by Torey Hayden
Being a hospital, we didn’t have the kind of mop-and-bucket ordinariness that had always been part of the schools where I’d taught. Here any mess was responded to by full-time cleaning staff ever ready with their antiseptic scrubs and special equipment. It took some dedicated searching to locate something we ordinary mortals could take back to the therapy room.
Cassandra was unexpectedly compliant. She didn’t speak at all while we were out on the unit, but followed meekly and did as she was told. I took her first to her room so that she could change her clothes. Afterward she came with me to the dayroom, where she accepted and carried cloths and disinfectant while I ferreted out latex gloves and a bucket. We returned then to the therapy room.
“Here are the things you need to clean the floor,” I said.
I expected her to rebel or, at the very least, respond with her brash, negative comments. She didn’t. Cassandra pulled on the gloves, then knelt with the cloths and straightforwardly cleaned the urine up from the floor.
When she had finished, she rose to her feet and let the cloths drop into the bucket with a heavy plop. Continuing to stare into the water, she said without looking up, “Do you like me?”
“Yes, I like you,” I said.
“Do you really like me?” She raised her head then and met my eyes.
“Yes, I really like you,” I replied.
“Then why do you make me do this?”
“Because urine doesn’t belong on the floor. Someone could slip and hurt themselves. So if you have been unable to get to the toilet in time and, as a consequence, wet your pants, it is necessary for you to clean it up.”
She frowned. “I didn’t wet my pants.” Her voice wasn’t defiant but rather simple and clear-cut.
I regarded her.
“And if that was pee on the floor,” she said, “I’m going to tell my mom you made me touch it. She’ll call the police on you, because that’s dirty. You shouldn’t make kids touch stuff like that.”
“Cassandra, yes, you did wet your pants. I don’t know what’s going on here that makes you say you didn’t, but I was here, too. And yes, you did wet your pants.”
Cassandra looked down at herself, but of course, because she had changed clothes, her pants were dry. She looked back up at me with an incredulous expression, as if I had made it all up. And, indeed, for just that moment, everything felt hideously surreal to me, as if her version might be a possibility, as if we’d stepped into some kind of mirror world without my noticing.
“Cassandra, I’m not very happy right now, because I can’t understand what’s going on. You just wet your pants. About twenty minutes ago. And we went out onto the unit. We went to your bedroom and you changed your clothes and that’s why you’re dry now. We got the cleaning equipment and came back here to wipe it up. I’m not sure if you are confused about what happened or if you have forgotten what happened or if you are simply still angry with me and feel in the mood to argue. But it is hard for us to understand each other when we have these kinds of conversations.”
She started to cry then. They were not angry tears so much as despairing. “You don’t like me,” she sobbed. “No one likes me. It’s horrible here. You treat me terrible and I want to go home.”
To say I was confused at the end of that session was certainly an understatement. On one hand, Cassandra had a history of being very manipulative, sometimes pathologically so. It was fairly easy to interpret what had just happened as a deliberate effort to avoid responsibility, a calculated lie that threw the blame for her behavior onto me. Nor was it much of a stretch to interpret it as sociopathic behavior, that she was construing the events in an attempt to dominate me, that having assessed it was important to me to be understanding and accepting, she now sought to twist me into the dangerous and humiliating position of abuser.
But …
At that moment I couldn’t put my finger on “but.” Something felt seriously weird. Things just didn’t fit together in a way that made sense. Often when finishing sessions with children I would come away filled with unanswered questions, with the feeling that there was much more I had to understand before I’d know what to do. This, however, was a normal kind of not understanding, the kind where I knew it was me; I knew I simply needed more information, more time, or more insight. These instances were like doing a jigsaw puzzle where I didn’t know the picture that was being formed. I knew from the onset I didn’t know. And I knew likewise that it was unrealistic to expect to know until I’d found a sufficient number of pieces and fitted them into place. So that kind of not knowing was a normal state.
This was different. There was a bizarre, Alice-in-Wonderland quality to working with Cassandra. It felt as if every time I went to add another piece to her particular jigsaw puzzle, it changed into a completely different puzzle from the one I’d been adding pieces to before.
I didn’t have the time immediately after the session to think further on it, because I had a staff meeting and then needed to go out in the early afternoon to do two assessments.
It was after five when I returned to the unit, so Dave Menotti had already gone home. Not that I’d really had plans to consult with him over Cassandra so late in the day. Not that I’d even intended to do anything more with it myself at that point. However, as I came into the office, I unexpectedly saw the videotape of our session that morning sitting on my desk. In all the brouhaha over cleaning up after Cassandra had wet herself, I hadn’t gotten around to taking the videotape out of the machine in the observation room. Most likely someone else had wanted to record in the therapy room, and seeing my tape still in the machine, that person had brought it in and left it on my desk.
Impulsively, I popped it into the video recorder in the office and turned on the monitor, thinking I’d watch a few highlights to give me something to mull over during my commute home. I quickly got caught up in the tape, however; and instead of just whizzing through for highlights, I ended up watching it all.
