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If ever a child needed a mothering figure, B did. She sat in my office, a sullen, thin girl of 12 years, wearing a purple bandana over her shaved head. During our visit, B hardly made eye contact with me. She responded to my questions with a paucity of words, and the only spontaneous speech she offered was her repeated, tearful utterance, "I want to go home. I just want to be with Mama."
And why not? I felt at first. Three years earlier, B had learned that she had Ewing sarcoma. The cancer had metastasized to her brain. B had undergone several resections, chemotherapy, and radiation therapy. Although her cancer was now in remission, the prognosis was very poor. She had foot drop as a result of surgery and walked with a leg brace. She was not expected to live beyond her 17th birthday. B had been sent to our unit involuntarily from the oncology service after her mother reported that B had attempted suicide 4 days earlier. Apparently, B's mother had found her trying to choke herself with her own hands. Indeed, B admitted that she had intended to kill herself and that she had tried to do so 2 years earlier, unbeknownst to her mother.
Bdescribed long-standing feelings of depression and pananxiety symptoms. She was taking quetiapine and sertraline for her mood lability and anxiety, and this regimen had been moderately effective. B had also been receiving lorazepam as needed from her oncologist.
B's developmental and family history were traumatic and complicated. She had been sexually molested at the age of 3-allegedly by a teenaged cousin-but B had only a vague memory of this event. Her parents had been divorced for 4 years. B was fond of her father but stated that she did not get to see him much because "Mama doesn't trust him." B had shared a bed with her mother, a 43-year-old noncombat military veteran, since B was an infant. "My Mama needs me," B told me. Her 91-year-old stepfather slept in another bed. Further questioning revealed that B's biological father was homosexual and that she believed that she was as well. B was in the 7th grade and was often teased at school for "looking like a boy."