by Olaf Kroneman

Sarah walked around and around and around my examination room. I got dizzy watching her. Mom’s eyes followed her as well. “There is something wrong with her,” she said. “She’s worried about Mr. Andrews.”

 Sarah wouldn’t talk or interact but continued to walk in circles staring vacantly forward.

“Hello, Sarah,” I said. “Please sit.”

I motioned to her. I smiled. She was more isolated than usual.

“I don’t know what’s gotten into her; she’s frightened,” her mother said. 

 “Mr. Andrew is going to die,” Sarah said. Her voice was loud and piercing, almost a scream. 

She became mute and returned to her mysterious parallel world, but it seemed like she could still hear everything we said. As her long-time family physician, I had grown accustomed to her living in a private world. She would interact with me when she needed something basic or when I attempted to drag her into my world.

She returned to pacing the exam room.

“There is something wrong with her,” Mom repeated.

The phrase “there’s something wrong with her” brought back the heartbreaking memory of Sarah as a toddler. She came for a well-baby visit, and I didn’t think there were any problems. I summed up Mom as overly anxious. The child was physically ahead of her milestones. She rolled over, sat up, and walked early. She skipped the crawling stage.

She didn’t talk, but then a lot of kids were late with speech. My task was to reassure the parents.

“Doctor, the child won’t interact. If I try to hold her, she becomes stiff. She won’t look at me. She won’t even try to talk. Other children know there’s something wrong. They ignore her; they refuse to be around her. I have been reading, could she have autism?” Mom asked.

“Autism is rare in girls. It is an affliction primarily of boys,” I said. “All kids usually come around.”

The child stared at the wall. I called her name. Nothing. I picked her up. She stiffened and almost escaped from my arms and landed on the floor.

My first impression was wrong. This was a child with autism. I sent her to a specialist for confirmation, and Mom’s suspicion was correct.

The strain of a child with autism broke the marriage. Her husband blamed his wife for Sarah’s condition. Dad read outdated texts about autism and the early belief that it was the fault of the mother. The “experts” opined that the mother of an autistic child was cold and unable to emotionally bond with the child. They were labeled “refrigerator moms.”

With time, the experts were proved wrong, and now autism is accepted as a capricious neurologic disorder. It was nobody’s fault.

Too late to save the doomed marriage and ease Mom’s guilt.

One of the pleasures of being a family physician was watching people grow and develop. I tried to help them along the way from cradle to adulthood and the grave. They have given much back to me. I have learned from them. I got meaning.

I learned that people with autism sometimes are blessed with special gifts. They used uncharted areas of the brain to amaze and fascinate.

Sarah taught me about the weather. She focused on the highs and lows of the day. She could predict it. I was not sure how she did it. I suspect it had something to do with her innate sensitivity to circadian rhythms, bariatric pressure, or the phases of the moon or something, but her predictions were so accurate that the local weatherperson would call her to confirm and compare notes before going on TV with a forecast.

Her reputation spread until all three local networks consulted with Sarah before going on air.

Sarah would put her hands on the window and, through touch, would divine temperature and humidity. She was correct. I tried to do it. I was always wrong. I functioned poorly in her world.

Mom devoted her life to helping Sarah. She wanted her to go to the local elementary school and then junior and senior high, where Sarah could socialize and interact with other children. At that time, it was unprecedented. The child with autism was relegated to “special classes.”

Mainstreaming was thought to be pointless. The elementary school refused. Mom persisted.

Mr. Jim Andrews was the school counselor who stepped in. He agreed to help Sarah.

She went from segregated classes to full integration in junior high and then high school. 

It was not an easy route. But it appeared Sarah could not register the insults being protected in her shell of autism. She, like many children with autism, was a natural beauty and so was exposed to inappropriate touching, and one time a boy was caught trying to unbutton her blouse. 

Mr. Andrews rushed in and grabbed the boy’s arm back, bringing the whining bully to his knees.

Mr. Andrews was sanctioned by the school and threatened by the coward’s parents. Sarah’s mom told the parents she would file a sexual assault charge with the police and have their son placed on the sexual offender list. An elite college would be out. All complaints were dropped, but from that point on, Mr. Andrews was her protector.

Today something was wrong with Sarah.

She repeated, “Mr. Andrews is sick- he is going to die.”

Mom shook her head. 

We needed answers.

“Let’s call the school,” I said. “We can talk to Mr. Andrews.”

We called. Mr. Andrews came to the phone.

“Mr. Andrews, it’s Doctor Kline with Sarah and her mom. You are on speakerphone. Sarah thinks you’re sick. Talk to her and reassure her.”

