Wednesday, August 27, 2014

ASPERGER'S; THE MISSED DIAGNOSIS 1


                     ASPERGER'S; THE MISSED DIAGNOSIS  PART ONE
         
I suppose it is true that someone with my history as described in Children of the Manse has deep within him the ghost of the neglected and abused child he once was.  For whatever reason, all my adult life I have found myself especially drawn to children whose struggles bore some resemblance to my own.  The following story is about children I remember from two summers working as a ward attendant in a psychiatric teaching hospital in Iowa some years ago.  
          If your interest is primarily in Asperger’s I suggest you begin with the second part of this story.     
                   
                                                  PART I

Following my first year of graduate theological studies I was required to work in a hospital, a prison, in programs for recovering alcoholics or for unwed mothers. I chose to spend the summer of 1959 in the psychiatric teaching hospital of the University of Iowa. My program had little structure.  I worked as a ward attendant under the same conditions and for the same modest pay as other attendants in the hospital.  I was also required to do some additional reading and to meet every two weeks or so with a short, rotund and mildly cynical hospital psychiatrist and an Episcopal priest of impressive learning from Cedar Rapids who was himself a psychologist before entering the ministry. 
          I quickly realized I had begun one of the most exciting summers of my life.  I adjusted easily to the environment of the hospital, admired the nurses and attendants I worked with…all decked out in medical white… and was fascinated by what I was learning.  The social scene among the nursing students, medical students, and attendants was free and open, so unlike the semi-monastic environment in which I had lived for nine months in the seminary.  One special excitement was a summer romance with a recently divorced, attractive blond nurse. More than once that summer I considered abandoning my studies for the Episcopal priesthood to become a psychologist.                                   
                                        The Hospital               
          The hospital, of dark brick and one story, was built for its function. The west wing was for female patients, the east for males.  The two south wards of each wing were for neurotic patients.  The north wards of each wing were for psychotic patients who were locked behind heavy gray metal doors with tiny thick glass windows that closed with a comforting click.  These patients were closely watched, especially in the bathrooms where they were carefully monitored to thwart suicides.  Occasionally one of the psychotic patients would have to be sequestered, raging, screaming, and threatening violence, in one of two padded rooms near the middle of each ward.   
          The fifth ward was for children who were kept separate from the adult wards of the hospital and had their own adjacent outdoor play enclosure.  I rotated through all five wards over the course of the summer but I most enjoyed the weeks I spent on the children’s ward.  
                             
                                        The Second Summer

          The following year the US economy was in recession and I was having difficulty finding a summer job, necessary if I was to afford the next year of theological studies.  I decided to call Mary, the friendly nurse director of personnel, to ask if I could return to again work as an attendant for the summer.  The salary was enough to cover my expenses and put aside some savings.  The social life was great, though I suspected my summer romance had found a new boyfriend, which turned out to be so.    
          Mary was at first non-committal but called me a few days later. 
“Yes,” she said, “There is a possibility.  We’re sometimes asked to hire athletes on the football and basketball teams as part of their scholarship package.  A few years ago two of the football players roughed up one of the boys on the children’s ward and we decided to ban adult males from the ward.   We would like to explore changing the “no males” policy. We think the children need a positive male image. We were impressed with your work on the children’s ward last summer.  So, yes, if you are willing to spend the summer full time on the children’s ward, we have a position for you. You will be on probation and if for any reason the reintroduction of a male to the ward does not seem to be working out, you will be released immediately.”  So I climbed on a Greyhound bus in Chicago and returned to Iowa City. 
          I had forgotten how hot and humid summer is in Iowa.  The stillness, the absolute immobility of the summer air is stifling.   The river which divides the university and the city seemed almost stagnant without wave or ripple.  At dusk hundreds of bats fluttered through the thick air.  I again donned a white medical jacket, thrusting my arms through the stiffly starched sleeves and struggled with closing the buttons on the left side.  I waited outside Mary’s office for her briefing while she finished a phone call.  I began to recall the most memorable patients from the summer before; the acutely depressed elderly bearded Amish man who recovered quickly after three courses of electro-convulsive therapy treatments; the paranoid dermatologist who, looking out the bathroom window, described for me in detail a helicopter loaded with marines that was coming to rescue him, a fiction real only to him.  I remembered the nearly comatose forty-year-old woman who in youth had suffered a frontal lobotomy, one of early psychology’s dreadful horrors.   And fondly I remembered Ben, the fourteen-year- old boy whose addictive glue sniffing stimulated his fantasies of becoming a major league baseball player. 
          And I most especially remembered nine-year old Willie, who had lived in institutions most of his life and whose blazing eyes could show more hatred than I had ever seen in a human being.  Willie was afraid to love, even to show affection, for fear of being hurt again.  I saw myself in Willie.  I was an abused and neglected child who eventually was placed in an orphanage.  I also feared to love and found it impossible to respond to affection.  When finally adopted at the age of eight, my mother told me that a year passed before I would permit her to hug me and another year before I could return her affection.  When Willie one day surprised me by holding my hand and later giving me tiny awkward half-hugs I wanted to cry.  Those moments are what make working with wounded children so fulfilling.     
          One memory I tried to remove from my mind and could not was that of Joyce, a pretty woman with clear blue eyes, delicate features and soft brown hair.  Joyce weighed less than 100 lbs.  I and another attendant assisted the psychiatric resident and nurse who administered Joyce’s series of electro-shock treatments, three times a week for four weeks.  Joyce had asked to be the first of the eight patients we treated with electro-shock therapy each morning so she wouldn’t see the other patients as they were returned to their beds, pale and seemingly dead. 
          I winced as I recalled how I as one of two attendants on separate sides of her body had gently grasped one of her shoulders and a lower leg as the electric shock hit her tiny body which pitched up in an arc from the gurney, went rigid, and then fell back again.  Her lungs gasped, she turned blue as the convulsions began, at first large and far apart, and then smaller and faster until they were hardly more than twitches.  She did not appear to be breathing.  Her skin was white, bloodless. 
          Mary finished her phone call, walked into the reception room where I had been sitting and brought me back to the present as she began much the same briefing she had given me the summer before.  She singled out a single key from the mass she carried on a large circular ring.  “This is your “B” key, she said.  It will open most doors except for the padded seclusion wards and the medication cabinets.” She reminded me that dating patients was cause for immediate dismissal.  “Neurotics can be charming.  More than one nursing student or attendant has fallen in love with a patient,” she added.  “And remember, you will be on probation.”
          I said I understood, thanked her for hiring me, and soon settled into the regular routines of the children’s ward; the briefing at the beginning of shifts by the duty nurse, and the reading and writing of medical charts.  We did not take the temperatures and pulses of the children daily as we had on the adult wards and only the duty nurse was authorized to distribute medications when those were prescribed. There were, of course, no padded cells in the children’s ward and I was no longer required to assist at electro-convulsive treatments.  Activities on the ward included reading to children, board games, trips to the university’s swimming pool, visits to museums and walks in the neighborhood.  I ate with other attendants and nurses in the cafeteria in the main hospital building across the street and managed to rent a dorm room near the hospital, a single I enjoyed having all to myself. 

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