I saw a young boy of five,Harry,who had been brought in by his aunt having sustained a 'head injury' whilst playing hide-and-seek with his cousin.He had a tiny little wound to his forehead which didn't really require any treatment although I got Julian to put on a single Steristrip so that the boy could have some 'bragging rights'.
We have a head-injury protocol here that requires quite a significant examination and serial observations over the course of an hour.So I initially saw the child when he was being seen by the Triage nurse;then examined him a short time later;and then saw him when he was ready for discharge.
The process involves taking the standard medical history; a social and psychological history;a physical examination of things like cranial nerves and pupillary reaction to light,etc;some cognitive testing;and a reflection on the findings filtered through your experience.
He was what is called 'a well presented child'...clean,polite,well mannered,well dressed...and his aunt,and six year old cousin were the same.His aunt explained that he was staying with her family for a few days as his parents were relocating to the UK from Europe and needed some space to sort out the new house.His cousin was chatty and inquiring and keen to have his own cranial nerves checked .
During the exam I had a vague sense that I was missing something...he was answering all my questions correctly...he was able to do all of the age-appropriate cognitive tests that I asked him to do...(my PDA is just loaded with those sort of programs)...and he was able to preform all of the physical tests that I undertook...and he did it all with grace and determination...but it felt like he was working a few seconds slower than I would have expected...talking to him was as if we were on a time-delayed phone line...
And he wasn't keen to look at me or his aunt...
Most worryingly,when I wasn't doing anything to him or with him,he sat quietly on the bed,holding his hands straight up in front of his face,fingers pointing skyward...and moving them as if he was playing the piano to a manic tune only he could hear...
I asked his aunt if he was usually this quiet and self absorbed,and his cousin chirped in...
You have to ask him two times if he wants some pizza!!
"Uh huh...tell me Harry...do you like computer games?"
His aunt said that he spent a lot of time playing on the computer.
I looked at my notes again and then asked the boys to wait outside with their grandmother who had accompanied them to the Unit.
"Ma'am...does Harry have any brothers or sisters?"
Yes...he has a younger brother...he's 4...
"Is he in a normal class at school for a child of his age?"
I'm not really sure...because they have been in Europe...but why do you ask?
"Well...I cant find anything that bothers me in terms of the head injury...obviously you'll need to keep an eye on him for the next 24 hours...but....hummh...well,he just seems to be a little self-absorbed...and a little 'slow' in his responses....hummh....I don't mean to be offensive or alarmist....but I can't help wondering if Harry is perhaps mildly autistic...?"
Slowly,silently,his aunt started to cry...her eyes filling,the fat teardrops spilling over and rolling down her cheeks.
She reached out and gripped my hand.
I let her cry for a few minutes.
I knew...I knew
His brother is profoundly autistic....I knew that Harry was autistic ,-I'm a teacher-,but I didn't want to believe it...
...or to bother my sister...his brother takes up so much time and effort and money...that's why they are coming back to the UK...
We sat for a few moments.
And then she took the kids home.
Sometimes...in the middle of an ordinary day...you find that you've given a family a life sentence...
You just have to try and act with grace.