Clinical material

Background

Maya is 13 years old, and from a Hindu family. Father owns a business near the teaching hospital and mother supports him in the business and looks after the home. Maya is the youngest child and has an older sibling at university. Maya was due to start at an expensive and prestigious private school in a few months. Maya is intelligent and particularly gifted in maths. Her parents were thrilled that she had gained a place at this school and mother had said to the consultant that she was proud that they had been able to give their children such a privileged education. Six days before she was due to begin her new school Maya was taken ill with Guillain–Barré syndrome: a disorder in which the body's immune system attacks part of the peripheral nervous system. The first symptoms of this disorder include varying degrees of weakness or tingling sensations in the legs. In many instances, the weakness and abnormal sensations spread to the arms and upper body. These symptoms can increase in intensity until the muscles cannot be used at all and the patient is almost totally paralysed. In these cases, the disorder is life-threatening and is considered a medical emergency. The patient is often put on a respirator to assist with breathing. Most patients recover from even the most severe cases of Guillain-Barré syndrome, although some continue to have some degree of weakness. Maya was admitted to the teaching hospital four days after her symptoms appeared.

Maya's first session

I arrive at 12; Maya is just finishing her physiotherapy session. Mother invites me in and I sit on the visitor's bed close to where Maya is seated in a large armchair. Maya half smiles at me, and I introduce myself and say that I am from the CAMHS team and that we are part of the team who care for Maya on R ward and I could offer her some counselling time. I say that she spoke with D (our lead nurse) about this. Maya nods in understanding. Mother is talking quietly to the physiotherapist who is just