- The Washington Times - Sunday, December 24, 2000

Rachel Crossett dances around the living room, her best dress flaring around her and her little sister Catherine, 2, toddling close behind. Older brother James and older sister Sarah watch, but they talk about school, computers and horseback riding, the activities of preteen life.

It seems like a pre-Christmas whirl at the Crossetts' Centreville home, but the lights and reindeer and a tree hung with Rachel's favorite Beanie Babies serve as distractions from the chaos of the past two years.

Rachel, 5, was diagnosed with neuroblastoma, an aggressive form of cancer that began as a tumor in her abdomen, two years ago this month. She has had surgery, months of chemotherapy, and last spring, a bone-marrow transplant. Rachel and her mother, Meg, spent several months in New York as Rachel received state-of-the-art treatment at Memorial Sloan-Kettering Cancer Center. Despite the treatment, the cancer has recurred.

The other five Crossett children missed their mother. They missed their sister. They still miss the way life was before the cancer.

"I wish everything was the way it used to be," says Sarah Crossett, 12. "Finding out Rachel had cancer is your worst nightmare. Any family could get it, and you realize they could not be here in a year or two."

Indeed, when a child has cancer, his or her siblings suffer, too. There is confusion and fear. The siblings may feel responsible. They may feel guilty. They may feel jealous that the sick child gets attention and get-well presents, says Dr. Allan Peterkin, a Toronto psychiatrist and author of the book "What About Me? When Brothers and Sisters Get Sick."

"Siblings are very vulnerable," Dr. Peterkin said in a telephone interview. "It cuts across all ages. They might be angry that the sick child gets the attention, then feel guilty for feeling that way. They may worry that the illness will happen to them. Their behavior may change: They might excel and go out of their way not to be a worry or go to the other extreme and manifest in behavior problems."

Talking truthfully to the well sibling is the best way to quell a child's fears, Dr. Peterkin says. Though many parents may want to hide the details of the sick child's treatment and prognosis, that eventually may do more harm than good, he warns.

"You should explain something about the illness," Dr. Peterkin says. "A pediatrician can help you find age-appropriate ways to tell young children. Even small children can pick up on anxiety and feelings, so it is important not to shield them."

Helen Fitzgerald, a Northern Virginia grief counselor, agrees."Parents should take the well sibling to the hospital for short visits," she says. "The trip can include a visit to the cafeteria, which makes the place less scary. Children need to know what is going on; otherwise they are going to be fantasizing."

Without some appropriate information, the well sibling may theorize that he is responsible, Dr. Peterkin says.

"I treated a little boy, about 8, whose sister had been diagnosed with leukemia," he says. "He thought he had caused her cancer. He remembered pushing her into the white snow, then later heard his parents talking about white [blood] cells and confused the two."

Behavior to watch

Every sibling copes with cancer differently. James Crossett, 9, began having trouble in school, his mother says. Sarah began "doing some things she knows I wouldn't approve of," Mrs. Crossett says.

In Sheri Canniff's family, her 8-year-old son, Bryan, has shown signs of stress over his brother Sean's leukemia. Sean, now 11, has been undergoing treatment since he was diagnosed in 1997.

"Bryan would act up in school pushing kids, starting fights, and the school would excuse it," says Mrs. Canniff, of Springfield. "People don't realize they are not doing you any favors by doing that. Now Bryan is acting sick a lot at school. He wants me to come get him. He sees all the attention Sean gets. I tell him he should thank God he is not the sick one."

All of those behaviors are common signs of sibling stress, says Shara Sosa, a social worker for Inova Fairfax Hospital who works with children coping with cancer in the family.

"Anger is normal," Mrs. Sosa says.

At the support groups run by Mrs. Sosa, siblings get out their anger by kicking balls, tearing up paper and drawing pictures of the way their lives have changed.

"A lot of things present [themselves] at school," Mrs. Sosa says. "Some kids develop school phobia. Sometimes they are afraid to go to school and leave the sick person. Other times, they develop psychosomatic illnesses so they know they will get the attention they need.

"For older children and teens, they sometimes feel that negative attention is better than no attention," Mrs. Sosa says. "They are not going to try and excel, because the better they do, the less their parents know how much they need them."

For children who are acting out anger, such as in hitting or starting fights, Ms. Fitzgerald suggests helping the healthy child make a list of all the things that make him angry. Parent and child can then discuss which items they can change and which items they will have to accept.

"You can say to your child, `It is OK to be angry, but it is not OK what you do when you are angry,' " she says.

It is important to voice disapproval of attention-getting behavior, Ms. Fitzgerald says.

"These kids want to know something is consistent," she says. "It is important to still set limits. The rules and regulations need to stay in place, or soon a common excuse will be, `My brother is sick, so I didn't get my homework done.' "

Don't let good work go unnoticed, she adds. This will give the well sibling positive attention.

"If you come home and see the dishes have been done, really pour on the praise," she says.

Loss of a parent, too

For part of Mrs. Crossett's and Rachel's stay in New York, baby Catherine was there. Part of the time, she was in the care of her father, Jim, and brothers Andrew, now 19, Robert, now 17, and James.

"Sometimes Catherine would stay up all night and call for Mommy," James says. "We would take turns getting a bottle for her."

For the older siblings, missing their mother showed up in less primal ways.

"If I wanted to go somewhere, I needed a car pool," Sarah says. "I had to be more mature. Mom was gone a lot, and Catherine was here. I had to be like the second mother."

Says Mrs. Crossett: "I worry about the other kids a lot. I worry about them not getting enough attention. We stopped activities like soccer. They each need attention. I try to find it whenever I can. I feel terribly guilty."

Mary Ann McCabe, director of health psychology at Children's National Medical Center, says families need to work together to accept their limitations. That is no small task because the small disruptions, such as mom not being at the bus stop in the afternoon, can "derail the healthy sibling," she says.

"Parents don't have control under these circumstances," she says. "After they accept the reality of the situation, I like to tell them to be creative. There are ways for the well sibling's needs to be met. It is possible they could find 10 or 15 minutes once a week to spend one on one with the well child or children. They can also stick to their normal routine and get other adults such as neighbors and relatives involved."

Dr. Peterkin recommends appointing a "guardian angel," such as an adult relative or friend, for each well child.

Mrs. Canniff says her husband and neighbors helped immensely during Sean's treatment.

"An illness like this affects the whole family," she says. "We didn't understand all this at first. For six months, Bryan didn't have me here. I stayed in the hospital with Sean for three to five days at a time. Bryan was going into kindergarten. I couldn't even be there.

"I would tell anyone else going through this if you can't be available, then have someone else do something special," Mrs. Canniff says.

Mrs. Crossett's time challenge is large. She has six children ranging in age from 2 to 19. She and her husband also run their own landscaping business.

"I try to find 15 minutes to spend with one child or half an hour to spend with another," she says. "Even if I am just going to the store, I will take one of them with me just so we can talk in the car. I have depended on a lot of friends to help me."

Friends of families with sick children commonly ask if there is anything they can do. It is more helpful just to go ahead and do something, Mrs. Crossett says. That way parents won't be pressed to think of more details, as no doubt dozens of things would be appreciated. Among the ways to help are picking up the well children at school, taking them for special outings or bringing over grocery staples.

"Rachel's illness certainly affects everybody," Mrs. Crossett says. "When Rachel is not feeling well, the other kids have to understand that. Our life has been changed always and forever."

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