The Diagnosis
by Laney
Luka grabbed the chart for the next patient and headed down the
hall
reviewing it as he went. Uncontrollable arm and head
twitches. Vital signs
normal. He paused briefly outside the door and peered
through the window at
the mother and child inside the room. The boy, who looked
to be about 10,
sat on the exam table, bouncing his legs nervously against the
side. He
seemed a typical pre-adolescent, tan lanky limbs, hair cut so
short as to be
almost non-existent, regulation hi-top tennis shoes drumming a
staccato beat
against the table. Every few moments however, he would
raise his right arm
and make a circular motion in the air with his hand, duplicated
immediately
after with the left. Then the childs head would snap
back and off to the
side, as if he were tossing an imaginary lock of hair from his
brow. The
mother rocked; up and down on the balls of her feet in front of
the boy,
stopping at each repetition to grab his arms and pull them down
to his
sides.
Luka pushed open the door and entered the room. How
do you do, Mrs.
Randolph? My name is
Dr. Kovac, he introduced himself. The woman backed
away from her son and
turned to face Luka. She shook her head acknowledging at
once both her name
and the greeting. She stood before him, an older, female
version of the
boy, tall and slender, streaks of gray just beginning to show in
the
abundant auburn curls that formed a bright red aura encircling
her face.
There could be no doubt that this boy and this woman belonged
together.
Luka wondered if the boys hair were longer, if it too would
display the
rich color and impressive body of his mothers and whether
there could be
any traits left that reflected the father, so perfectly were
these two
matched.
Luka began his examination, the mother hovering tensely in the
background.
He ordered a series of tests, although nothing seemed out of the
ordinary,
in fact, ever since Luka had entered the room, the boy had not
made another
movement, not a single arm or neck twitch. When the test
results came back,
everything appeared normal. He asked questions to try and
pin down if
perhaps there were a psychological cause; the repetitive
movements smacked
of obsessive compulsive disorder. The mother sensed
immediately where he
was heading and became defensive.
Ben isnt crazy, she said with certainty. Hes
having muscle spasms, or
seizures. You need to find out whats causing them and
stop them, do you
hear? She placed her hands on her hips, defying Luka
to further his
insinuations.
Mrs. Randolph, I assure you that we will check everything,
but we have to
be completely thorough. Doesnt it seem strange to you
that Ben hasnt had
an episode since I have been here?
Im not making this up, doctor. She
insisted, thrusting her arms and
hands before her now, palms up, backing away from her defiance,
pleading
with Luka to believe, He really does these things with his
arms and neck.
When I tell him to quit, he says he cant.
Luka sought immediately to calm the distraught woman placing a
comforting
hand on her arm. I believe you Mrs. Randolph. I
observed Ben from outside
the room before I entered, and saw what you are talking about.
He
understood that she had brought the boy here wanting an answer,
wanting a
condition that required a simple pill or a shot. She had
come seeking a
cure not some psycho jargon.
Luka had a sudden thought, a diagnosis that fit all of the
symptoms. He
turned from the mothers anxious face to the boy on the
table. Ben sat
fidgeting, fingering some loose strands of thread on his hospital
gown. He
looked small for his age, but his eyes were bright and
intelligent. He
regarded Luka keenly, leaning back to look up at the imposing
figure before
him. Ben, do you sometimes feel like you have to make
sounds? Luka asked
him, lowering his voice. Ben paused for a moment and
glanced furtively at
his mother over the doctors broad shoulder. He ducked
out of her sight
behind Luka and gave a quick nod. Do you ever feel
like you have to say
words? Again, almost imperceptibly, the boy nodded.
Luka lowered his
voice further, to a near whisper, so that only Ben could hear his
next
question. Do you ever feel like you have to say, you
know, bad words?
The boy hung his head in shame, but shook it nonetheless.
I dont understand, he said, softly. I
dont want to, but I have to. If
I bite my lip real hard, sometimes till it bleeds, then I can
stop it, but
not for very long. Bens hands shot up and he
performed the waving motion
and head twitch that Luka had seen earlier through the door.
You can stop that for awhile too, cant you?
Just not for very long?
Uh huh, Ben answered as his head flew back again and
his eyes raked the
wall and ceiling. Its so much worse though when
I finally quit fighting
it. He lowered his head again to look solemnly at his
knees and said in a
choked whisper, They make fun of me at school sometimes.
