The Diagnosis
A father confronts the implications of his son's diagnosis of special needs.
Diagnosis Med. 1. a. The act or process of identifying or determining the nature of a disease by examination. b. The opinion derived from such an examination.
I take Alex to the developmental pediatrician armed with a few granola bars, a bottle of water, a few diapers, and wipies. I also bring my certainty of what the doctor will say should she make a diagnosis.
I steer Alex into an open room that has carpeted stairs, a gym pad, a two-way mirror, and a door that won't lock from the inside. The ped's assistant occupies Alex with shopworn toys while she asks how he's doing in school, how he's sleeping, how he's getting along with his little brother? This is only the third time we have seen this doctor, only the second time I've watched Alex bounce around this room, flying every two seconds to turn off the light switch or open the door. Now when he opens a door, and this is an improvement over previous appointments, he turns around to machine-gun the room with "Bye! Bye! Bye!"
The doctor enters. "Who do you see up on the shelf?" she asks. Alex looks at her. Incredible, but even now there's a germ of impulse in me that wants to please doctors. "Who do you see up on the shelf?" she asks again. "Elmo," I say, looking at Alex.
"Let him answer," she says.
Her forehead creases with concern. "No signs of aggression at all with the baby?" she asks. I tell her no, and in fact Ned is usually the one pushing Alex, who turns to us for help. I tell her Alex is counting a little, identifying letters in books, saying three-word sentences. Since this doctor last saw him, Alex has started eating cheese, ice cream, and some yogurt!
To balance my report, I relate how he hit the roof during his birthday. I tell her we were told it was performance anxiety. "I wish he was old enough to have performance anxiety," she replies.
Alex is ricocheting from toys to stairs to door to light switch. "What would he do if you were to leave the room?" the doctor asks me. Probably not much, I admit. Play a little, ricochet, probably open the door in a few moments, but more to get out ("Bye! Bye! Bye!") than pursue me.
"What would you do?" the doctor asks Alex in a playful voice. Alex laughs. "Where are your teeth?" the doctor asks. Alex busts a gut, and repeats the phrase "Where are teeth?" over and over. Alex actually kisses her.
We go to the doctor's office next door for the exam. Alex refuses to acknowledge figurines of Big Bird and Tinkie-Winkie, though he does spy a plastic train on the shelf. "Iwanchocho," he says.
"Did you hear that?" asks the doctor. "He asked for the train."
Alex laughs. She tries to weigh and measure him. She shines a light in his left eye. "I'm very concerned about what that left eye is seeing..." she says. She lassos Alex's skull with a tape measure. He puts up with that better than I've ever seen. He likes her. I do too, abruptly. Maybe I sense I can talk business to her, as a tired father looking for some doc to finally offer a clue about Alex's life.
"Doctor," I say, as she makes dots on a blue chart, denoting Alex's increasing -- or not increasing -- skull size, "do you have any kind of a diagnosis?"
And she says, "I do."
She spins in her chair to face me. "Alex has, I'm pretty sure, static e-" I confess I didn't keep what she said in my head. It wasn't "encephalitis" or anything easy like that. When I go home tonight, I'll take out the letter she gave us and read the word again. I won't remember it then, either. I'll have years to memorize it. "Basically," the doctor says, "it means that at some point, during either the prenatal or perinatal stage, there was a lack of oxygen to the brain."
"Brain damage?" I ask.
Yes. Okay.
I tell her my plan: Get Alex's new school year started. Get the oxygen tank out of our house. ("Are you still paying for that?" she asks, and I like her more: She's a doctor who talks about money.) Get Alex to a neurologist. Get Alex back to the eye doctor. I further stipulate that I don't like ADD drugs.
"I think Alex would be one child who would really benefit from them," she says. "But that's, that's down the road."
"Well," I say, "now we can concentrate on getting him the best life we can age five to ten, then the best adolescence, then the best young adulthood while we're still around to help him." That's a solid speech. I even ask what this doctor knows about assisted living homes. But that's, that's down the road.
Then she asks: "If you had it to do over again, what would you have done differently?"
I like her most of all for asking that question, though of course my answer is worthless.