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What Happened to Ella Marsh? “Ella, would you come in here, I’ve got the bath running.” a female voice called out from the bathroom in a flat monotone pitch. Wake up! Please wake up! Not this dream again, please! As if on cue, dream Ella lifted her head out of the bucket before wiping the vomit from the corner of her chin with the back of her hand. It was another rough night thanks to the chemotherapy. Her legs shook as she slowly stood, trying to resist the urge to vomit from the effort. She grasped the bedpost to steady herself and surveyed the damage. Regurgitated chicken covered her nightgown, as well as the bed covers. This had almost become a nightly ritual. “The bath is ready.” “Coming!” Ella yelled back in response. Don’t go in there! Wake up! Ella took one shaky step, then another, holding onto every surface she could along the way for support. She stopped for a moment, taking in her frail form in the mirror. Her eyes were sunken. Her skin gave off a ghostly white glow. Her cheekbones protruded from her face. And of course, her bald head. She slid her hand over the top, missing the black curls that had been there two months before. She turned her attention once again to the light coming from the end of the hall. Ella’s heart hammered as she inched forward. In her mind she wanted to stop and turn back. Her feet had other plans. They propelled her body forward despite the owners objection. She stood in the doorway to the bathroom as the feeling of dread washed over her, more intense with every passing second. She felt a hand tighten around her arm and she let out a yell of fright. ……………………………………………………………………………………. “Hey, you, it’s time to wake up.” Ten year old Ella jumped and let out a startled moan. “I’m sorry, I didn’t mean to scare you.” Rose said, with a slight smile. Ella turned to see the nurses hand still on her arm. She breathed a sigh of relief as she began to come to her senses. “Were you having a bad dream?” Rose asked. Ella nodded her head. “I’m sorry, sweetie, do you want to talk about it?” Ella shook her head. It had been almost a year since she had last spoken. She sat up in bed and looked around her hospital room for what she hoped would be the last time. She was going home with a new family today. As if reading her mind, Rose asked.” Are you excited?” Ella made a “so-so” motion with her hand by turning it side to side. “Nervous?” Ella pinched her fingers together leaving a small space in between. “It’s not going to be the same here without you.” Ella smiled slightly. It had taken nearly six months to find someone willing to take her in givin her medical history. Nobody wanted a child with cancer, even if she was officially in remission. Not to mention she came with more baggage than an airplane. Rose ran her fingers through the short stubble on Ella’s head as Ella leaned her head toward her. She loved the sensation of fingers on her scalp. “Heather and Danielle will be here in the next hour, so let’s start getting you ready. First I need to check your vitals.” The small girl held out her left arm as the Rose placed her middle and index fingers on the inside of Ellas wrist. “Pulse is good.” Rose said before writing the number 76 on the whiteboard next to the large letter “P” Next came her blood pressure. Ella stared at the words written on the board as the navy blue cuff began to fill with air. “Daily Goals” Eat at least half of every meal. Draw a picture. Take medication. Use the toilet at least once a day “Long Term Goals” Gain twenty pounds Talk with Words not gestures. Become famous artist Use bathroom unassisted Ella squirmed as the nurse finished with her vitals. “Looking good, kiddo.” Rose said as she wrote down the results of her blood pressure. “Breakfast will be here soon, but before that.” Ella gave her a pleading look, but Rose shook her head. “I know you don’t like it, but you need to start getting used to it. “ Ella could feel the tears starting to fill her eyes. She waved her head from side to side defiantly. Rose sighed and sat on the edge of Elle’s bed. “I wish you would tell me what’s going through your mind.” Ella shook her head again, letting the tears spill down her cheeks. “How can I help you if you don’t tell me what the problem is?” Chair, Ella signed with her hands. She was starting to fidget more. “I know you want the chair, but you need to start using the restroom.” Ella stuck her palm out facing forward to indicate NO! “Yes, look at me” Rose said. “You’re going home with your new family today. The chair isn’t going with you. What will you do when you have to go to the bathroom?” Hold it. “Forever?” Yes. “I think you’ll have an accident before forever comes. Do you like having accidents?” No, gross. “Those are your options now. Bathroom or accident.” Ella sniffled as she placed a hand in between her legs. “C’mon, take my hand. You can do it.” Ella cried silently as she placed her free hand inside Rose’s. “That’s a good girl. You’ll be in and out in less than a minute.” Rose pulled her to her feet and led her across the room to the closed bathroom door. She frowned as she felt the cold sweat in the young girls hand. Out of curiosity, she stopped and checked her pulse. 