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 child’s 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

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 boy’s hair were longer, if it too would display the
rich color and impressive body of his mother’s and whether there could be
any traits left that reflected the father, so perfectly were these two

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 isn’t crazy,” she said with certainty.  “He’s having muscle spasms, or
seizures.  You need to find out what’s causing them and stop them, do you
hear?”  She placed her hands on her hips, defying Luka to further his

“Mrs. Randolph, I assure you that we will check everything, but we have to
be completely thorough.  Doesn’t it seem strange to you that Ben hasn’t had
an episode since I have been here?”

“I’m 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 can’t.”

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 mother’s 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 doctor’s 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 don’t understand,” he said, softly.  “I don’t 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.”  Ben’s 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, can’t you?  Just not for very long?”

“Uh huh,” Ben answered as his head flew back again and his eyes raked the
wall and ceiling.  “It’s 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 Luka’s protective shield
and was in the boy’s 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 he’s all right, then I’m going to have to start punishing him.  It’
s all for attention, isn’t 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 didn’t 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

“Mrs. Randolph, Ben is exhibiting classic symptoms of Tourette’s 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 other’s
words or the use of improper language.  The condition is considered
hereditary, although recent studies have pointed to a possible
bacteriological trigger.”  She hadn’t 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 didn’t deal with it.  There are drugs
that can lessen the urges, control to some extent the movements and sounds.
I’ll 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 isn’t anyone in either of our families with something as crazy as
that.  I would think we would know, it’s not like it’s something you could
hide.”  She looked accusingly at her son.  “Give him a test, that’ll prove
you wrong.”

“No, I’m 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 don’t accept this.  You are telling me that he can’t control this, that
he will be doing this forever?”

“I don’t know.  The condition changes throughout the patient’s 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 don’t believe you.  I’m taking Ben somewhere else.  I
can’t afford it, but by God, I’m 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.  She’s 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.  Luka’s 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. Randolph’s 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 hadn’t
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

“Let’s 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

“I wanted to apologize to you for yesterday.  I know I acted crazy, stupid.”

“No, goodness no.  You don’t have to worry about that.  You were given some
difficult news.”

“That’s just it.  You see, I was thinking about it all night.  My boy’s not
going to die Dr. Kovac.  He isn’t 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 can’t be a mime.”  She gave a nervous laugh, “It’s 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 Luka’s 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 moment’s 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 didn’t, and forged ahead without his answer.

“You want what’s 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?  It’s not
about what I want.  It’s 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 don’t 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 wasn’t 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 “it’s 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 wouldn’t 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
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 wouldn’t 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.

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