by Torey Hayden
It was only at that moment he realized what he had done, that he had made the sign himself. The laughter fell away immediately. There was a heartbeat’s hesitation and then came a curious, almost expectant expression.
“Can you do it again?” I asked.
A long pause. Then he did it very quickly, almost as if not to be caught doing it.
“Good! Good job. Here.” I gave him a second M&M.
I returned to my chair and sat down. As I did so, Drake reached out and tapped my arm. I looked at him and immediately he signed “candy” again. I laughed and gave another piece.
“Now, here is a new sign. What do you think this is?” I drew my index and middle fingers of each hand back from my eyes.
For a moment Drake wrinkled his brow in concentration, then shook his head.
“It’s an animal. What animal has stripes like this going back from his eyes?”
Still Drake couldn’t guess.
“It’s an animal right in this room. Right now!” I said.
Drake exploded with joy. Leaping from his chair, he shot around the table and grabbed Friend tightly around the neck.
“That’s right! This is the sign for ‘tiger.’ And we have a tiger right here, don’t we? Can you make this ‘tiger’ sign, too?”
Drake promptly complied.
“But we don’t just want to call him ‘Tiger,’ do we? That would be like my calling you ‘Boy.’ We want to call him by his name. ‘Friend.’ Here is the sign for ‘Friend.’ See. Fingers coming together like this, because friends like to be together.”
Drake imitated my gesture.
“That’s right! How good you are at this! You can learn these signs very quickly, can’t you? And isn’t it nice to be able to say his name? Now if I ask ‘What is your tiger’s name?’ you can tell me, can’t you? All by yourself!”
Clearly delighted, Drake leaped up and down, turning in a circle as he did so such that his long hair lifted up off his shoulders in a jerky twirl. He signed Tiger-“Friend” as he did so.
It was an immensely pleasurable session. I taught him the sign for “doll” but he learned so fast that I also taught him “up,” “down,” and “under.” We made up games with these signs and spent the rest of the session communicating eagerly with each other.
When the time came to leave, Drake grabbed Friend tightly around the neck and tore out the door, dragging the tiger behind him. Then he stopped halfway down the corridor. He turned and ran back to me, embracing my legs.
I knelt down to his height. Drake lifted his fingers to his lips and signed “kiss.”
As I stood in the corridor outside the therapy room and watched Drake and Friend heading back to the day-room, I was both encouraged and bewildered. The ease with which he had acquired and used the signs was fascinating, because if he were withholding communication for psychological reasons, I would have expected considerable hesitance in signing also. While Drake had held back initially, once he overcame that, he had signed enthusiastically. This indicated either he wasn’t withholding speech for psychological reasons or that the reasons he withheld were very specifically to do with speech itself and not with communication. There was a much bigger surprise in all this, however, and that was Drake’s signing “kiss.” I had not taught him that sign.
So? What was going on? Logic told me someone else must have already been teaching Drake to sign. If so, who? And why had no one mentioned it? And if he knew them, why had Drake never used any to try and communicate with us? It did occur to me that I might be reading more into all of this than was there. American Sign Language is very intuitive, relying on movements that are easily connected to the meaning of the word. The sign for “kiss” involves touching the tips of the fingers to the lips, which could be a gesture he and his mother might have developed spontaneously between them. The second part of the sign involves then touching the cheek, which I wouldn’t have expected him to come up with on his own; however, it was conceivable I’d overinterpreted the gesture. Perhaps it was just accidental movement.
I met with Harry Patel later in the afternoon that day to bring him up to date on my sessions with Drake. I took along two of the videotapes, having marked out particular parts for him to watch and give me his assessment. We spent about forty-five minutes going over the case together.
I asked Harry if he thought Drake’s lack of speech could be a purely physical problem. I was thinking primarily of aphasia, which is a type of brain damage that disrupts speech at the neurological level before it ever reaches the parts of the body involved in speech production. I hadn’t seen any particular indicators of neurological problems in Drake, except perhaps the slight jerkiness in some of his movements. On the other hand, I had had several children previously who were presented to me as electively mute but turned out to be aphasic. I did acknowledge that in all the instances it had been fairly easy to identify indicators of brain damage, either via the child’s history or via observable behaviors. On the other hand, during my time teaching I had come across some much more subtle examples of aphasia. None of these had been mistaken for elective mutism, but some had gone undetected for many years and they had caused a quirky dysfluency in expression. In an extreme form, perhaps it could mimic elective mutism.
Harry said, “We have other problems. Mason Sloane phoned this morning. He was anxious to know how things are coming. I told him we had made arrangements for Drake to be seen by the audiology department. Well! That didn’t please him.” Harry widened his eyes in a telling expression. “He got very angry and accused us of just being in it for the money. He said, did we think they were stupid? Did we think his own family would not notice if Drake was deaf? Of course they have had all that investigated long ago. He said, in fact, two years ago, Drake was seen at the Mayo Clinic in Minnesota. He had a very thorough investigation to ascertain why he was not speaking normally and there was absolutely no evidence of physical involvement whatsoever.”
