“Back off Mom! I’m FINE!”

An adolescent male has had asthma since he was a toddler. His mom has spent those years learning about his triggers and honing her ability to zero in on the early, tell-tale symptoms so she could treat them before they bloomed into full-blown, scary asthma attacks.

It was a responsible, by-the-book approach that worked great for a long time. Asthma was seen by son and parents as simply a part of life and this kid happily complied with the program.

But then, the child became a teenager. No longer could this mom take matters into her own hands when the warning signs flared up. Now she had to convince her son that it was the necessary thing to do. She found herself having this conversation often and it drove her wacko:

Mom: Hey, I hear you coughing a lot today. Sounds like asthma to me.

Son: Mom, I’m fine! I just have a little cold.

Mom: Really? Do you have a runny nose or sore throat or any other symptoms or is it just the cough?

Son: Mom, I’m not a baby. I know when I have asthma and I feel fine. Relax!

Mom: Well, yeah, but that cough is your symptom that asthma is starting and you need to get on it now before it really gets going.

Son: Mom, my chest feels fine. Seriously, I know when I need it. God! You treat me like such a baby!

Mom knew that this teen, like all teens with chronic medical conditions, didn’t want to face the fact that he needed to take his medicine regularly and monitor his condition closely. She knew that he saw himself as invulnerable to danger and able to manage his life with little help from the grown-ups. Having to take medicine wasn’t cool, and despite what he said, she knew that sometimes he just plain forgot to pay attention. But his overall health was good and his asthma didn’t really cause him much trouble.

Then he went to college. The climate there was very cold (cold air can trigger asthma), and it was hundreds of miles from home. New germs, new schedules, new routines (or lack of them), and total freedom to attend to his asthma or not created a riskier situation. Mom could occasionally hear the little achhh, achhhh cough that made her brain light up in fear when she talked to him on the phone and she felt her helplessness increase.

But now there was little she could do except hope for the best. Until last week. Here’s what happened:

Son, home for winter break, had been coughing for a week and blowing it off, as usual. Mom decided to institute a covert mission. Moms are smart that way. So she called her son’s pulmonologist and got his nurse on the line:

Mom: Here’s what I’m dealing with — I’ve got an adolescent who’s symptomatic and in denial about his asthma. I know it’s his age that’s getting in the way, and I need help from you guys. He’s home from college and we’re doing our dance about whether he needs his medication. I hear his cough, which I know is his symptom, and tell him to start the meds and he argues that he doesn’t need them.

Nurse: Oh boy.

Mom: He thinks it’s not asthma unless his chest is tight and he’s wheezing. I need you to explain what that cough means and help him understand that he has to be proactive and nip it in the bud. Will you please help me? He doesn’t want to hear it from his mom, but he might listen to the doctor. I promise to let you guys do the talking and not to gloat too much in the background.

Nurse: (laughing) I totally get it. Adolescents are notoriously bad about taking medication. Bring him in and we’ll read him the riot act, but nicely of course.

So Mom told Son they were going in for his annual asthma exam. She said she was glad because she wanted to find out once and for all (even though she already knew) what that little cough meant. She was curious, she said. Maybe he was right after all. Maybe it was just a bit of a cold and it didn’t signal asthma. “Fine,”he said. “No problem, sounds good.”

On the way, Mom kept things light and conversational. She didn’t talk about asthma or medicine. Mostly they just talked about sports. As the nurse walked them into the examination room she said to the son, “Wow, you sound a little winded just from the walk in. Is your asthma flaring up now?” Shocked son said, “No, I just have a slight cold.” Mom winked conspiratorially to Nurse and sat down feeling really good about what was about to happen.

As Nurse started to quiz Son on what was going on, she casually mentioned his cough.

Nurse: I hear a little achh, achhh.

Son: Yeah, I just have a little cold.

Nurse: Are you sure you’re not in denial? Because that cough could definitely be a symptom that your asthma is acting up.

At this point, Mom is pinching herself to keep from breaking into song and working hard to keep her face a bland combination of matter-of-fact and mildly curious.

Mom: Really? Is that right? The cough IS asthma? Because we have wondered about that. So let me get this straight – even though his chest isn’t tight yet and he’s not wheezing, he actually does have asthma and you know that because of the little cough?

Nurse: Well, we’ll have the doctor confirm it but most likely, yes. And the funny thing is that even when people are having symptoms they often don’t even notice them. One of the nurses here was constantly clearing her throat and finally I asked her when she was going to see the ENT about it. She didn’t know what I was talking about. She had no idea that she was clearing her throat every few minutes. So it was pretty funny. She did have a problem but wasn’t even aware of it.

Son: Huh.

In walks Doctor, who greets Son with a handshake and a warm hello. He gives Mom a quick nod but focuses, lazer-like, in on the gangly young man sprawled on the examination table.

Doctor: So, how’s college going? Haven’t seen you for a while.

Son: Great, I really like it. Everything’s good.

Doctor: How’s your asthma been? Have you had any problemas with it at all?

Son: Oh, no. Nothing really. It’s been fine.

Mom: (Silently, to herself) WHAT? Everything’s fine? Is he serious?

Doctor: Really? Nothing at all? Have you needed your inhaler at all since the school year began?

Son: Well yeah, a few times I’ve had to use it but not much.

Doctor: What about the other medicine for prevention? Are you using that?

Son: Just when I have asthma and then for a couple weeks after the symptoms go away.

Doctor: Yeah, I gotta tell you. I see this situation with people your age all the time. It’s really a typical thing with you guys and I want you to pay attention to what I’m going to tell you. You don’t think you need to take your medicine until you have a real problem going on but that’s not how it’s meant to be used. You get away with it for a while because you’re young and have a lot of good lung function but that can change fast and then you can have really serious problems. And believe me, you don’t want that, it’s not a pleasant experience.

As the doctor laid out the facts, clearly and emphatically, Mom listened in awe and wondered where she could erect a statue in his honor. He struck just the right tone and her son listened and took the information in in a way that he hadn’t before. The doctor was bold (You’re probably going to have this for the rest of your life…) but reassuring (…but if you just take one puff per day of the medicine, most likely you won’t have any problems or even much need the inhaler).

And he even got him to see that the blasted achhhh achhh was indeed a real symptom of asthma and not just a little cough. Mom didn’t have to say a thing. She got to melt into the background and watch the magic happen.

Once back in the car, after the doctor had extracted a promise from the young man to take his medicine every day, Mom asked him what he had heard.

Son: Oh, he just basically said that if I take the medicine 90% of the time, I’ll be fine.

Mom: What do you mean 90% of the time? He said every day!

Actually, at one point he HAD said 90% of the time — that idiot. Mom started to rethink the statue idea. Maybe a plaque would be more appropriate. Clearly, that doctor didn’t have adolescents. He didn’t realize that they will always focus on that one piece of information, thrown out without thinking, that fits best with their view of the world.

Oh well, that’s a battle for another day. At least her mission had been mostly successful and she could let go and loosen up a little more.

But as they drove off, she was once again left wondering when, if ever, she would be able to completely stop worrying about her kids. I think I know the answer but she probably wouldn’t want to hear it.

 

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Ellen W. Schrier, LCSW, is a family therapist and the mother of three adolescent/young adult kids.


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