My 16-year-old had to make medical decisions on his own. I was shocked.

IV drip pole against blue background

By Lauren Apfel

Last week my oldest son got hurt. He was doing me a favor, we needed a few boxes of books put away and, at just over six feet tall, he is used to doing the heavy lifting in the house. I’m a single mom. As he tried to take down the loft hatch from the ceiling of his room, the cursed thing slipped out of his hands, dropped a good distance toward the floor and crashed ominously into the second and third toes of his right foot. Blood and chaos ensued and off we rushed to the hospital, his good foot clad in the Iron Man sock he had been wearing that day to school—a gift for his sixteenth birthday, four days earlier.

The fact that his birthday had come and gone at the time of the accident would prove to matter—more than I could have imagined. In America, where I grew up, children are considered adults at 18, the “age of majority.” In Scotland, where I’ve lived for the past 17 years, this milestone is a bit more complicated. We joked about what he was now legally able to do given his new age: get a provisional driving license! Have sex! Vote! What we didn’t talk about was how he would be treated in a medical context, that in the face of a surgery to repair two serious compound fractures he would be, for all intents and purposes, deemed a bona fide grown up. 

I am a great believer in giving kids appropriate autonomy. The problem is that it’s hard to know what’s appropriate and for which kid at which age. This issue was dealt with in the famous 1985 case, Gillick v. West Norfolk A.H.A, which continues to serve as the standard-bearer for establishing a young person’s competence to make medical decisions: children, even those under 16 the ruling goes, can give medical consent if they have sufficient understanding and intelligence to fully comprehend what is involved in a proposed treatment, including its purpose and risk and likelihood for success.

My son is a preternaturally mature child. I say this as a mother of four, that is, with a fair degree of objectivity. He is responsible and stoic and emotionally intelligent and there was more than one occasion during this ordeal that I felt awash with gratitude it was him and not one of his siblings who had been forced to deal with it. But for all of his maturity he is also, by many standards, still a child. He has the gangly coltishness of a person not done growing. Braces on his teeth. His childhood blankies remain stuffed in the corner of his bed. As with most teenagers, he makes bad decisions from time to time, like ignoring every warning I gave him about taking down the loft hatch without my help and/or a stepladder. The teenage brain is notoriously lacking in a developed pre-frontal cortex, the area of decision-making that operates from a place of awareness of long-term consequences.

When we got to the hospital, the first surprise was that we weren’t going to be admitted to the children’s A&E. The next, and this was to do with Covid no doubt, was that my son was taken in to register on his own before we could wheel him over to minor injuries. There too he was seen initially by himself, the nurse only dipping out of the room to ask what medications we had given him to make the agony of the journey down two flights of stairs and into the car bearable. He couldn’t remember the name of the drug, of course, he had never heard of it before. They cleaned up his foot, he told me about 45 minutes later, the care was excellent. He said he’d teared up when the needles slid into his severed toes to deliver the numbing agent. I know he doesn’t cry very often these days, so it stung even more that nobody was there to hold his hand.

Eventually, as the night wore on, we were able to stay with him at various points, to accompany him for an X-ray, to transport him to the main hospital as it was determined he would need surgery. When the orthopaedic surgeon finally saw him, hours after our arrival, to explain that they would most likely have to remove a portion of one his toes, a process referred to as “terminalisation,” she looked to him for consent. She was lovely. She asked him to repeat back to her what he was in fact agreeing to. Whether she went through this step because he was young and it was her way of ascertaining he truly understood what would be happening, or whether she does this with everybody, I wasn’t sure.

What I was sure about is that she didn’t look to me.

In the UK, the ages between 16-18 seem to be something of a twilight zone. Capturing the nuance of these years, Lord Fraser writes in Gillick, “It is, in my view, contrary to the ordinary experience of mankind…to say that a child or younger person remains in fact under the complete control of his parents until he attains the definite age of majority…and that on attaining that age he suddenly acquires independence. In practice most wise parents relax their control gradually as the child develops and encourage him or her to become increasingly independent.” 

Quite right. And while I did believe my son was “competent”—and was beyond proud at how well he handled the whole thing—I wasn’t prepared for him to be crossing the threshold into adulthood so quickly and so starkly.

The morning of his surgery, I wasn’t there. It had been postponed from the day before and as I was rushing to get my other children to school before heading over to the hospital—I hadn’t been allowed to stay overnight with him—I received a text: “Going to the theatre rn btw.” And off he went. I phoned him, I tried to ask questions, which he then relayed to the nurse standing in his room. I panicked a little and sped over to the ward even though he wouldn’t be back there for hours. 

The surgery went smoothly, I am incredibly grateful to the team who took such good care of my son. But whisking him off without even a mention to one of his parents still seemed a strange and swift and possibly premature exit from the cocoon of childhood. Especially when I heard that, moments before going under, he had been asked to choose which kind of anaesthesia to have—the first decision of major import I’ve ever known him to make completely on his own.

An irony: here he was at the tender age of 16 deciding for himself, in a nerve-wracking and novel situation, whether to have an epidural or a general, two fairly major interventions, while a few weeks earlier in a local restaurant I was told in no uncertain terms that I couldn’t buy him a drink at a family dinner. For this privilege, apparently in Glasgow, he would have to be 18. 

Neither at the hospital nor at the restaurant did anybody invite me to weigh in on what was right for my particular child; in one setting he was treated as a fully capable adult, in the other as no different from his ten-year-old twin siblings. I understand why this is the case, in theory. That societally we need to protect our older kids: from instances of parental coercion and/or irresponsibility, from the ravages of alcoholism. And I also understand that we need to give teenagers certain rights, in certain scenarios, over their own bodies and health—a phenomenon that is becoming freshly relevant with regard to Covid vaccines, where in instances of conflict even 12-15 year olds will be able to override their parents’ wishes. But the inconsistency felt jarring. And the exclusion of his mother from both decisions felt like an untrue representation of the extent to which we continue to be enmeshed.

As parents, we are always shocked by our children’s growing up—and the seemingly warp speeds at which it happens. One minute they are utterly dependent creatures, who need us for, well, everything. The next they are out in the world armed only with their own faculties. The transition from one phase to the other is among the most difficult aspects of parenting: learning to let them go, to make their own decisions and, with that, their own mistakes. While I wouldn’t have chosen any differently for my son in the hospital, had I been given the chance, I’m still reckoning with what it means to have never been asked. 

Lauren Apfel is co-founder and executive editor of Motherwell. She is still recovering from her son’s injury, while he keeps reminding her they were actually HIS toes. Connect with her on FacebookTwitter, and Instagram

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