Something odd caught my attention.
Just after Cassandra had wet herself, she said to me, “Babies come out in your wee.” And then, when I had used the word urine, she had replied, “I say ‘wee.’ Wee-wee. We, we have babies come out.”
At the end of the session, however, when Cassandra had denied responsibility for wetting herself, she said, “If that was pee on the floor, I’m going to tell my mom you made me touch it.”
Why would she use wee in one reference and pee in another? Linguistically, it is unusual for children to alternate slang terminology in that manner. They inevitably know plenty of words for bodily functions and as any adult around children experiences, they often glory in trying the full vocabulary out. This is for play or shock value, however, or for the sexual connotations the words carry. During genuine communicative conversation, however, people tend to stick to one preferred word or phrase and typically don’t vary.
It was possible that wee was the word used with her father and that this was also why it appeared to have additional sexual connotations, whereas pee might be her mother’s word, and thus, Cassandra was, indeed, expressing two different things with the words. Or perhaps she was accustomed to using two different expressions for the same act, because of the parents using different words. However, it still seemed odd to me that she would alternate so indifferently within the context of the conversation. I thought, it was almost like two different kids talking.
The penny dropped with that thought.
What if these were two different kids? As in multiple personalities. What if there was more than one Cassandra in there? What if she was telling the truth and the second girl genuinely hadn’t realized that first one wet her pants?
Chapter
16
Gerda was not proving any easier to crack than Cassandra or Drake. Each morning I stopped at the rehabilitation center before work to spend half an hour to forty-five minutes with her. However, she showed no inclination to speak to me spontaneously. Indeed, she showed little interest in speakin
g at all, as even direct questions produced only the barest of mutterings.
After a few days of wearisome struggles to make conversation, I resorted to reading to her, to demanding nothing from her, no words, no sound, indeed, no response. I just came and I read.
To say there was an actual method to my actions in doing this might have been stretching the term, but I did have a process in mind. My very, very earliest experience with elective mutism and, indeed, with special education itself, had occurred when I was still a college student and took on work as an aide in a preschool program for disadvantaged children. There I’d been given charge of a four-year-old named Mary who did not speak. She spent most of her time hiding under a piano, and I’d started our relationship by lying under there with her and carrying on a long, very one-sided monologue while she just watched me. When finally I ran out of conversation, I started reading to her. It took months to achieve a relationship with her and to get her speaking again, but it did happen and the connection between its happening and the long hours I spent apparently doing no more than reading to Mary was not lost on me.
In fact, during my years as a graduate student in special education I devised a small research project in learning disabilities on one occasion. This was in the 1970s when learning disabilities were the New Big Thing. Tests were popularly used to identify which of a child’s learning modalities were strongest and which were weakest as a way of explaining learning problems. For example, a person might be strong in visual memory and thus a good sight learner but might be weak in auditory discrimination and, thus, was poor at learning to read using phonics. All this kind of knowledge was in its infancy in that era and as seems a common human trait when first discovering things, we immediately think we know all about it. Thus, it became hugely fashionable to give these modality tests and then assume we knew precisely why a child wasn’t learning—because he or she suffered various visual, auditory, or kinetic weaknesses—and, therefore, all that was necessary to correct the problem would be to switch the child to his or her strengths. Which, of course, sounded really good in theory but isn’t quite how it worked out. But we didn’t know that then.
I was curious from the onset about more subtle factors that might be influencing successful outcomes. For my graduate project, I designed a small research study in which I divided the children with identified learning disabilities and poor reading performance into three groups. In the first group, the children were paired with a trained tutor who used the most up-to-date learning modality-based methods to help them with their reading; in the second group, the children were paired with an untrained college student who was instructed to read books, magazines, and comic books to them; and the third group was a control group who had no special interventions. The tutors/college students met their children twice a week for half an hour, and the project ran for six months. In the first month, both groups’ reading scores improved, although the improvement of the first group was statistically better. However, after six months, this wasn’t so. In both groups, the children had made statistically significant improvements in reading, and the first group, with the trained tutors, was still making slightly higher scores. However, it was no longer statistically significant. Both groups improved, whether the children were being actively taught or whether they were simply listening to an adult read.
My conclusion from this was not that we don’t need to actively teach children to read nor that we don’t need to address reading problems with specialist help but that the significant influence was human interaction, rather than the method used. To me the results of the study spoke of how much it matters to us that someone else is willing to take the time to be with us, that our problems tend to improve simply by being with people who pay positive attention to us.
Consequently, coming along each day to spend half an hour of time reading to Gerda not only didn’t seem like a waste to me, it seemed a feasible method of intervention.
I discovered, however, it didn’t to a man named Dr. Jamieson.
“And you are who, exactly?” he asked, as I came out of Gerda’s room Monday morning.
I gave my name and explained briefly that I was there because of a request from Joy Hansen, who had contacted me because of my experience in psychogenic language problems.
“Are you a relative?”