“Sarah, I’m fine. I’m going to play tennis after school today. I just had a physical last week. I have a clean bill of health.”

She shook her head. Her eyes were wide with panic.

“No.”

“I’m fine Sarah.”

“No.”

Mom led Sarah out of my office.

That night I was paged. I called back. It was Sarah’s mother.

“Dr. Kline, Sarah went up to her room. She wouldn’t come down. She cried. She screamed Mr. Andrews is dead. Mr. Andrews is dead. I called his home. His wife answered. She told me she was glad I called. Before going to school, she wanted Sarah to know, ‘Perhaps you heard that Jim died today on the tennis court.’ Sarah is worse than this afternoon. I need help.”

I drove to their home. Sarah was crying and screaming. I touched her, but she stiffened like when she was an infant, only she was now very strong. She pushed me away. I caught myself. I held her again. Her mom came over to help. I injected her with Ativan, and she slowly melted to the floor.

She was placed on a stretcher, taken to the hospital in an ambulance, and admitted to a general medical floor. The hospital closed the psychiatry unit because it was losing money. Sarah would be oblivious. I had her heavily sedated. I would not allow her to be placed in leather restraints.

Dr. Patel, the psychiatrist, put her on antipsychotic medications. It made her manageable but dull. 

Sarah made progress over the next few hours.  By progress I mean she was sedated to the point that there were no further outbursts. But we were treating ourselves rather than Sarah. These were chemical restraints just as harmful as four-point leather restraints, only easier to stomach. The antipsychotic medication had to be lowered.

 She was transferred to a semi-private room.

 I was attending to her roommate. She was a young woman who was pregnant and had nausea and vomiting, which is common in women in their first trimester. Her condition improved, and I was going to release her.

Sarah continued to stare at the ceiling, but at least she was not agitated. 

I pulled the privacy curtain.

“Now,” I said to the pregnant woman. “Take these pills; they will help with the nausea. Call me if your symptoms return. Come to the office next week.”

Sarah slapped her bed. “No,” she shouted.

I repeated to the patient, “Come to the office next week.”

Once again, “No.”

The patient was frightened. She looked at me. 

“Are there any new symptoms?”

“Not really,” she said. “Maybe a little abdominal pain, a slight discharge.”

“Bloody?”

“Just a very little.”

 I canceled the release and sent her to the ultrasound department, and the images revealed an ectopic pregnancy on the verge of rupture. I contacted her obstetrician, and she went to the operating room immediately.

Sarah saved the woman’s life.

“How did you do it?” I asked. “How did you know?”

No response.

Sarah went home but remained on the antipsychotic medications. She was manageable but all her unique abilities were absent. She took no interest in the weather.

I lowered her medication.

“She’s not the same,” her mother said. “She’s lost her personality. This is not her. I would rather have her like before. I miss her. I’m lost without her.”

Mom preferred a difficult Sarah rather than a sedate catatonic daughter. I had talked with other parents who had a child with autism, and they didn’t consider themselves heroes or special. They told me it was the most rewarding, meaningful thing they could do. The child with autism was put on this earth to validate their humanity. Make them a better person. They developed as spiritual human beings- everything else being superficial.

It caused me to reflect. Patients continued to teach me, but Sarah lived in a dimension without any way to influence me. 

I wanted to observe Sarah closely on the lowered dose of medications, so I had her follow me on my hospital rounds. She never interacted, but I knew she was taking it all in, remaining between two worlds, the one she was comfortable in and the one we tried to bring her into.

She remained mute but warily looked around the hospital.  We entered the room of an elderly woman whom I had admitted for nausea, vomiting, and dehydration. I thought it to be the stomach flu and viral gastroenteritis.

I was planning to discharge her and approached the bedside. Sarah blocked my progress.

“Sarah, I need to release the patient. She is better now. The hospital wants to shorten the length of stay.”

Sarah shook her head rapidly. She pointed at the patient.

“Okay. I’ll examine her again.”

The patient looked at us.

“Mrs. Flynn, may I examine you once again, before your release?”

“Of course.”

I placed my hand on her abdomen. She did wince a bit but nothing like before. I tapped her abdomen. It was a bit distended.

“Doctor, there is a lump in my upper thigh area that comes and goes.”

I placed my hand over the area; indeed, there was a lump. I pushed on, and the patient winced.

“Ouch.”

It was a femoral hernia, easily missed, that caused the bowel to be intermittently obstructed. That’s why her symptoms waxed and waned.

Sarah was correct.

I consulted a surgeon, and the elderly woman went to the operating room to correct the hernia and avoid a complete bowel obstruction.