“Gosh,” I said in surprise. Stuff kept turning up on this kid that none of us had had any idea existed. I didn’t need to mention how incredibly helpful it would have been for the family to share everything with us at the onset, because contrary to popular opinion, we weren’t in it for the money. We were genuinely trying to help this boy and if we didn’t know something existed, then it was hardly our fault if we duplicated it.
“Well, anyway, I’ve asked him if we can see this report,” Harry said. Then he gave an impish grin. “Know what the son-of-a-canine said back when I said why had they not sent this at first? He said, ‘You don’t need that. What you need is to deliver the goods.’ That’s exactly what he said. Like it was a product he had ordered. He said, ‘Your therapist needs to get on and do what she said she could in that newspaper article’!”
I rolled my eyes.
The next day, the audiocassette from Lucia arrived. I was very curious to listen to it. Not only did I want to hear Drake’s voice, but I also wanted to hear the quality of his speech: how fluently he spoke, how well he formed the words themselves, how he used vocabulary and grammar, how he pitched his speech. This would tell me a great deal about where we actually were with this problem, including whether it was likely to be a physical disability, a neurological problem, or a psychological one.
I popped the tape into the cassette recorder immediately and sat down at my desk. The tape was scratchy, as if it had been played often, but it was clear enough. First there was Lucia’s voice, soft and maternal-sounding, chatting in the way one does with small children. She was speaking in English, but she didn’t sound very confident. There was also a very faint nervousness to her tone that made me more convinced than ever that she did not normally speak in English to Drake. Two or three minutes of tape spent listening to her talk about animals and noises animals make. Lucia imitated several herself. I could hear the presence of another person in the room, but no one else spoke. Then came a hesitation. It grew long, leaving me with nothing but the static of the tape.
Then Lu
cia started to recite a nursery rhyme.
Hickety, pickety, my black hen,
She lays eggs for gentlemen;
Sometimes nine
And sometimes ten,
Hickety, pickety, my black hen.
Immediately a little voice joined in.
At first Drake spoke in unison with her, and it was hard for me to hear what he was saying. They continued repeating nursery rhymes together, reciting three or four common ones.
“Now,” Lucia said, “‘Dance to Your Daddy.’ Can you do that one?”
And a little voice alone started saying,
Dance to your daddy,
My little babby;
Dance to your daddy,
My little lamb.
You shall have a fishy
In your little dishy;
You shall have a fishy
When the boat comes in.
Lucia responded animatedly, “You know that very well! Good boy! Can you sing that now? You know the tune. Here, I will sing it with you.”
This wasn’t a nursery rhyme I was very familiar with, and I had never before heard the rather haunting little tune that went with it. Lucia and Drake sang it together, and then she said, “Can you sing it now yourself for me?”
He sang alone. He had a soulful little voice, almost as if pleading for the fish in the rhyme. It was unexpectedly skillful singing for such a young child; he held the tune well and made the words plain.
And the tape ended.
That was all there was. Only one nursery rhyme said and then sung alone. No conversation. No interaction beyond saying the rhymes together and getting him to recite the final one on his own.
Hmmmmm.
All I could determine with any certainty from the tape was that he could, indeed, speak. His voice was clear and strong. He spoke with an American accent. The words were well enunciated and said in a manner that gave them correct meaning. In fact, even during the song Drake gave meaning to the words. This indicated that, unlike children with autistic spectrum disorders, he not only understood the communicative value of words but that he was also capable of using them appropriately. The tape didn’t tell me much else, however.
I played it again.
And again.
And again.
Trying to garner every little bit of information from it I could, I played the tape so many times over that the little tune lodged in my brain and dogged me the rest of the day.
He did speak. That was a vital confirmation. Moreover, he spoke clearly, with no trace of a speech impediment or bilingual accent. He gave appropriate meaning to the words as he said them. He did not sound shy. Although he didn’t speak until asked to do so, he did not hesitate once he was asked. He complied immediately. Nor were there any untoward pauses or silences.
Nonetheless, I found the tape unfulfilling. Perhaps this was because I’d assumed it would be conversation, which would allow me to get so much more from it, or perhaps it was simply because it left me with more questions than it answered. If Drake could speak this well, why wasn’t he doing it spontaneously? Even on the tape with Lucia, there did not appear to be any spontaneous speech. Why? How had such a young child come to be so silent, especially when he did not seem to have the anxious or withdrawn personality normally associated with such silence? Drake was in all other respects such a charismatic little guy. He always made joyful efforts to socialize with the children on the unit, the other staff, and me on every occasion. So what was going on here? If he spoke without hesitation when asked by his mother, why was he refusing to make even the faintest vocal sounds with me, with his schoolteachers, with even the other members of his family? How could he, on one hand, be a warm outgoing child who interacted so enthusiastically, and on the other, so determinedly silent that not even an audible laugh escaped him? Something didn’t add up here.
Chapter
15
In preparation for our next session together I had set out on the table the papers with the columns of feelings that Cassandra had so carefully done. However, when Cassandra came in, she immediately said, “I don’t want to do that.” She dismissively flapped her hand at the table.
