THE MAGIC WAND | Brian Deady
She comes whooping and high-pitched screaming to the emergency department’s triage desk, which I interpret to be her look-out-‘cause-I-can’t control-myself warning. She is slight teenage girl accompanied by a woman I presume to be her mother, who looks less than pleased to be here. I have work to do and carry on.
It’s one of those days where it’s hard to get one thing done for having to do six others. You know how it is. You’re writing on a chart and a nurse interrupts you to tell you there is a patient with chest pain in bed 106 who needs your attention but before you can sort out this patient’s presenting complaint you get an overhead page to talk to a consultant on the phone.
“I meant to tell you that mother is getting increasingly forgetful, doctor,” a middle-aged woman says to me, as I hang up the phone.
“Oh,” I say, staring a bit blankly at her.
“Yes, I hate to interrupt but I didn’t want to risk upsetting her when you were with us at the bedside. You managed to make her laugh and I didn’t have the heart to take that moment away from her.”
And then my brain matches the elderly patient to the concerned woman before me and I say, “Okay, thanks for letting me know. She is quite the feisty woman. Loved her Glaswegian accent,” I smile before continuing. “So anyway, listen, we can talk about it when all the test results are back. Then we can come to a decision together. Okay?”
“Yes, quite. And while I have your attention, that little line that she liked, sorry, I know you’re busy, but what was it again? The men of Scotland?”
“Aye. The men of Edinburgh have deep pockets and short arms.”
She smiles, “Yes, that’s it! I’ll remember it now.”
“Funnier if you’re from Glasgow, to laugh at the supposed stinginess of gentleman from the capital, of course. But it’s adaptable. You can put any town you like in there.”
Satisfied, she returns to her loved one’s gurney. As I try to return to the task at hand, I am told the adolescent girl is ready to be seen and could I come now? I pick up the chart — 15-year-old female, agitated.
I walk in to see a mother, perhaps early 40s with occasional strands of grey hair streaked blonde, looking somewhere between pissed-off and tearful. And on the gurney, sits a slender youth with long brown hair. I introduce myself to the mother and am momentarily unsure of how to proceed. She greets me flatly, like she is trying to control her emotions but wouldn’t mind if I give her an excuse to tear a strip off me. Like she needs a pop-off valve to let off some steam.
I look at the teen and talk to her, “ Hi Agnes,” saying the name on her chart.
She looks my way only momentarily before she parrots back, “Hi Agnes.” She flaps her hands briefly before letting out a whoop-whoop. This time it is not piercingly loud, for which I am thankful.
“Yeah nice try but you’re not gonna get much from her,” she says.
“Okay, but you know I’ve gotta try.”
“Go ahead. Fill your boots.”
So the kid and I play our game. I become convinced that my initial walk-by diagnosis had been correct. I return to her mother.
“So she’s on the autism spectrum?”
“Yes,” she said and a tear forms in the corner of her eye.
“Frustrating sometimes, isn’t it,” I say, not as a question, but as a self-evident statement.
“God, yes. The school called half-an-hour after I dropped her off. Told me she was unruly and screaming and basically disturbing the peace. And that I ‘d have to come and pick her up. Like I don’t have other things to do in my life. Just drop everything now and come pick up the pieces they can’t hold together. I mean, I had just got to work. Boss is patient with my home situation, but you know, I am getting fearful for my job. This isn’t the first time this has happened.”
There it was. I’d found the relief valve and she tears up for real this time. “No one else can pinch hit for you?”
“Who? Like her useless excuse for a father who bailed on us the minute things got tough? No, there isn’t, okay? It’s just me.”
I weigh the pros and cons and decide that a way forward for this mother might be for me to share a bit of my life.
Among the things I say, I offer this to start, “I want you to know that I have a son who is about a ten years older than Agnes. He’s on the spectrum, too. So, I really do understand your frustration. Nothing about raising your child is how you had imagined. Goals and dreams for her, for example. And for you as her parent everything shifts, too — your friendships, career aspirations and married life itself. And I won’t get started on how the school system fails for kids like Agnes.”
I have a few suggestions for her. I make an outpatient referral to a child psychiatrist with an interest in autism. I tell her that as the mother of a significantly challenged daughter, she needs and has a right to at-home assistance and provide some information to get started. We discuss potential medications to help her daughter stay on track. I can’t say she looks happy with the information. I understand only too well that the magic wand she really desires doesn’t exist.
Later, on the drive home, I stop to pick up a baked dessert for everyone at home, but mostly for my son. I think about how it will likely play out at the dinner table. That between his caregiver, my wife and me, we will be able to coax him to finish his supper with a bribe of apple pie. And that if we are lucky and he is in a good mood, I might be able to cajole an infectious laugh from him. He will tilt his head back and guffaw. And we will follow suit.
Brian Deady has practiced as an emergency physician for the past 25 years at the Royal Columbian Hospital in Greater Vancouver, British Columbia, Canada. He and his wife have raised four children, all now young adults. During his career he has published a number of medical humanities pieces, primarily in the Canadian Medical Association Journal and the Canadian Journal of Emergency Medicine plus a few others in Humane Medicine, The Yale Journal for Humanities in Medicine and The Globe and Mail. He is pleased to see his writing for the first time in Intima