Dr. Melendez entered the hospital room to review his new surgical patient, closing the door behind him. He consulted the chart and read it thoroughly before looking at the young patient lying quietly in the bed. A woman, apparently the boy’s mother, hovered nearby. A light drizzle outside made shimmering patterns against the hospital window glass.
‘Yes. I’m Mrs. Laird. This is my son Bobby.’
Melendez stared at the boy, who seemed to find a small, wet feather stuck to the glass outside fascinating. ‘Hello, Bobby. I’m Dr. Melendez. I’m going to take out your appendix and make you feel better.’
The boy never moved nor acknowledged anything around him. Melendez glanced at the mother. ‘He’s…autistic, is he not?’
‘Not high functioning then, I gather.’
‘Dr. Melendez, those who are autistic and their caregivers really don’t appreciate that label.’ Mrs. Laird stated evenly. 'Bobby is quite intelligent. It just takes ingenuity to reach that intelligence.’
‘My apologies. He’s thirteen, I see.’
‘His tests confirm an inflamed appendix. We’ll operate in the morning. I need to examine him one more time.’
‘He should be all right as long as I’m here and he can see the feather.’
Melendez nodded. Assisted by Bobby’s mother, he folded the sheet and blanket down. He lifted the boy’s hospital gown and moved to gently palpate the tender abdomen. His shoulder cast a shadow over the boy’s face, obscuring the feather on the window. The boy keened in a high-pitched tone and began waving his fists in frustration. Only the pain in his abdomen prevented him from rocking violently back and forth.
‘This won’t do. I have to find some way of examining him unless you can compel him to behave.’
Mrs. Laird glanced at the window. The feather had been washed away. Bobby continued his forlorn wail, the sound of which permeated the hallway, despite the closed door, and could be heard in the elevator down the hall as Dr. Shaun Murphy emerged.
Clasping his fingers together, he jogged with his distinctive gait down the hall and into Bobby’s room.
‘Well,’ said Melendez, glancing up. ‘Come on in. We could probably use you at a time like this.’
Dr. Melendez introduced Mrs. Laird and Bobby to Dr. Murphy and outlined the case. Shaun seemed unperturbed by the boy’s screaming. He turned to Mrs. Laird. ‘What was the boy’s focus?’ he asked in a monotone, his voice rising in query only on the last word.
‘There was a feather on the window,’ Melendez said in irritation. ‘It’s gone and now he won’t behave long enough for me to palpate his abdomen.’
‘Dr. Melendez. May I ask that you stand back…please? Mrs. Laird. Would you please dim the lights. At the switch there by the door. Just turn the knob to the left.’ She complied.
Shaun withdrew a red fidget spinner from his pocket. He managed to catch and gently clasp Bobby’s closed fist in his hand and slip the spinner under the fingers. Bobby instantly stopped screaming and began examining the new toy.
‘He’s very tactile.’ Shaun waited a few minutes. ‘If you will allow me, Dr. Melendez, I will palpate the abdomen.’
‘Do you know what to look for? This boy’s being operated on in the morning.’ There was no mistaking the doctor's sarcastic tone. Mrs. Laird looked at Shaun doubtfully.
‘I am looking for signs of localized guarding, a reflexive tensing of the abdominal muscles over the area which indicates peritonism and rebound tenderness which suggests peritoneal irritation. Rigidity indicates peritonitis. In peritonitis, the abdomen also does not move during respiration and bowel sounds are absent,’ Shaun recited.
With Bobby’s focus on the fidget spinner and the lights set to a more soothing illumination, Shaun was able to successfully carry out the final examination.
‘Peritonitis is not present; the appendix remains intact. There is no need to reschedule the operation before morning.’ Shaun now turned his attention to Mrs. Laird. He had learned a great deal in his first week, not the least of which was to assure the patient and family and to make sure they heard and understood him. ‘Bobby’s condition is not severe. He will be fine. Dr. Melendez will perform the surgery.’
Shaun looked at his fidget spinner in the boy’s hands. ‘He may keep that. It seems to calm him. It calmed me. I can get another one. I can afford it now.’
Mrs. Laird had been surreptitiously studying Shaun. ‘You became a doctor?’ she whispered, with a note of hope in her voice.
‘Yes, I did. I am a surgical resident here at San Jose Saint Bonaventure Hospital. Bobby is going to be fine.’
Shaun, hands clasped, turned and left the room, softly closing the door behind him.
Presently, Dr. Melendez concluded his bedside visit and exited the room. He glanced at his young colleague in the hallway. ‘Thanks, Shaun,’ he said grudgingly.
‘You’re welcome,’ Shaun responded. His eyes looked off to the side, a trait which annoyed Melendez to no end.
Melendez shook his head and turned away. Shaun spoke to his superior's retreating back. ‘Patients with autism have different needs than usual. You learned that from me, Dr. Melendez.’