Clinical Opinion

There are a few things you’d rather not hear your pediatrician say, such as “cancer,” or “this is a fatal disease and there is no cure.” Then there’s this one:

“So. Is there any possibility you two are related?”

The doctor’s rust-colored hair was cropped close to his head, and he wore an extravagant blue bow tie, likely an affectation from the years (he made a point of telling us), “I practiced in Boston.” When he saw Silas he peered at him, tilting his head like a viper assessing a mouse for juiciness. Silas stared right back.

We sat down in his office, my heart thundering as though this pediatrician were about to administer an oral exam—which, in a sense, he was. “Do you think Silas can hear? What does Silas like to do? How does Silas play with others? Does he eat well? Sleep well?”

He skimmed through the medical records, scribbling notes on a separate sheet of paper, then looked up, continuing to stare pointedly at my son. Sensing the tension in the room, Silas crept behind my chair, then peeked out at the doctor with a tentative smile, not sure if he was friendly or not.

“He makes good eye contact,” the doctor declared. “But it’s not a social gaze. It’s a sort of a cold, hard stare.”

I didn’t want to be the silly mother in denial, so I kept quiet. Not a social gaze? I wondered to myself, knowing full well the way Silas’ smile can light up a room. You’re staring at him as though he were a Petri dish, growing an interesting species of mold. What do you expect him to do?

Then I began answering the questions. “Silas loves to chase balls and bottles, anything that will roll. He loves to spin things. I once saw him spinning a smaller pot lid inside of a larger pot lid, adjusting both lids very gently, to get them spinning together just right.”

“Obsessed with spinning things,” the doctor noted, jotting this down in his notebook.

Peter spoke up. “But it’s not like a mindless action. He’ll take the big basin we wash him in, turn it on its side, and get that rolling in a huge arc around him. He’s very concentrated, and he gets very frustrated if it isn’t just the way he wants it.”

“Short-tempered,” the doctor scribbled. “Easily frustrated.”

“He absolutely adores—and he has always adored—his books,” I ventured. “He can sit and listen to a stack of books, one after the other. And he has a rapturous love for music. Some of the mixes I’ve made for him, he’ll sit and listen to for an hour at a time, just entranced.”

The doctor ignored the part about the music. “When you read to him,” he asked. “What does he do when you read to him?”

“Do?” I was a little taken aback. What’s a toddler supposed to do? What was the right answer? “He smiles, looks from me to the book. He’ll turn the pages when we say ‘turn the page.’” Then I admitted, “But he doesn’t point to things. If you say ‘where’s the dog,’ he won’t point to it.”

“But he knows his books,” Peter interjected hopefully. “Antonia can start reciting the words from one of his favorite books—even when the book isn’t there!—and his face will light up. He recognizes the book, definitely.”

The doctor was writing furiously. “Cause and effect,” he announced, without looking up. “Would you say he has an understanding of cause and effect?”

I was eager, the little girl in French school again. I felt like raising my hand, anxiously calling oooooo I know this one! “Definitely,” I told the doctor. “From a very early age, as soon as we had him up at the table with us, he had this game he’d play with the water or wine glasses.”

Peter took over. “He figured out that if he bounced in his seat, the table would shake, and he could make the water slosh over the side of the glass.”

“Obsessed with water,” the doctor muttered, jotting this down on his pad.

“But isn’t that cause and effect?” I asked. “And turning the pages of a book because he wants to see the next page, isn’t that cause and effect? And flipping the light switch to see the light go on and off?”

The doctor raised his pale green eyes. He looked impatient. “Simple, rote behaviors. Repetitive flicking and bouncing. That’s all it is.”

I was quiet; I was wrong. But what about when Silas gets so excited to see what’s on the next page, and he turns it, at the right time, without even being told? That’s a rote behavior?

“His gaze, as I mentioned, seems very intense, but not social. Does he feel empathy at all, do you think? Does he smile socially?”

“Absolutely.” I told the doctor about the time Silas’ little friend Sammi started to cry, and Silas looked so worried and upset.

The doctor shook his head. “He was probably just responding to the sound. Is he hyper-sensitive to sound at all? Does he clamp his hands over his ears?”

“No, never. And he looked really troubled that the little girl was crying. Even her mother noticed it.”

The doctor pounced. “Ah, but was he troubled because the little girl was upset? Or because the sound was bothering him? He’s in his own little world, you see. Does he ever try to get your attention, does he seem gratified when you smile at him?”

“Of course,” I nodded emphatically. “Whenever I’m cooking, and he wants attention, he’ll pull on my legs or hang on me until I respond to him.”

The pale green eyes flashed. “But does he want the exchange with you, or is he just trying to get his own needs met? There’s a difference, you know.”

This didn’t make sense. “But what would a neuro-typical child do to get his mother’s attention? Aren’t all little children selfish? Aren’t they all trying to get their own needs met?”

The doctor snapped his head back and forth. “Even infants show empathy. It’s been shown in studies.” He turned his pale gaze on Silas. “Now let’s have a look at him. I’ll just measure his head, shall I?”

At this point, Silas was sitting in my lap, looking warily at the man with the notepad. He saw the tape measure come out, and he started to squirm. The doctor pushed his rolling chair towards us with gleaming leather shoes. He put the tape measure around Silas’ head. Immediately, Silas started squirming and twisting. I imagined he was whining in protest at this strange man, and his insistence on nineteenth-century phrenology.

“Hyper sensitive to touch,” the doctor noted. “He won’t even let me get near him. He hates being touched, doesn’t he?”