As quietly as the boy had spoken, his words were still picked up
by the
extra sensory ears of his mother. She sidestepped Lukas
protective shield
and was in the boys face in an instant. Of
course they make fun of you!
If you would just stop acting so crazy! She turned to
face Luka, If you
say that hes all right, then Im going to have to
start punishing him. It
s all for attention, isnt it? Luka was
beginning to lose his patience
with this woman. She seemed to have no understanding of
what her child was
going through. Then he had to pull himself up and remind
himself that this
was an uncommon condition and often parents didnt have a
child properly
diagnosed until well into their teens. That was a lot of
years of
misunderstanding and reproof for something that was entirely out
of their
control.
Mrs. Randolph, Ben is exhibiting classic symptoms of
Tourettes Syndrome.
Do you know what that is? Although she shook her head
no, Luka thought
that she must have an idea what he was talking about, most people
had at
least heard of it. He could also see plainly the fear in
her eyes, another
indication that she understood. He went on to explain as
simply as
possible. It is a neurological disorder characterized
by tics both
physical and vocal. Vocal tics can include repetition or
echoing of others
words or the use of improper language. The condition is
considered
hereditary, although recent studies have pointed to a possible
bacteriological trigger. She hadnt moved and
seemed hardly to have
breathed. He continued with his explanation.
The need to perform the tic is all consuming. Think
of it as having an ant
bite and trying not to scratch it. You can ignore it for
awhile, but
eventually you would go crazy if you didnt deal with it.
There are drugs
that can lessen the urges, control to some extent the movements
and sounds.
Ill make you an appointment with a pediatric neurologist
and he can go over
all of the options with you.
Mrs. Randolph looked at Luka in disbelief; the fear in her eyes
now replaced
with anger and denial. That is ridiculous, she
spat out each word.
There isnt anyone in either of our families with
something as crazy as
that. I would think we would know, its not like its
something you could
hide. She looked accusingly at her son. Give
him a test, thatll prove
you wrong.
No, Im sorry, there is no test. It is diagnosed
through observation and
the presence of the symptoms I have just described.
Mrs. Randolph was
already shaking her head again.
I dont accept this. You are telling me that he
cant control this, that
he will be doing this forever?
I dont know. The condition changes throughout
the patients lifetime.
Sometimes it gets worse, especially through puberty and
sometimes, when
patients get older, it might improve. The symptoms change
as well. What he
does today, might not be what he does next week or next month.
What is most
important for you to understand, Mrs. Randolph, is that
physically, Ben is
healthy. He might need some extra help in school but with
understanding and
guidance, he should be fine. His greatest handicap will be
the people
around him, how they deal with this, especially you.
Mrs. Randolph resumed her intense rocking. She seemed to be
getting angrier
by the minute, her cheeks taking on the same flame color as her
hair. No,
she said finally, I dont believe you. Im
taking Ben somewhere else. I
cant afford it, but by God, Im not letting you tell
me that he is a
nutcase. Mrs. Randolph marched over to her son,
grabbed his hand and
jerked him off of the table. She turned without another
word and left,
dragging the boy after her. Luka could only stare at the
door as it snapped
shut behind them.
Late the next day, Luka had signed off on the last set of patient
instructions and was finally on break. He was starving and
had one giant
headache due either to the change in the weather; fall had
definitely
arrived in the form of a major blast of cold, crisp air, or
Carter and Chen
s incessant sniping. He had a theory about those two, that
their constant
bickering was really some form of foreplay, like when in the
third grade you
pulled the hair of the girl that you fancied and then ran like a
bat of hell
when she chased you, secretly hoping that she was a really fast
runner. I
m going across the street for something to eat, he said to
Amira on his way
out. Amira however, had other ideas.
Not so fast Dr. Kovac. You have someone waiting to
see you. Shes been
here for over three hours. I told her you were real busy,
but she insisted
on waiting, said she had to talk to you. Amira
pointed to chairs and Luka
headed that direction, tired and disappointed. Mrs.
Randolph was sitting
with her arms thrown over the razor sharp back of the seat beside
her,
cushioning her head. Lukas stomach sank as he could
sense a long and
painful consultation ahead, but recognized also a woman in need.