I pulled out a chair to sit down.
“I want to play pterodactyls,” she said. “Like we did last time.” Before I could say anything, she had leaped up on top of the table, stamping her feet meaningfully near to my fingers.
“All right,” I said and shuffled the papers back together to put them safely out of the way. “But remember there are rules. I won’t let you hurt me or yourself. And when I take out my medal here, the area around me becomes a pterodactyl-free zone.”
“Yeah, yeah,” Cassandra said glibly.
“No, I want you to hear me, Cassandra. I don’t want you to say later, ‘I don’t remember that.’”
“I do hear you,” she replied. “Can’t you tell? I’m looking right at you. So are my ears. I can’t hear you more than that.” She grimaced. “You’re so uptight, you know. You got to have everything your way.”
“So how will we play? I asked. “What shall I do?”
Cassandra had turned sideways when I was talking about the rules. For a moment she was staring downward at the table, but now she looked at me out of the corner of her eye without turning her head.
“You’ve wrecked it,” she said. “I don’t want to play anything now. I don’t like you, you know that? I don’t want to do stuff with you. You’re stupid!”
“You feel angry because I interrupted your plans by reminding you of the rules?”
“Why do you think I want to play some stupid pretend game anyway? Only babies do stuff like that. You can’t make me play that.”
My first instinct was to refute what she was saying. I certainly hadn’t been trying to make her play the pterodactyl game. I held back, however. This was less due to some august psychological technique than simple confusion. We seemed to have switched sides very quickly, and I wasn’t sure how this had occurred.
A moment’s silence passed between us.
“Well,” I said at last, “if you don’t want to do that, let’s work with these.” I picked up the feelings papers again.
“I’m not going to do anything in here. You can’t make me. You can’t make me stay in here if I don’t want. I can call the police on you.”
“Cassandra, you seem upset today. Can you tell me why?”
“I’m not going to stay in here.”
“You don’t want to stay in here. I hear you saying that. You have very strong feelings about having to stay with me today. You wish you could leave. You want that so much you wish you could call the police on me, so that I would be forced to let you leave. I do hear you saying those things. But can you help me understand why you feel like this? Because our problem at the moment is, this is your time with me. Even though you have very strong feelings about staying, you still need to stay in here.”
“You’re trying to lock me up!”
“Can you tell me what is so upsetting right now?”
She cried out. It was a furious, frustrated cry accompanied by clenched fists and a truly enraged expression, but she didn’t move from where she stood beside the table. Indeed, she seemed to have rooted treelike, all her muscles gone so taut as to gnarl around her bones.
Bewildered, I watched her.
A moment passed. Two, three. I’m not sure how long this was in minutes. Only a few, I’m sure, but it felt longer.
Then, still standing, she began to wet herself.
This caught me completely unawares and I didn’t react for a moment.
Cassandra looked down at herself. She didn’t show any particular embarrassment or even surprise at what was happening, nor did she appear to make any effort to stop. Instead, she spread her legs and continued to urinate through her clothes.
My first coherent thought was that she was unwell. Perhaps she had developed a urinary infection or was coming down with the rather nasty flu making its way around the children’s ward. This
would account not only for wetting herself but also for her difficult mood.
I came over and put my arm around her shoulders. “Are you feeling okay?” I asked.
She looked up at me with an oddly uncomprehending expression on her face. “Seizure” flashed through my mind. While teaching, I had had children with epilepsy who lost bowel and bladder control during the process of grand mal seizures. Cassandra was obviously not having a grand mal seizure, but the fleeting vacancy in her expression was reminiscent of that odd, out-of-sync look that accompanies some seizures.
“Are you okay?” I asked again.
Cassandra recovered herself quickly. She said in a very little-girl voice, “Babies come out of your wee-wee place.”
Not anticipating this comment at all, I was caught unawares yet again by this kid. I had my own blank moment just then.
So Cassandra spoke again. “Babies come out in your wee.”
“Babies come out of their own special place,” I said. “While this special place is down between a woman’s legs, it’s not the same place as urine comes out.”
“Urine. You-rine. I say ‘wee.’ Wee-wee. We, we have babies come out.” She pointed saucily to me and to herself.
“I’m thinking we need to go get some cloths and clean this up,” I replied. “Urine doesn’t belong on the floor. Someone might slip.”
“You might slip. You might fall on my you-rine and die. You’re thinking we need to get some cloths. I’m thinking you might have a baby and it will come out in your wee.”
To be honest, at just that moment, what I was really thinking was that a psychiatric unit was a pretty appropriate placement for Cassandra.
I had misgivings about taking Cassandra out onto the unit to help me to find cloths and a bucket, because she was being so unpredictable. I wasn’t too sure about having her help me clean the mess up, either, because I was concerned it might overstimulate her, as there seemed to be a sexual association with wetting herself. Nonetheless, there was still enough practical, real-world teacher in me to want her to connect her actions with their natural consequences. So out we went.