I had to disagree. “Not at all,” I protested. “He loves touch. He just hates being restrained. And we’ve seen several doctors in the past few days, and everyone keeps trying to put a tape measure around his head.”

“I’d be pretty pissed too,” Peter joked, thinly.

The doctor sat back, examining Silas’ face. “Round head. Full cheeks. A tendency to synophrys. He doesn’t really look like either of you, does he?”

Everyone says Silas looks just like Peter, but it seemed pointless to bring this up. I gestured to the space between my eyebrows. “I’ve got a bit of the Brooke Shields thing going. And Peter’s pretty hairy.”

The doctor lifted one of Silas’ feet and examined it. Silas, who had long ago decided he hated this man, kicked and howled. “Rather pronounced heels,” he murmured. “And very mottled skin.” At this point, it was clear to me that Silas’ skin was mottled because he was both Caucasian and cold, especially because he was wearing no pants. However, this seemed too obvious to mention.

The doctor was ready to grade our baby. We sat silent, breathless.

He reviewed his notes, not looking at us. “Without wanting to say the ‘A word,’ there is a possibility of autism. The lack of empathy, the inability to form social relationships, the repetitive actions.” He tapped his pen on his notepad, three short, sharp clicks. “From some elements of his appearance—as we’ve spoken about—there is a possibility of a genetic or metabolic syndrome of some kind.” He began pulling forms out of his briefcase. “I’m going to order a series of karyotyping tests, and we’ll see what comes up.”

He paused, looked at us. “This may be a strange question,” he asked. “But is there any possibility that you two are related?”

What the hell? I hesitated. “There’s a remote chance that we might have the same ancestors from Poland or something, but we’re not cousins or anything, if that’s what you’re asking.”

“I know it’s strange, but I have to ask. In some cultures, you know, it’s accepted. And it can increase the possibility of recessive genes appearing in the offspring.”

“The offspring,” at that moment, was down on the ground, crawling over to the doctor. Perhaps he had decided to give this horrible man a second chance. As the doctor talked, Silas pulled himself to a standing position, drooling on what were undoubtedly an expensive pair of black pants. Instinctively, I started reaching for the diaper bag, to pull out a little towel and apologize. Then I stopped myself. The guy’s a pediatrician, I considered. Juicy babies must go with the territory.

“He certainly does drool a lot,” the doctor commented, distastefully. He edged his knee away from Silas’ wet chin. Silas reached out for balance, then fell backwards on his bum.

“He’s making five teeth right now,” I explained, scooping up my baby. “It’s part of the teething.”

“Maybe,” the doctor mused. “Or perhaps not.”

Oh, God. Is he going to tell us our child is a drooling idiot? We waited.

And then, he did. “In my clinical opinion, Silas is globally at a nine-month level for a nineteen-month chronological age,” the doctor pronounced. “This is what we call a global developmental delay.”

There it was. Our kid’s retarded. “So without sounding too Polyanna-ish,” I asked softly, “is there a chance he can catch up with his peers, with early intervention?”

The doctor studied me, tilting his head in that serpentine way. “Likely not.” His words fell around us like stones. Cold, hard, final. “We can’t test cognition in a child this young, but as a rough guide, we divide the chronological age into the developmental age.”

“So nine, divided by nineteen. Help me with the arithmetic and the implications.”

The doctor didn’t skip a beat. “He could have an IQ of 50.”

Beside me, Peter breathed out. “Wow. That’s heavy.” I looked over at my husband. His face was strained, in a way that perhaps only I know means he is holding back tears.

Silas was on the floor, flipping the pages of his caterpillar book, seemingly unaware that he’d just been assigned a future as a drooling cretin.

“What do we do with this?” I stammered. “I mean, where do we go from here?”

“What do we do?” Peter wanted to know. “How can I help my son?”

The doctor looked startled at our emotions. “There’s really not much you can do. Help him to get out of his own little world, if you can. I’ll leave you with the forms for the child disability allowance. You’ll get money now, every month.” He tapped his watch, pointedly. “I really must be moving on. It’s after one o’clock, you know.”

The doctor handed us forms, and a bill for $350. We tucked Silas’ things into our bags. We changed the baby’s diaper, pulled on his pants. I felt detached, as though I were floating in air.

Silas started to squirm again, impatient with the mean man and his cramped little room. Peter took him outside. I turned to the doctor. His eyes looked troubled, as though he wasn’t sure what it was he’d said to upset us. As though, I thought, he can’t read other people’s feelings.

I shook his hand. “Thank you for your candor, doctor.” What more was there to say?

We paid our bill, in cash, as required. We walked to the elevator in silence. We rode down to the ground level. We said nothing.

We floated to the car. Peter strapped Silas into his seat, removing his jacket first because it was hot and we’d been parked in the sun. He sat in the driver’s seat. He leaned over, putting his arms around me. We sat, rigid, for a moment, then our shoulders loosened. The tears came, hot and tight. I clawed his neck, screaming rage and fear into his shoulder.

After a few minutes, Peter started the ignition. He was wearing his sunglasses, but I saw his eyes were wet behind the lenses. I turned back to Silas. Will he ever love books? Have a stimulating conversation? Challenge someone’s ideas? Fall in love?

Will he ever say ‘mama’?

“Ready to go home?” I asked, and smiled at my son.

Silas looked at me, his face instantly alight with love and joy. His big, brown eyes looked clear and intelligent. He craned his head around, eager and curious to see more.

He doesn’t look retarded to me.

But what the hell do I know? I’m just his mother.