at the other squares of calligraphy displayed upon the wall. There it is—Harvard Medical School. She is relieved. Not that she has anything against Pasadena, but good God, if you’re paying for top drawer, you damned well want a thoroughbred.
Danielle settles into one of the two wicker chairs that seem to be reserved specifically for parent consultations. Like her, they feel out of place. She thinks about Tony, wishing she had been able to see him again. After she cancelled their dinner, he left a note at the desk that said he had to go back to Des Moines. He wrote down his cell number, but she hasn’t used it. Her life is far too uncertain right now to add him to the mix. The note is still in her purse, a hopeful talisman. She turns her mind to plane reservations. If they leave early tomorrow, she can get Max back to their apartment and still have time to unpack his things. Even the thought of doing his laundry makes her smile. Maybe Georgia, who has returned to Jonathan, can stop by Danielle’s apartment tonight, open the windows, and get a few groceries in so it won’t seem so deserted. Then maybe Max won’t remember they’ve been gone so long.
Celia returns and hands her a lukewarm coffee. Reyes-Moreno is running a few minutes late. Probably still meeting with Max’s team, she thinks. They work in packs here. No one shrink, neurologist, or psychiatrist—no one doctor responsible for anything. She takes a sip of the bitter brew. She’ll have to try and square things at the office as soon as she gets home—big-time. She feels a fleeting panic and then pushes it out of her mind. First things first.
So, what will Reyes-Moreno tell her? She’ll probably confirm all of the old diagnoses, tell her that the other doctors were mistaken, that they had him on the wrong medications. She smiles to herself. Max seems so much better. He looks more like, well, like Max.
The door opens and Celia comes in. Her eyes don’t quite meet Danielle’s. She is reminded of jurors who don’t look her in the eye when they file back into the courtroom after deliberations. Reyes-Moreno walks in and closes the door. She gives Danielle a broad smile and squeezes her shoulder. The knot of tension Danielle has felt growing somewhere around her neck just as suddenly disappears.
“Good morning, Danielle.” Her voice is soft and controlled. “How are you today?”
What appropriate niceties does one exchange with the person who holds your child’s life in her hands?”Fine, Doctor. And you?”
“Let’s sit, shall we?” She rolls the black swivel chair around until she faces Danielle, Celia slightly behind her. Danielle wonders what Celia is doing there, but doesn’t want to ask. Instead, she crosses her legs and puts her hands on her lap. Ready.
Reyes-Moreno sits erect in her chair, eyes intent and focused. “Danielle, I know you’ve waited very patiently for us to have this meeting, and I’m happy to report that Max’s team has reached a definite consensus on his diagnoses and treatment protocol.”
Danielle discovers that she’s been holding her breath. She forces oxygen into her lungs. Reyes-Moreno begins in a singsong voice. “It probably won’t surprise you to learn that we are confirming a number of diagnoses Max has been given over the years.”
Danielle relaxes back into her chair. Same old stuff.
Dr. Reyes-Moreno continues, her rhythm unbroken. “We confirm that Max is autistic—Asperger’s—and suffers from an unfortunately wide spectrum of learning disorders and disabilities,” she continues in her soft, melodic voice. “He has both a receptive and expressive communication disorder, an auditory processing disorder …” Her voice drones on.
Nothing in the litany gets Danielle’s attention. She has a legal pad in front of her. As Reyes-Moreno talks, she dutifully writes it all down, as if she’s at a deposition getting boring background on an inconsequential witness. As the list of disorders wears on, though, she feels very sad—probably because all she wants to hear is that all the other well-meaning but misguided professionals not only made mistakes about the medications, but also about the autism diagnosis and underlying neurological differences. It would have been wonderful if Max didn’t have to face all of these problems. Well, she thinks, as Reyes-Moreno ticks off the list—obsessive-compulsive disorder, fine motor difficulties, tactile defensiveness—she can deal with all of it.
“We recommend a new protocol of antidepressants to combat Max’s suicidal tendencies,” says Reyes-Moreno.
Danielle goes down a mental list of tricyclic antidepressants, SSRI’s, SNRI’s and their potential side effects, as well as those contained in the black box warnings. “What are you thinking of? Effexor? Cymbalta? Zoloft?”
Reyes-Moreno looks at Danielle, but doesn’t say anything. Danielle turns abruptly and stares at Celia, who starts to say something, but catches a vague signal from Reyes-Moreno and looks away. Danielle’s heart is beating too fast, a wild, caged thing struggling to get out.
Reyes-Moreno rolls her black chair closer, takes Danielle’s hand and squeezes it. Her voice is baby-blanket soft. “There’s more, I’m afraid.”
Danielle pulls back. Reyes-Moreno’s viridian eyes lock on hers. If she smiles at me, it means he’s all right. Danielle smiles first—a small, desperate invitation.
Reyes-Moreno has no smile for her. “I’ll just say it, and then I want you to know that we’re all here for you.”
Danielle has no body now. She is only her eyes, which see Reyes-Moreno and nothing else in the universe.
“Unfortunately, our testing has resulted in the diagnosis of a grave psychiatric illness. Max has an extreme form of psychosis, called schizoaffective disorder.” She pauses. “Fewer than one percent of all psychiatric patients fall into this category.”
Danielle is stunned. “Max is schizophrenic?”
“In part. However, schizophrenia does not have the mood-disorder component that the schizoaffective label carries.” She points to a stack of literature on her desk. “I’ve selected a series of articles that will better help you understand the challenges Max faces. Briefly, the onset of schizoaffective disorder peaks during adolescence and early adulthood. The severe disruptions to Max’s social and emotional development—compounded by Asperger’s—will continue over his lifetime. He will, in all probability, always pose a risk to himself and others, and involuntary hospitalizations will be frequent. Unfortunately, Max displays virtually all of the symptoms under the DSM-IV-TR: delusions, hallucinations, frequently derailed speech, catatonic behavior, anhedonia, avolition—”
Danielle forces herself to breathe. “This is crazy! He’s never had any of the symptoms you’re describing.”
Reyes-Moreno shakes her head. “Perhaps not when he is with you. However, our daily charts clearly reflect Max’s symptoms. You must have seen some of these signs. Parents often live in denial until, as here, the child breaks down completely.”
“I do not live in denial.” Danielle feels her cheeks flare. “Are you sure that these symptoms aren’t a result of the overdose you gave him?”
“No.” Reyes-Moreno shakes her head sadly. “These issues are far more pervasive and long-standing.
“What we don’t know is if there is a history of psychosis or mood disorder in your family or his father’s family.” Reyes-Moreno’s lips keep moving—like one of those Japanese cartoons where the red mouth looks like a real person’s, but the rest of the body is a stiff, poorly drawn animation of a human being and the words come out long after the mouth has stopped. Danielle tries to absorb what Reyes-Moreno is saying, but her thoughts are a silent, deafening scream.
“As I mentioned, Max will require frequent, lengthy hospitalizations over the course of his lifetime due to recurrent psychotic breaks and the extreme incidents of violence we have observed and anticipate. I must tell you that with each successive break, Max’s memory and his ability to assess reality will deteriorate exponentially, which unfortunately will compound the severity of his schizophrenia. It will most likely be impossible for him to hold a job or live independently as a result of these breaks. We must also be ever-vigilant with respect to the possibility of future suicide