met with a steely glare, as if she couldn’t wait to be elsewhere, and I was nothing more than an unwelcome distraction.

As our concerns for Rachel remained and my anxieties for her future development increased, I persuaded Tom to accompany me to see our GP for his opinion on getting a referral for our daughter to a child psychiatrist. My husband initially resisted the idea but eventually agreed that we should at least inquire; we didn’t have to take Rachel with us for a preliminary visit.

Our GP was familiar with our family, we’d been with his practice for more years than I cared to remember and Dr Simons had seen us through some challenging times. It helped that he was aware of our past concerns about Rachel and the morning’s visit was made easier by his patient attentiveness to the things we were finding difficult to verbalise. Counselling had been tried and ruled out when Rachel refused to engage with the psychoanalyst, and I found it difficult to tell the doctor exactly what kind of help we were seeking. Eventually, I simply blurted out my fears that Rachel was not normal and we were at a loss to know what to do.

Dr Simons asked questions about Rachel, an easier way for him to understand our concerns and allow us to express them.

In answer to questions concerning her behaviour, we established that she didn’t present violent or unruly behaviour yet was frequently withdrawn, unsociable and often moody. The doctor asked if there were changes in her behaviour, a drop in performance at school perhaps, or any paranoid ideas and unease with others. I explained that we weren’t seeking help due to any changes, but rather a continuation, and possible escalation, of traits that had always been there. Rachel’s preference for her own company wasn’t new but not typical in a child of her age. Her apparent coolness and lack of emotion had always been evident, but again was becoming increasingly disturbing. The only thing which appeared to surprise Dr Simons was when I told him that I’d not seen our daughter cry since she was a very young baby, and only then when she’d experienced physical pain.

The doctor’s question and answer approach worked well for Tom and me and prompted us to explain things that we might have forgotten to mention otherwise. Dr Simons paused, looked from Tom to me and took a deep breath.

‘I think there may be value in referring Rachel to a consultant paediatric psychiatrist, but perhaps not at this particular time. Even then the initial step would be to perform a series of tests to discover if there could be a metabolic disorder causing Rachel’s symptoms.’

I interrupted, alarmed at the mention of disorders. ‘What would you be testing for?’

‘Hypoglycaemia, Wilson’s disease, meningitis and encephalitis.’ He reeled off the list and I was horrified, particularly at the mention of meningitis, a word that strikes fear into the heart of every parent, a disease I knew could be fatal.

Dr Simons, sensing my panic, continued.

‘This is simply the first stage of any referral process and we would not expect to find these diseases; they’re simply performed to rule them out. As Rachel’s problems are ongoing and have been for some time, I would be surprised to find any such issues. Before we go ahead with a referral, I’d like you to go home and think very seriously about embarking on this next step. Rachel is still young and has suffered more than her share of trauma and time is on our side. She could grow out of the unsocial behaviour she exhibits without intervention, which I’m sure you’ll agree would be the best possible outcome.’

I remember leaving the surgery after this encounter, turning to Tom and asking, ‘Did he just give us a verbal pat on the head?’

Tom nodded sadly and agreed that we were no further forward. It appeared that our daughter’s behaviour would have to deteriorate to levels far worse before treatment was considered necessary, an unpalatable thought if ever there was one.

Tom and I discussed our visit to the doctor over the next few days. My mind dwelt on very little else. Were we making a mountain from a molehill? My husband seemed to think so.

‘It could simply be in her make-up, Alice, her DNA. We’ll never know what her biological parents were like. Maybe they were introverted, unsocial people?’ He had a point I couldn’t argue with, so I didn’t. I attempted to take the doctor’s advice and give the situation more time – after all, Rachel wasn’t violent or destructive in any way. Perhaps I was an overanxious mother and the problem was more with me than our daughter?

And so, once again, I let the subject drop, waiting for an improvement in our mother-daughter relationship, which never came. Did I do the right thing, or should I have fought for my daughter to be assessed by professionals? I suspect this is something I will never know.