He
straightened his attitude and touched Mrs. Randolphs arm.
Mrs. Randolph, you wanted to see me? Her head
snapped up and she stood
immediately, looking both embarrassed and exhausted. He was
sure she hadnt
slept the night before. He was very familiar with the look.
Yes, Dr. Kovac, if you could spare a minute, I would like
to talk with
you.
Lets go in one of the exam rooms where we can talk
privately, shall we?
Luka led the way to exam 2 and closed the door behind them.
What can I do
for you? Mrs. Randolph stood in the center of the
room staring at her
toes, deep in thought. Luka was getting a little impatient,
she had after
all, had the last three hours to think up whatever it was that
she wanted to
say. Finally, she looked up at him, and he could see that
she had been
crying.
I wanted to apologize to you for yesterday. I know I
acted crazy, stupid.
No, goodness no. You dont have to worry about
that. You were given some
difficult news.
Thats just it. You see, I was thinking about it
all night. My boys not
going to die Dr. Kovac. He isnt even going to be kept
from doing most
things in his life. I guess he might not be able to work in
a library, or
maybe he cant be a mime. She gave a nervous
laugh, Its just that, well,
one minute everything was normal, everything was fine, and the
next minute,
it all changed. She paused to take a breath and took
a step closer to
Luka. Do you have kids, Dr. Kovac?
It was Lukas turn to be at a loss for words. He had
denied having a wife
not long ago when a patient had asked, and that had seemed okay.
It had
given him a moments hesitation, though. But to deny
his children, to deny
being a father, how should he answer this one? If he
answered yes, he might
get caught in a mire of questions and evasions. As he
hesitated, Mrs.
Randolph didnt, and forged ahead without his answer.
You want whats best for them, always. You want
them to have the best
schools and the best doctors and the best teeth and the best
hair. You want
them to be beautiful and smart and happy. But you know
what? Its not
about what I want. Its about that little boy of mine.
So I cried last
night for me, for what I lost yesterday, all of those dreams of
perfection,
and I cried for him too, because I know its going to be hard for
him. But I
m done crying now. Now I just have to figure out
where to go from here. I
wanted you to know that, cause you really seemed to care. I
wanted to say
thanks for you caring, too. You know, if you dont
have kids, you should.
I think you would be a great daddy.
Mrs. Randolph gave Luka a shy smile and slid past him to the
door. Her
eloquence and obvious love for her son moved him. Mrs.
Randolph? She
stopped with her hand on the doorknob. Your son is
very lucky to have you
for a mother. I give bad news to people all of the time.
Your reaction
yesterday wasnt at all unusual. Your actions today
are. If there is ever
anything I can do to help, please let me know. Luka
held out his hand to
her. She shook it carefully, holding his hand briefly, a
moment of mourning
for that other time, when things were normal, passing between
them. She
relinquished her grasp finally, gave him another quick smile and
slipped
through the door. Luka told Amira again that he was
leaving, but instead of
heading directly for the restaurant across the street, he took a
seat on the
bench outside, breathing in the brisk fall air, hoping the sun in
his face
might drive out the headache that still pounded behind his left
eye.
How would he have reacted if he had faced something like this, he
wondered?
It was certainly a matter of its all relative.
Luka would give anything
to have to face this crisis, any crisis with his children, if it
meant that
they were here, now. He would take them anyway he could get
them, that was
for sure.
Someone had asked him once, if he had known how his life would
go, if he had
known the horrors that were in his future, would he have changed
anything?
Would he have not married, or not have had children?
Certainly, he would
have changed that his family wouldnt have suffered and
died. But even
knowing what he knew, and perhaps here he was being selfish, he
would not
have given up one moment of his life with them. He would
not have wished
for some other life; that he had married someone else; that his
babies had
never been born. He would bet that Mrs. Randolph would say
the same.
In his head, he repeated the words to a song that he had started
but never
finished;
Yesterday, I looked into your eyes,
If I had known then what pain you would bring,
Would I have given you my heart, my life?
Would I have made you my everything?
And the last verse went the same, only ending,
If I had known then what pain you would bring,
I wouldnt have changed a thing.
It had been one of his first attempts at being creative in
English and it
had proven more difficult than he had expected. Someday,
maybe he would
finish it, but he had written the most important part.