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Silence then. Again she looked expectantly at James. When he didn’t say anything further, she said, “Until now we’ve had Conor at the Avery School. In Denver. Have you heard of it?”.
“I don’t know it well,” James replied. “I’ve only been out here since February, but Dr Sorenson has mentioned it.”
“They work on a very structured behavioural program. Called ‘repatterning’. The school has an excellent reputation for success at socializing severely autistic children.”
A pause.
“Although,” she said with faint sarcasm, “maybe that’s simply because they do to the failures what they’ve just done to us. We received a letter right out of the blue saying they didn’t want Conor back this autumn. That they felt Avery wasn’t ‘helpful to his needs’. It was worded wonderfully. Like it was their fault things didn’t work out, when you knew they meant just the opposite. That they think we’ve got a funky kid. So here we are with absolutely no place to send him. Completely stuck.”
James looked at Laura closely. He was finding her difficult to read. On the face of it, she appeared straight-talking, but her words and body language gave off none of the usual subtle subtext. She sat absolutely still in a relatively neutral pose that was neither open nor closed. She made good, although not outstanding, eye contact. Her tone of voice was even but not very nuanced.
His inability to glean more intuitive information from her surprised James. He’d been prepared for other challenges in meeting Laura Deighton. Would her fame unnerve him, for instance? Or more likely, would he take an instant dislike to her? The literary people he’d known in Manhattan were, to a person, pompous and self-absorbed, and he hated these traits. When he’d discovered she was coming in, he caught himself feeling a certain gratification at the fact he’d never actually read any of her books. But her blankness was unexpected. There was just no discernible subtext. That was where James was accustomed to doing all his “reading,” where he got so much information about clients, there in that intuitive space beneath words and gestures. With Laura Deighton, it was as if this space did not exist.
“Has Conor always been in a residential program?” he asked finally. “Have you not found suitable programs locally?”
“It needs to be residential. Our ranch is out beyond Hill City. Realistically, we just couldn’t be driving him a long distance every day.”
“Was Dr Wilson clear with you about what kind of therapy I do?” James replied. “Because if I took Conor on, I would expect to see him three times a week.”
Her eyebrows lifted slightly, although perhaps not so much so that it could be interpreted as surprise.
“I’m a child psychiatrist,” James continued. “What I prefer to do with the children I see is traditional play therapy, which means having them in on a very regular basis.”
She was silent a long moment. “No. I hadn’t quite realized that’s what you did. So perhaps it’s not appropriate. Conor’s autistic. I know in the old days it was common to send autistic kids to psychiatrists, but, of course, we understand now it’s not a psychiatric condition. It’s neurological. Consequently we’ve always had Conor in behaviour-based treatment because that’s the proven way of teaching life skills to children like him.”
“Did Dr Wilson give you any reasons why he thought it might be helpful for Conor to come here?” James asked.
“No, he just suggested it.” She paused. Her silence was at first expectant, but grew longer and more indistinct.
Then without warning, the mask slipped. Her shoulders dropped in a gesture of despair. “Probably just because I’m so desperate. I know I’m driving Dr Wilson demented with my calls. It’s just that Conor’s so difficult. Home for a month and he’s destroying us.”
Sympathy washed over James. He leaned towards her, his folded arms on the desk, and smiled reassuringly. “Yes, I can understand. Children like Conor can be very demanding,” he said softly. “Don’t worry.”
The muscles along her jaw tightened. She wasn’t teary but James knew she was in that moment just before tears.
“Why don’t you tell me a little bit about how Conor is at home?” he said. “That’ll give us a better idea of whether or not coming here would be appropriate.”
Laura became teary.
He smiled gently and leaned forward to nudge the box of tissues towards the edge of the desk. “Don’t worry. This is a very hard moment. Most parents feel pretty upset.”
“It’s just … just such a nightmare. Like one of those nightmares where you keep doing the same thing over and over and it never works out, it never achieves anything.”
She took a tissue. The tears hadn’t really materialized, so she just clamped it tightly in her fist. James had a strong sense that she was feeling deeply conflicted in that moment, that self-control was a huge issue but that at the same time the burden of this boy was so overwhelming that she was desperate for help.
“Is Conor your only child?”
“No. We have a daughter too, who’s six.”
“When did Conor’s problems first start?” James asked.
Laura let out a slow, elongated sigh. “When he was about two. He seemed all right when he was a baby, although it’s hard to know with your first child. There were things I had always been concerned about. He was very jumpy, for instance. If you came up behind him or there was a loud noise, he’d always startle badly. Dr Wilson said it was just a temperament thing, that it simply indicated he was a sensitive boy, and not to worry about it. Otherwise, he was a good baby. He slept well. He didn’t have colic or anything.”
“Did he seem to develop normally to you?”