“Sarah, how do you do it?”

She ignored me.

We walked out of the hospital.

I lowered the dose of her medication further.

Sarah was now a regular on my hospital rounds.

We made quite a team. She kept an eye on me. Sarah used areas of the brain that I knew little about. When she was interested in something from our world, she emerged from hers to help. 

I was able to get her off her medications, and one day she looked at me.

“Ninety-two degrees and ninety percent humidity.”

I was sweating. Then I got chills. Sarah was back to predicting the weather.

I talked with her mom.

“Sarah’s her old self. It took you a while to notice.”

“Sarah’s a better diagnostician than I am.”

“Thank you, Dr. Kline.”

Months later our hospital was purchased by a large hospital chain. We were the victims of hospital consolidation. Unique community hospitals were dinosaurs. It was one size fits all.

I received an email from the new hospital CEO regarding the young woman who followed me on rounds. Sarah and I were to meet with the man to explain what we were doing. This was not going to be good. A heartless decision had already been made.

We sat in front of the CEO.

Sarah stared at him. He appeared uncomfortable. But he proceeded.

“Dr. Klein, why does this woman follow you on rounds?”

I looked at Sarah.

“She has a sixth sense. I don’t know how she does it, but she helps me make decisions and diagnoses. She can save lives.”

He looked at the ceiling.

“Does she have any medical training?”

“No.”

“Does she have any medical credentials?”

“No.”

“No, you say?”

I wanted to tell him that he didn’t have any medical credentials either but thought better of it. You don’t want hospital administration to put a target on your back.

“She should not be rounding with you. It is not correct. At a minimum, it is a HIPAA violation.”

 He wouldn’t understand. He wouldn’t believe me.

“This entire hospital is semiprivate rooms. Two patients to a room divided only by a curtain. The hospital is one big HIPAA violation.”

He ignored my comment, but it didn’t help.

“I cannot allow this woman to follow you on rounds.”

“Why?”

“Because, as you admitted, she has no medical credentials.”

“Neither do you,” I said. I couldn’t help it. Now I was in the crosshairs.

Sarah stood. She pointed at him. She looked concerned. She went to touch his abdomen; he slapped her away.

“She is threatening me,” he said. “She is not stable. You two leave, and she is not to come back to this hospital.”

There was nothing we could do. 

That evening, we received news that the CEO collapsed and died at home.

I met with Sarah.

“We can continue our rounds at least for a while.”

She nodded.

“The man we met died. He had a heart attack I think.”

“No.” Sarah pointed to her abdomen.

“Not a heart attack?” I asked.

She again pointed to her stomach.

“An ulcer that ruptured?”

“No.”

A week later we got the word on the autopsy performed on the CEO. The large artery in his abdomen ruptured. He died of a bleeding abdominal aneurysm. Sarah knew.

I met Sarah. We would start rounding again. 

“Sarah, the man died from an aneurysm. You knew he was in trouble?”

She nodded.

“He wouldn’t let you help him.”

She nodded.

“Will you help me see things like you do?”

“Yes,” she said.

“How?”

She put her hands on the window. She gestured for me to do the same.

I placed my hands on the window. She looked at me.

“Seventy-eight degrees and seventy percent humidity.”

She laughed, something she rarely did.

I kept my hands on the window.

She placed her hands on mine. I felt a peculiar energy.

“Eighty-four degrees and sixty percent humidity?”

“Yes.”

It was strange. We were communicating in her way, and she was helping me and guiding me into her fascinating world—just a tiny opening that I hoped to widen, enter, and explore. It was an untapped dimension of our two minds. 

I discovered what autism was all about. People with autism have a purpose.

“You have a gift,” I said. “You make people better. We think we are helping you, but you are saving us. You made Mr. Andrews a better man. You made your mom a better mom. Not everybody can understand. You must be receptive. Your father was unreachable. The hospital CEO was unreachable and couldn’t be saved.”

She did not respond, but I believe she could comprehend what I said.

“Will you make me a better doctor? You feel things I can’t. Can you show me how? Will you make me more human?”

She nodded.

 Sarah took my hand, and we walked out of the hospital. 

Olaf Kroneman is a native Detroiter who left only for medical training. He has been in practice in Detroit since 1983. He has published over thirty short stories. His story “Fight Night” won the Winning Writers Sports Fiction and Essay Contest, and “The Recidivist” won the Writer’s Digest short story contest for popular fiction 2009. In 2010, he was nominated for a Pushcart Prize for “A Battlefield Decision.” His novel Detroit Heroic is to be published by Heliotrope Press.

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