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Volume 2, Issue 2
Summer 2006:


Brian T. Maurer

Cell 2 Soul. 2006 Summer; 2(2):a5

Spring Awakenings
Photographer: Thomas Doty
[Larger Image]

Walter has come in for his four-year-old check-up. I can hear him bleating like a frightened lamb as his father drags him down the hallway.

His mother follows closely behind; her young infant swaddled in a cloth hammock sleeps soundlessly against her chest.

The more his parents entreat him to calm down, the louder Walter's cries become, until they fill the hallway with a deafening cacophony.

I am not looking forward to this visit. I push back into my office chair and stare up at the ceiling, recalling my last conversation with Walter's mother, just two short weeks ago.

It was then she told me that Walter had been diagnosed with autism by one of the pediatric neurologists. The diagnosis certainly fit with Walter's bizarre behaviors, which had surfaced shortly after he received his immunizations at 15 months of age. (The mother was adamant that her new baby not receive any routine immunizations in infancy, despite my attempts to convince her otherwise.)

She also related a curious incident to me that day.

Walter had been given midazolam, a sedative, during a recent visit to the dentist to allow the dentist to fix his teeth. Instead of becoming drowsy, Walter became lucid: he stopped fidgeting in the dental chair and focused on what his parents told him. He actually uttered several coherent phrases — something he had never done before. (Walter's speech is primarily echolalic: he repeats words and phrases spoken to him without understanding what the words mean.) Afterwards, Walter spent some time coloring in a coloring book, again an activity that he had never engaged in previously.

By the following morning, Walter had regressed to his usual agitated incoherent self.

They had never considered medicating him before, the mother told me; but these changes, although transient, were dramatic.

She asked what I thought. I told her that I knew of no studies in the medical literature on the use of midazolam in autistic children. I offered to consult with Walter's neurologist to ask her opinion.

Subsequently, I faxed a detailed letter to Walter's neurologist, explaining the anecdotal incident; she never responded to my query.

Now here they were in the office, and I had no new information for them.

Walter's cries again reach my ears, calling me back to the present.

"He wouldn't let me take his blood pressure," the Medical Assistant explains, handing me the chart. "I barely got him weighed and measured."

I accept the record and step into the exam room where Walter waits with his parents.

After a brief greeting, I launch into an explanation of my failed attempts to find any helpful information regarding the use of midazolam in autistic children. The parents listen intently as best they can over Walter's bleating cries. Once again the father recaps the salient points of the incident that had occurred at the dentist's office, when Walter seemed to wake up.

I suggest to Walter's parents that they consider getting a second opinion from another neurologist. To my delight, Walter's mother informs me that she has already taken steps to do just that.

"Excellent," I say. "Now, let's see if we can have a look at Walter today."

I pull my stethoscope from my shoulders and quietly approach the boy where he struggles in his father's arms. Slowly I begin to speak to him, modulating my voice in soft tones, explaining that I am going to listen to his chest, that it won't hurt, that it will be all right, everything will be fine.

And now a curious thing happens: Walter stops bleating and looks at my face. I notice his eyes: clear and dark and deep. For some reason, he doesn't look away; he seems to fixate on my voice.

I show him the stethoscope, encourage him to touch it, gently place it on his chest. He recoils a bit, and then sits quietly in his father's lap as I move the diaphragm back and forth over his chest and back.

Afterward I praise Walter for how well he has done. I continue to talk to him as I move through the remainder of the exam. Walter allows me to feel his belly and neck, to look into his ears and examine his teeth. His eyes, clear and dark and deep, follow my movements. I finish the examination and step back into the hushed silence that now permeates the tiny room.

Then Walter's father speaks: "Can we rent you for the hour, Doc? How does $500,000 sound for one hour on Sunday afternoon?"

I chuckle, not knowing how to respond, and then I say: "Well, that's even more than Bob Costas makes for covering the Olympics."

Clearly his parents are astounded at Walter's response; I am too. I can offer no explanation for what has taken place. No medication has been administered, only the sound of my voice seems to have stirred something within him.

I recall the opening lines in Thomas Wolfe's rambling novel Look Homeward, Angel:

"In her dark womb we did not know our mother's face; from the prison of her flesh have we come into the unspeakable and incommunicable prison of this earth.

"Which of us has not remained forever prison-pent? Which of us is not forever a stranger and alone?

"Remembering speechlessly we seek the great forgotten language, the lost lane-end into heaven, a stone, a leaf, an unfound door.

"O lost, and by the wind grieved, ghost, come back again."

Walter's response has been an awakening of sorts for all of us.

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