“Yes.” Her voice had a plaintive, almost querulous note of bewilderment to it and James wondered how often she’d had to give these details. Or was stopped from giving them. In this era of insurance and accountability, there often was little time spent on collecting psychosocial histories beyond what was needed to prescribe the appropriate drug. James had found listening carefully to the parents’ initial version of events was one of the most valuable thing to do, not only for the concrete information it provided in building up a picture of a child’s problems, but also as a way of cementing that crucial relationship with the parents, because they often felt so desperate and unheard.
“Conor was always timid,” Laura said. “He cried easily. He worried about things. Even as a little, little boy. But he was very bright and interested in things. He talked early. Even by a year old, he could use several words.”
“So you say the difficulties starting showing up after he turned two?”
Twisting the tissue between her fingers, Laura nodded. “It started with his becoming very clingy. He’d always been inclined to be clingy but suddenly it got much worse. He never wanted me out of his sight. I couldn’t even go to the bathroom without him. He began having these terrible temper tantrums. Dr Wilson was still telling us not to worry. Kids have tantrums at that age, he kept saying, but I don’t think he realized how bad they were. Conor would just go frantic and do things like literally rip the wallpaper off the wall with his fingernails. To complicate things, that’s when I got pregnant with Morgana and it was a challenging pregnancy. I had some serious medical problems. And we were having some financial difficulties, which meant the pregnancy wasn’t very well timed – it hadn’t been planned – so a whole lot was going on.”
“Can you describe Conor’s behaviour in a little more detail?” James asked.
“He got really hyper, really agitated. He wouldn’t sleep. He could go days without sleeping. Which, with a new baby …” She let out a defeated sigh. “And the screaming started. He’d be sitting, playing normally with his toys and then suddenly he’d get all panicky, and start screaming and screaming. He had been in a nursery program two days a week, but we had to take him out because his behaviour upset the other children so much. The school wouldn’t keep him.” She put a hand over her eyes for a moment in a gesture of desperation and then rubbed her face. “It just got so distressing to live with. Finally Dr Wilson arranged for him to go into the children’s unit at the university hospital in Sioux Falls to be assessed. That’s when autism was diagnosed.”
James nodded thoughtfully.
“And now …” Laura said. She sighed again. “It’s getting just like that all over again. ‘Difficult’ doesn’t half describe living with Conor. For example, everything has got to be just so. His room, his toys, his food. Everything must be in a special place and in a special order. I can’t do anything for him if it isn’t exactly the same way I did it before. Like at breakfast, I can’t put the eggs on the table if the juice hasn’t been poured first. All these little rituals have to be followed precisely. Like those wires. Did you see those? Those bits of string around his waist? There must four of them. Exactly six feet long. Each with twelve bits of foil. Then there’s that frigging cat. That cat rules everything in the house. It goes everywhere he goes, does everything he does, investigates every molecule that comes in contact with Conor.
“This all makes even the smallest, most ordinary task a trial. Try giving a bath to a kid who must have string, foil and a stuffed cat on his person at all times. Or putting him to bed. It’s like putting Frankenstein’s monster to bed. All those wires have to be attached to the bedpost and crisscrossed over the bed just so. If they’re not just so, he’ll sit there ‘adjusting’. He can be up for hours ‘adjusting’, scanning the cat over them, ‘adjusting’ some more and all the while he is making noises – buzzing and whirring, or worse, meowing. This then wakes Morgana. She goes in to see what’s going on. She means no harm. She’s just being your typical, nosey six-year-old. But if she tries to help him or she touches his cat, he freaks. So then I yell at her for upsetting him and she cries. Then he cries. Like as not, I end up crying too.”
James smiled sympathetically. “That must be very difficult. What about your husband, Alan? Does he help much with Conor?”
Laura leaned back in the chair and expelled a long, heavy breath. “Well, there’s another issue …
“It’s not so good between Al and me at the moment,” she said softly, and James could hear emotion tightening her words. “That’s a whole other story. A long one and I don’t want to go into it right now. But the short answer is: yes, he helps when he can. It’s just I don’t know how long that’s going to last, because we’re splitting up.” She looked over tearfully. “So, see, this is why I can’t cope with Conor at home. Even I have to admit I need help.”
Chapter Two (#ue8feb99c-1d3e-51df-8a32-c348b7df44de)
“Laura Deighton, huh?” Lars said, leaning over the appointment book that was lying open on Dulcie’s desk. “So is the boy coming in then?”
James nodded. “I couldn’t get her to agree to three times a week, but we’re going to do Tuesdays and Thursdays.”
“What’s she like?”
“Seems okay,” James replied.
“Not all …?” Lars wiggled his hand in a gesture that James took to mean “above herself”.
“No, not really. Just trying to cope with some big challenges, like all parents of autistic children.”
Lars rolled his eyes teasingly. “But then you’ll be used to celebrities, won’t you? The high-falutin’ crowd. City Boy.” He grinned.