130 bmp and rising. “Honey, there’s nothing to be afraid of. Nothing’s going to hurt you in there.” Ella shook her head, nearly bawling. “What if I let you use the chair in the restroom. Would that help?” Ella shook her head no. She tried to turn and run, but Rose held her by the arm. “Don’t run away. We’ve been through this at least ten times now. The sooner you go in there and take care of business, the sooner you can leave.” No! Please no! Ella mouthed. “Then tell me what it is you’re so afraid of. Is it using the toilet? Does the toilet scare you?” Ella shook her head, still trying desperately to pull away. “Is it the flushing noise?” Ella shook her head again, closing her eyes tight as Rose opened the bathroom door. Rose sighed as Ella became dead weight. She looked in the small unit bathroom for some possible sign or clue as to what would cause her such fear. There were no shadows lurking in the corner, not a single sign of bugs. Just a sink, toilet, and bath surrounded by white linoleum tile on the floor with a cream color wallpaper. “Are you going to try to bite me again if I pick you up?” Rose asked. “Do I need to put your mouthguard in?” Ella didn't respond. “Honey, open your eyes. It’s okay.” Still no reply. “Will you walk to the toilet at least?” Rose sighed in defeat. This was as much progress as they had made in the last week. At least she wasn’t clawing and biting anymore. Rose bent down and picked her up with minor difficulty. At a mere 55 pounds, Ella was severely underweight and malnourished. The cancer treatment had delayed her growth, but as for her behaviour, Rose was at a loss. Did she somehow correlate bathrooms to being sick? Was her mind reliving the memories of chemo nausea when she stepped inside? No, that wasn’t it. She was fine using the portable commode, or what she referred to as the chair, but she had spent many nights with her face inside its pink bucket regurgitating her stomach’s contents. “I’m gonna set you down now, okay?” Rose lifted the girls hospital gown up and set her down. She tried to back away, but Ella still clung to her sobbing. “I need you to let go, I promise I won’t leave.” Ella shook her head, heaving and sputtering for air while clinging to the front of Roses scrubs. It broke Roses heart to do this to her, but it was what the Doctor wanted. Exposure therapy. “You’re fine. You’re fine. I’ve got you.” Rose whispered, rubbing the top of Ella’s head. The poor child was shaking now, and she doubted Ella would relax her body enough to pee anytime soon. She tried to distract her by talking about other things. She asked her what she was most looking forward to, but her question went unanswered. Her questions always went unanswered. She tried turning the faucet on, but it only seemed to heighten her anxiety. Five minutes went by, followed by ten. The hospitality staff had already come and gone, leaving Ella’s breakfast to grow cold on the table. “Anything?” Rose asked. Ella shook her head from in between the crook of Roses arm. “How about I get you back into bed then?” Ella nodded enthusiastically. “I think you gave it your best shot, but you’re just having a rough morning.” Rose grabbed her waist and lifted her back up. She peeked inside the toilet bowl, but it was as she expected, not a single drop. She set her back down on her feet outside the bathroom after closing the door, and Ella scampered off towards the bed, trying to put as much distance between her and the door as possible. Rose figured by the time she calmed down and finished her breakfast she’d have to go again. But then what? Repeat the process until something finally happened? And what if Heather and Danielle showed in the middle of one of her fits? They were aware of her issue, but what if it really hadn’t sunken in yet? “Go ahead and eat your breakfast. I’m going to go grab a few things.” Chair, Ella signed looking hopeful. “Dr. said no more chair, remember?” Rose said giving her a sympathetic smile. Ella let out a barely audible whimper. Rose took a quick glance behind her to make sure they were alone before leaning in close. “I’m not going to make you go back in there today, I promise.” The look of relief washed over Ella’s face, followed by confusion. Rose backed out of the room instructing Ella to eat. Ella looked down at the soggy looking toast and scrambled eggs. She poked at the eggs briefly with her plastic fork before taking a single bite of each. She pushed her plate aside resisting the urge to “ accidentally” dump it on the floor. The morning's events left her feeling a bit ornery. She reached by the side of the bed for her art supplies and pulled out the picture she had been working on. She wanted to have it done before her new foster mom, Heather, arrived. She had just finished putting the finishing touches on the horses mane when Rose came back pushing a cart of tubs and washcloths for her “bath”. “Is that all you’re going to eat?” Rose asked with a disappointed scowl. Ella just shrugged before placing her colored pencils and picture back in the shelf by her bed. Rose pulled the curtain around Ella’s bed giving them privacy. She helped Ella out of her dirty hospital gown, leaving her naked. “Go ahead and turn on your right side.” Ella frowned. This was not part of her routine. Was she about to get a shot in the butt? She tensed up expecting the worst, but instead of a needle she felt something hard and plastic cup her bottom half. Once instructed, Ella rolled back with the plastic pan resting under her. Once her brain registered what it was, she gave a slight push to get her bladder to start emptying. “He only said no commode,” Rose said with a wink. “Cheating I know, but I didn’t think you’d mind too much.” Ella grimaced slightly, feeling the urine run down the inside of her thighs and down her butt cheeks, before finally settling in the pan below. It was one of her least favorite methods, but her need to go outweighed her disgust. Rose nodded her approval at the sound of sloshing liquid. Ella didn’t mind the noise, in fact, she preferred it. She let the noises her body made speak for her. Rose didn’t