Adolescence is a frustrating time in life few of us can ignore or forget, even if we wanted to.
Fortunately, medical science is finally taking those tumultuous teen-age years seriously by specially training physicians and nurses in the emotional needs of teen-agers during illness and injury, and setting up separate, unique adolescent facilities in hospitals and clinics.
Adolescent medicine encompasses everything from a football injury to leukemia, and includes the modern ills of alcohol, drugs, early pregnancy and sexual abuse.
Worldwide research studies show that the anxiety experienced by a hospitalized or chronically ill adolescent can be "overwhelming with serious and damaging psycho-social results," and when untreated this anxiety can have "life-long effects."
"Adolescence is such a time of turmoil," says Dr. Irene Chatoor, consulting psychiatrist at Children's Hospital National Medical Center, "yet I have been impressed by how much resilience our young people have to deal with physical illness . . . and also how it can change a youngster's whole life. We have seen kids growing . . . but some of them are getting crushed."
Most illnesses and accidents interrupt the normal emotional struggles an adolescent faces prior to adulthood -- struggles with independence, control, self-image, sexual identity and self-esteem. In Children's adolescent fellowship program, teachers like Dr. Chatoor "integrate the physical and emotional part of an illness to understand the patient."
(Thus the parents who once labored over breat- or bottle-feeding, and toddler temper tantrums need to make sure older children continue to get quality medical-care.)
Is your doctor or clinic communicating adequately with your teen-ager? Does your doctor's hospital have a separate adolescent department? Does your teen-ager have access to medical advice on drugs, birth control, venereal disease, alcohol, and sexual development?
"It is a common dilemma for parents," says Georgetown Adolescent Medicine Director Dr. Robert Sherrin, "to realize that your favorite pediatrician or internalist may not relate to your teen-ager or fill his needs."
"Some physicians and surgeons are scared to death of teen-agers," says Dr. Lucius Sinks, chief of Georgetown's Division of Pediatric and Adolescent Oncology. "They haven't got the foggiest idea what to say." Many doctors, says Sinks, talk down to teen-agers, if they talk to them at all.
Conversation and listening may be as important as X-rays and pills in adolescent care.
Some of the predominant fears expressed by adolescents are "not knowing what is going to happen," says Dr. Andrew Riggs, director of Children's Hospital Adolescent Medicine, "and also the fear of pain and not wanting to show pain.
"We have to let them know, especially the boys who want to be tough and independent, that it is all right to show pain . . . or to cry."
Another problem is loneliness. Most hospitals solve this with separate adolescent facilities and the peer roommate system.
"We now recognize that if you put a 14-year-old with a 74-year-old with lung cancer" says Dr. David Reese, chief of Arlington Hospital's Pediatric Department "nobody does well . . . and the 14-year-old doesn't do much better with a 2-year-old either."
"This is dramatically shown with young cancer patients who are given a chance to live, but are "devastated," says Dr. Sinks, when placed with older dying patients.
Peer and sibling visiting hours, recreation, and the freedom to wear their own clothes and to socialize on the floor also help. (As testimony to its use, Arlington Hospital's 2-year-old pool table is pockmarked and held together with surgical tape.)
A weekly event that gets most patients out of bed in adolescent-aware hospitals is the rap session. These supervised groups run and thrive on whatever comes to teen-agers' minds.
"Teen-agers don't necessarily talk about their illness," says Linda Larson, adolescent clinical unit co-ordinator at Children's. "And we can't predict what the subjects will be, but when there is a death they want to talk about it, for they get to know each other and each other's parents."
One problem plagued with ambiguities is the loss of control.
"Anyone, particularly a teen-ager, tends to get in a panic state when control is taken away from them," says Dr. Stephen Hersh, director of Adolescent Services at St. Elizabeths Hospital. "We have to give the patients some control, or an illusion of control." (Allowing the patient, for example, to decide the time of a painful treatment.)
One issue that affects all teens, no matter how sick they are, is sex and body image.
"A teen-ager cannot hang up his sexuality before being admitted," says Dr. Hersh. Often the illness heightens the need to be touched, held or physically loved.It is a frustrating time for teens, wrapped up as they are in their physical development and changes.
"Lying in bed," as one patient put it, "doesn't make you feel very attractive."
"Adolescent patients have a real concern about what they look like . . . this is sexuality in terms of body image," adds Dr. Richard Jones, Georgetown's associate director. "One big problem we've had is boys who have breast development, some have had reductive memoplasty, often they won't go to school, or are failing in school, because of abuse from their peers."
No matter the problem -- 14-year-olds with venereal disease, cancer patients with hair loss, or adolescent diabetics with needle-marked arms -- they all need to be reassured.
"Young people," says Dr. Hersh, "actually have a lot to say about their illness . . . if people would listen, it would help."