City Boy, indeed. Culture shock was too mild a word for what James had experienced in moving from Manhattan to Rapid City. South Dakota might as well have been the dark side of the moon. James did manage to do what he’d dreamed of – set up his own private practice in family therapy – but it hadn’t turned out to be exactly like his fantasies. Even at South Dakota prices, James had discovered he couldn’t afford to go it alone. Consequently, he’d ended up in partnership with a local psychiatrist, Lars Sorenson. If James had wanted freedom from the strict Freudian theory that had ruled his life in New York, he couldn’t have done better than Lars, whose ideas of psychiatry had more to do with football scores or gilt hog prices than Freud. James’s former colleagues would have frozen stiff at Lars and his homely country doctor approach. Indeed, James himself had taken so much thawing out when he first came that he’d probably left puddles behind him, but if Lars had noticed, he’d never let it bother him. In the end, James was grateful for the partnership. Lars was never in such a hurry that he wouldn’t stop and listen or answer one more stupid question about “real life,” as he liked to call living and working in Rapid City. And while there was a lot of good-natured teasing, he had never once laughed outright at James’s city-bred ideas.
“Ehhh-ehhh-ehhh-ehhh,” Conor murmured. “Ehhh-ehhh-ehhh-ehhh, ehhh-ehhh-ehhh-ehhh.” As before, he stood only just inside the playroom door.
James listened carefully to the noise. It had a distinctive mechanical sound, like a car ignition turning over on a cold morning. Turning, turning, turning but never catching.
“Ehhh-ehhh-ehhh-ehhh. Ehhh-ehhh-ehhh-ehhh, ehhh-ehhh-ehhh-ehhh.”
Conor had the stuffed cat clutched tightly against his chest. Slowly he lifted it up until it was pressed under his chin, then higher still until the head of the cat lay against his lips. He stopped the ignition sound. Taking one hand off the cat, he flapped it frantically. “Meow?” he said.
Was he making the noise on behalf of the toy? James wondered. Was he trying to make it ask something that Conor dared not voice himself? Or was it the other way around? Was the cat putting its words in Conor’s mouth?
“Meow?”
“When you’re ready, Conor, you can come all the way into the room and we’ll shut the door,” James said. “But if you wish to stand there, that’s all right too. In here you can choose what you want to do.”
The boy remained immobile in the doorway, the toy cat pressed against the lower half of his face. His eyes flickered here and there but never to meet James’s gaze.
An expectancy seemed to form around them and James didn’t want this. He didn’t want Conor to feel there were any expectations of what he should or shouldn’t be doing, so James attempted to diffuse it by lifting up his spiral notebook. “This is where I take my notes. I am going to write in it while I sit here. I will write notes of what we are doing together so that I don’t forget.” He picked up his pen.
For a full five or six minutes Conor stood without moving, then very cautiously he began to inch inward. As with the first session, he stayed near to the perimeter of the room and kept well away from James, sitting at the small table. Once, twice, Conor circumnavigated the room and pressed the cat’s nose lightly against things as he went.
He was saying something under his breath. James couldn’t hear at first, but as Conor passed the third time, he could make out words. House. Car. Doll. Conor was naming the items he saw, as he passed them. This was a good sign, James thought. He understood the meaning of words. He knew things had names. He had at least some contact with reality.
So it was when Conor came again on Thursday. And again the next week. Fifty minutes were spent quietly circling the room, touching things lightly with the nose of the stuffed cat, naming them. James didn’t intrude on this activity. He wanted the boy to set his own pace, to construct his own sense of security within the room, to understand that James had meant what he’d said: that Conor alone would decide what he wanted to do in here. That was how trust was built, James believed. That was how you made a child feel safe enough to reveal all that was hidden. Not by schedules. Not by reward and punishment. But by giving time. There were no shortcuts. Even when it meant session after session of naming.
Three weeks passed. During the sixth session Conor circled the room upon entering and again touched everything he could easily reach with the toy cat’s nose, still murmured the names, but this time it was different. He elaborated. Red house, he whispered. Brown chair. Blue pony.
For the first time, James answered Conor’s murmuring.
“Yes,” James said, “that’s a blue pony.”
Conor’s head jerked up abruptly. “Ehhh-ehhh-ehhh-ehhh.” He stared straight ahead. The hand not holding the cat came up and fluttered frantically in front of his eyes. “Ehhh-ehhh-ehhh-ehhh.”
James sat very still.
Moments passed.
Slowly Conor exhaled. Extending the cat away from his body, he touched its nose to the edge of the shelf. “Wood,” he murmured very softly.
“Yes, that’s made of wood,” James said.
The cat was retracted instantly.
James watched the boy, who kept his head averted to avoid eye contact.