have to ask if she’d gone pee yet when it trickled and drummed in the hollow basin. Even now she didn’t care that Rose watched her trying to squeeze out the last little bit before wiggling the droplets off her bottom . She had grown so accustomed to Rose’s presence when it came to her personal needs. Rose was the only one Ella trusted, and that trust had taken a long time to build. Ella gave the signal she was done. “Try and go number two.” Rose said. “You have a long drive ahead of you.” Ella scrunched up her face, and made a show of effort. She found they asked less embarrassing questions this way. Since nothing was going in, nothing was coming out so Ella signed she was ready again. “Let’s get you cleaned up before they get here.” Rose said. She rolled Ella off the bedpan before dumping the contents in the toilet. Ella listened to Rose talk about all the fun she would be having in her new home while she wiped her down with a warm, wet washcloth. It would be a six hour car ride from the hospitals’ children center she was staying at to her new family’s house, but Rose insisted it would be worth every minute. As Rose was helping her into a shirt, she commented on the picture Ella had been drawing. “You draw pretty well for your age.” Ella shrugged. She knew it was the only thing she did well for her age. She had missed the last two years of school, and the only way she could communicate was through baby sign language. She hadn’t always been like this. She used to talk, but something had changed. Was it from the cancer, or was it something else? Had something happened? She couldn’t quite remember. Ella looked down as Rose was putting socks on her feet. Pants. “We’re gonna hold off on that until I talk to Heather and see what she wants to do.” Rose explained. Ella gave her a puzzled look. “I’ll just cover you up with the blanket until then.” Ella passed the remaining time working on her picture. She was admiring her artwork when there was a knock on the door and in walked Heather. She beamed at Ella and Ella smiled back shyly. Danielle, Heather’s twelve year old daughter, came in after her giving a small wave. The group exchanged pleasantries and idle small talk until Rose suggested Ella show Danielle some of her pictures while herself and Heather talked. …………………………………………………………………………………………………………... , Rose led Heather down the hall and into the small conference room. “Are you all ready to take Ella home today?” Rose asked. “Oh yes, we’ve got half of Danielle’s room cleaned out and made a space for her. Danielle’s not too happy about having to share a room, but she’ll get over it. How’s she been doing? Have you been able to make any progress?” “We’ve been trying, but we haven’t gotten far. I wanted to bring up a few issues we’ve been having. You understand she’s non-verbal?” “Yes, and we’ve prepared for that. I know she’s only ten, but I decided to go ahead and get both her and Danielle cell phones. That way she can communicate through text if need be. So was she born non-verbal?” Rose shook her head. “Only for the last year. I was also working pediatrics when she was brought in during her chemo treatments. That girl could’ve talked your ear off, but then when she came back, she was completely different.” “Did something happen? Was it the cancer?” Rose shook her head again. “Her dr. thinks it’s all psychological. It’s some kind of post traumatic disorder.” She paused for a minute as she thought of the best way to explain. “You know her mother committed suicide, right?” “Oh no, I didn’t know that.” Heather said frowning. “I knew she had passed away but…” “Right in the middle of Ella’s treatments. She was never the same since, so I think a large chunk of her behavioral issues stem from that.” Rose said before letting out a sigh. “But for the life of me… the bathroom thing, I just can’t figure it out. She acts like going in a bathroom for anything is going to kill her. She’s terrified.” “I’ve never heard of a child being afraid of bathrooms, but hey, a mailbox closed on my fingers once when I was little. Wouldn’t go near one for two years.” “Ella was in the house when her mother shot herself.” Rose said grimly. Heather covered her mouth. “Did she see… anything?” “She must have, she hasn’t spoken ever since. You don’t walk away from something like that without a few screws loose. I’m really happy to see her going to a real home now. Maybe that’s what she needs, some stability.” Heather nodded. “Poor kid.” The two women sat in silence for a minute. “Any ideas how we should handle the bathroom situation?” “I’m not going to sugar coat it. It’s going to be rough at first. I’m hoping she’ll move past this if she’s put in a routine. She hasn’t been able to go alone yet; she’ll honestly cling to you the entire time and cry. I’d suggest start slow, give her time to adjust to her new surroundings. Maybe set up a camping toilet somewhere if you don’t want to deal with accidents.” Rose said with a shrug. “Or you could jump right into it, if she has to go she uses the bathroom.” Heather bit her lip. “It’ll be like potty training all over again.” “In a way.” Rose admitted. “To be honest, I’d stick with plan A. Give her time, and you can always encourage her to use the bathroom, but I don’t think it wise to force it. The dr. has been trying to force it, and she’s only taken a step back. She’s very young for her age.” Heather nodded again. “And what about the car ride? Six hours is a long drive. “Well that’s up to you. It’s your car. I wouldn’t trust her to speak up, and I’d be quite shocked if you actually got her to use a toilet on the drive back. Like you said, six hours is a long drive. I think we should diaper her.”