Realizing I must not have been clear, I said no again and proceeded to explain a second time that I had come at Joy Hansen’s request because of my experience in psychogenic language problems.
“You’re a child psychologist?” This was said in a tone of voice that left nothing to the imagination, and clearly here was not a man for ambiguity, so he added, “And so what exactly are you doing here?”
For a third time I explained I was here due to Joy Hansen’s asking my advice on Gerda Sharple. Because I had experience in psychogenic language problems.
“What’s that got to do with anything here?” he asked.
“Because,” I said, very slowly, very plainly, and in a tone of voice verging on what I’d use with a small, dull child, “Joy Hansen had questions regarding the nature of Gerda’s mutism.”
“She isn’t mute,” he replied and used the same very slow, very plain tone of voice back at me. “She’s had a massive hemiplegic stroke. Strokes cause brain damage. Brain damage affects the center of speech. That’s why she’s mute.”
Odd, I was thinking, how in such a short exchange we’d already decided we hated each other. Sad, too, as it wasn’t going to further Gerda’s case any.
“Is it all right that I come to see her?” I asked, because I sensed this was actually an issue of territory, not treatment methods.
“There’s nothing for you to see,” he replied. There was a small heartbeat of a pause and he stepped back slightly, his shoulders relaxing. “I mean, I appreciate what Mrs. Hansen’s trying to do, but she’s a social worker and that’s her job. I appreciate what you’re trying to do, too. Which is your job. Realistically, however, there’s not much you can do. This is a different part of the continuum than you’re accustomed to working with. At your end, everything is newborn. Just starting. Growth. At my end, it’s decay and death. So there’s a difference of approach to treatment that’s significant. Nothing is going to happen in this instance, no matter how much effort you put in. Mrs. Sharple has had a massive stroke. She’s eighty-two. She isn’t going to be the person she was, no matter who does what.”
“Is it all right that I come to see her?” I asked again.
He paused, regarding me. Then finally he nodded. “As you will.”
The encounter was depressing. Normally I see narrow-minded people simply as unable to think deeply, creatively, or persistently enough to realize the limits of their views, and this allows me either to ignore them or challenges me to show them alternatives. However, as I passed room after room of decrepit elderly patients, I had to acknowledge the reality in Dr. Jamieson’s dead-end thinking. We did come from opposite ends of the spectrum, and yes, my work was about growth. It was about potential, about opening up the possibilities of a lifetime ahead. I was used to thinking that way. I had come, challenged by the possibility of giving Gerda a chance to return to the cottonwoods and the cats that had defined her rural existence.
Was this realistic?
The stink of disinfectant, the moans, the incoherent “hellos” of an unseen Alzheimer’s patient followed me down the corridor. Who was I to be here? While I wanted to give Gerda a chance, only Pollyanna could deny how slim this chance was. I was no miracle worker. Not only did I not have any precedence in my own experience for successfully treating mutism in the elderly, but regardless of whatever progress Gerda and I might accomplish, decay and, ultimately, death would still be waiting in the wings anyway. That was just reality.
It wasn’t a cheerful way to start the day.
Opening my box, I took out the bag of M&M’s. It was twisted closed, so I carefully undid the twist and poured half a dozen brightly colored M&M’s onto the tabletop in th
e therapy room. “What do you remember from last week?”
Drake quickly signed the word for “candy.”
“Yes, that’s right.” I signed “yes” as I said the word.
Without prompting, Drake signed “tiger-friend” and patted Friend on the head.
I smiled.
“Friend eats candy,” Drake signed and mischievously took a piece of candy and put it against the toy tiger’s lips before popping it into his own mouth. He laughed noiselessly.
“Hey, smart! ‘Friend eats candy.’ That’s what you were saying with your hands, wasn’t it?”
Grinning, Drake nodded. Indeed, he did it again, signing the sentence quickly and then feeding Friend another M&M.
“You’re very good at talking with your hands. I can see you like to talk that way.”
He reached down for Friend’s paws and attempted to make the toy tiger sign “candy.”
“You and Friend like this idea, don’t you? Of making signs and getting candy?”
Impishly, he smiled at me.
“But you know what? I think you’re so clever because you have a secret. I think you already know signs.”
Unexpectedly, his smile faded. Drake put his hands flat against his sides.
“You look concerned when I say that,” I said.
He smiled in the beguiling manner I was now coming to recognize as a gesture of appeasement.
“I didn’t mean: don’t use other signs,” I said. “I think it’s cool you can do ones I didn’t teach you. But know what? No one had told me you knew how to sign. So that makes me curious.”
Drake’s demeanor had changed entirely. He lowered his head and looked away.
“What’s wrong?”
Grabbing hold of Friend, Drake pulled the big tiger close and pressed his face against its fur.
“I see a little boy who’s upset,” I said. “But I don’t know why. Can you tell me what’s wrong?”
He shook his head.
“I wasn’t angry with you, Drake. Did you think it made me angry that you knew something I hadn’t taught you? Or was it when I said the word secret? When I said you had a secret? Did that make you upset?”