“Ehhh-ehhh-ehhh-ehhh.” There was a long pause, then Conor whispered, “Brown wood.”
“Yes, the wood is brown.”
Conor turned his head. Not to look at James. His eyes never left the far distant point they were fixed on, but his head inclined a little in James’s direction. That was all that happened.
“Bob and I were thinking of going over to the Big Horns to squeeze in a couple of days of elk hunting,” Lars said and sank down in the beige-cushioned softness of James’s office. “You want to come?”
“That’s a very kind invitation, Lars, but I don’t know one end of a rifle from the other.”
“You can borrow one of Davy’s guns,” Lars replied. “Davy killed his first buck when he was just twelve. Did I tell you about it? A six-pointer.”
“Yes, you mentioned it.”
“So come with us. Time you got blooded, Jim. How else we gonna make a South Dakota man out of you?” Lars laughed heartily. “It’ll just be Bob and me. We’ll take some beers and some grub and have a great time.”
“When?”
“Next weekend.”
Relief flooded through James. “Well, damn! Wouldn’t you know it? I’ve got the kids coming out next weekend. Remember? Because I’m taking Monday and Tuesday off the following week.”
“Oh Jesus, yeah.”
“Darn. I’m sorry to miss it. Maybe next time.”
Stretching his arms up behind his head, Lars settled back into the chair. “So how’s it been going between you and Sandy? Is she getting any more reasonable about the kids?”
“Not really. They can come out at Easter but she says no way over Christmas,” James replied, but he couldn’t quite keep the disappointment from his voice.
“Why not? I thought you got to alternate Christmases,” Lars said.
“The court says yes. But Sandy keeps on about how disruptive it is for them at their ages.”
“Yeah, but they’re your kids too. You’ve got the right to spend time with them.”
“I know, but all this fighting over them isn’t good for them either. I don’t want them to grow up seeing Sandy and me at each other’s throats the whole time. And she’s probably got a point. It is disruptive for them at Christmastime. Sandy always goes to her folks in Connecticut. They have one of those big old Cape Cod houses and do Christmas with this enormous ten-foot tree and all the trimmings. The kids have their grandparents there, their cousins, their aunts and uncles, their friends. Christmas is supposed to be a happy time. Desperately as I want Mikey and Becky with me, I want what’s best for them more.”
“You’re a pushover, Jim,” Lars said, shaking his head. “You need to learn how to stand up to her. To say: ‘This is important to me and I’m going to fight for it.’”
“I already have, Lars. That’s how I’ve ended up here.”
“Well, once in a lifetime isn’t enough. You need to keep at it.”
James nodded morosely. “Yes, I know.”
The day was one of those in autumn of pure lapis lazuli sky and crystal air. From the large playroom window, James could see out over the city to the open plains beyond. Below in the street the dappled tints of gold and orange flickered restlessly in the sunlight, but the sky stretched ever onward, a clear, almost luminescent blue.
Gentle joy always filled James when he stood at this window. Clichéd as the vision was, he knew there was a metaphorical eagle somewhere inside him that would one day spread its wings and soar in response to this infinite landscape. His heart still felt depressingly sparrow-sized most of the time, but seeing such immensity always gave him hope of greater things.
Not that his sparrow’s heart hadn’t had its own share of struggling to get free. The most horrible moment had come two years ago when, after ten years of training, James suddenly realized that he couldn’t bear the thought of spending another day in the sheltered prison of psychoanalytic theory. That moment still relived itself with soul-shattering clarity. He’d been fighting his way through heavy traffic on FDR Drive in Upper Manhattan when the insight mushroomed up with all the subtlety of an H-bomb going off. His hands went rigid on the steering wheel; sweat ran down the sides of his face and his heartbeat roared up so loudly into his ears that it drowned out whatever the hell was playing on that jazz station he always listened to but didn’t really like. He realized then that things had to change. He had to get out of the life he was living …
God, what that moment of insight did to Sandy. She’d been beyond furious when he told her. The rows they had. And some of her anger was justified. She’d supported him all those years. She’d put her own career on hold while he’d finished medical school, then the training, the internship, the residency and his own analysis to emerge as a fully qualified psychiatrist. Sandy had stuck through it all for the chance of a brownstone on the Upper West Side and private school for the kids. Those were her goals in life and she’d worked just as hard to achieve them as he’d worked for his.
“Theory?” she’d screamed when he’d tried to give voice to his confusion. “What the hell’s this sudden thing with theory? How can you wreck our entire lives over something like that? It isn’t even real. So what if you don’t believe it? You’re not a priest, for fuck’s sake. Believe in something else.”
How did he explain it, his inarticulate longing for something beyond the narrow corridors of analysis, the domineering views of his colleagues and the shadowy brick-and-mortar ravines of Manhattan? A panic attack in the middle of rush-hour traffic hadn’t been very subtle, but it got the message over.
