Chapter 6

     It was July, 2007, two months earlier.
Lizzy took Nicolas to his appointment at N.H.U. with a chief neurologist, Dr. Epstein.  
     Nicolas went through many tests.  He had an EEG with electrodes glued to his head, registering brain waves.  He had gone through a dark, frightening capsule, a cat scan and an MMR.  There were many technicians and staff members, employees, involved, and they were all very professional, and very nice mannered and upbeat.  
     He also went through a range of psychological testing, orally being asked many, many questions, some of which he could answer easily, and others not so much.  He was asked the meaning of words such as, compassion, empathy, equality, morals, devious, manipulate, and many others.  He could define many of them, but had to think for a while before answering.  Devious, for example, he had a difficult time with.  He basically defined compassion as, "caring about someone," which Lizzy who was present, thought was a good answer, but in all fairness, the words were somewhat advanced for his age, she thought.  He did well.  He was also asked some more involved questions about the meaning of phrases, and he did not do as well on those questions, and was quiet for long periods, as though he were racking his brain for answers, and then the questioning would just move on.  
Dr. Epstein asked the questions, and made notations.  His assistant was present throughout, also writing things down.
      Nicolas and his mother sat across the desk from Dr. Epstein at the end of the day, around 4:30 that afternoon.
     "Mrs. White-"
     "It's Ms White, but Elizabeth is fine."
     "OK, Elizabeth."  He stared at the test results, his reading glasses far down on his nose, graying hair.
     "There is nothing showing in any of the tests.  We see no brain tumor, or any strange or significant problems or abnormalities.  The cat scan was normal.  He is in good health.  His height and weight are perfect for his age range.  He may grow out of these seizures, but in the meantime, I will write you another prescription for valproic acid, which can be toxic and adults usually require regular liver checks, but with Nicolas being only fourteen, I do not think there is much to worry about.  It is sometimes prescribed for people with bipolar disorder or migraines, but it is an anti-seizure drug.  Of course, I agree with the diagnosis of pseudo seizures.  I do not feel that these seizures, as unpleasant and painful as they are, will cause any permanent harm, but we definitely want to prevent them as best we can.  I will prescribe depakote, which is a higher quality form of the pharmaceutical.  It is the same thing, but not generic, and I think it would be better for him.  Medicaid will still cover the medication, so don't worry about the cost.  Blood platelets should be checked regularly, because anemia is a possible side effect."
     "That sounds horrible.  He has already been on that a while.  He'll be fifteen next month."
     Nicolas was not saying anything, just swinging his foot, as well as wringing his hands a bit, wishing all this doctor business would end already.  He just wanted to go home and play XBOX or basketball with Daniel or watch Beevis and Buthead or Southpark DVDs.    
     "I really don't like the idea of keeping him on a toxic medication."  Lizzy felt annoyed by the fact that no answers had come.  She was glad there was no epilepsy, brain injury or anything worse, but wished there were some clear answers.
    "Nicolas, do you have friends?," Dr. Epstein asked, looking at him pensively.
     At first Nicolas said nothing.  He thought for a long time.  "Well - ," he began.  Pause, - "you can't really, um - where we live, - out in the country."  He was quiet for a long time.  Dr. Epstein waited patiently for him to finish talking.  "I'm friends with my older brother - and his friends."
     "What about at school?," Dr. Epstein looked Nicolas in the eyes, but this made Nick uncomfortable, so he looked away.
     Again, Nick had to think for a long time.  Lizzy was used to the way he spoke, so to her it was completely normal.  She knew he was unique, but she felt that was all. "Uh, no, not really," he finally began.  "Just don't really fit in.  Get picked on and stuff."  Again, he paused for a while, thoughtfully.  "Um, no - I guess I don't - have any friends," he finally answered.
     Nick was agitated and swinging his foot, and looking down.  Lizzy felt he was nervous, because he had no problem expressing himself at home, with her, Daniel, Daniel's friends, or Charlie, or the dog, Rusty, for that matter.  She felt like Dr. Epstein was interrogating Nick, and she felt the question was unfair and cruel.
     "Doctor, Nicolas is a straight A student, honor role.  He is very gifted with computers, technology, assembling anything, you name it.  I feel like you are putting him on the spot, and this line of questioning seems preposterous to me."
     "Yes, I am not surprised.  I know he is a very bright young man, and I'm sorry if I come across as being rude.  I don't mean to be.  I am just trying to find out more about Nicolas."
     He then turned to Nicolas.  "I am sorry if I upset you, Nicolas.
I just wanted to find out more about how things are going for you, with school and all.  Would you like to go out to the waiting room and watch television for just a few minutes?  I would like to talk more, with your mother, and I know you are tired.  Ask Jennifer at the front desk, for a soda.  You have had a long day here, I know.  I know you want to get going."
     Nick casually walked out and closed the door, saying merely, "sure, thank you," in his usual soft spoken way.  He was always very polite to everyone.
     Lizzy had a horrified look and was getting more worried.  What on earth would he want to tell her, that he could not say with Nicolas in the room?
     "Elizabeth", he began.  "Has Nicolas ever been diagnosed with any type of autism?"
     "No, of course not.  He is fourteen for crying out loud.  He's an A student, not nit picky either and he talks just fine."
     "Well", he continued, "sometimes there are mild forms and autism does not necessarily make one unable to speak and autistic children and adults can be extremely intelligent.  I am concerned about his fractured speech and not making friends.  I do not want to put a label on him by any means.  I may be wrong and at his age, it would seem highly unusual for something like this to be so delayed in being notable.  I may be wrong.  It is just some mannerisms.  I do not think it is connected with the seizures.  I think Nicolas has autism spectrum disorder, what is called ASD.  It often does not show up until  adolescence, but I can have him accessed by a team of doctors, but I think that this is the prognosis.  He is mostly just emotionally autistic, and does not respond emotionally, nor process things quite the way most people do.  It could get better, and he can live a perfectly normal life, drive, get married, have kids, go to college, have a career, everything.  Sometimes people put children and adolescents on anti-psychotic drugs, but in Nicolas's case, that is not necessary, since he does not have outbursts, and is highly functioning.  I think the seizure medication is enough.  I am for less medication and not more, especially if not necessary.  How is his behavior at home?  Does he get very upset at times?"
    "No, I mean, maybe once or twice when there were really loud noises, like a gunshot when his grandfather took them hunting when they were younger, a beeping car horn.  How on earth could something like this come about now?  I don't notice his speech being anything but normal.  I mean I know he is really quiet, but - "  she drifted off, thoughtfully.  She was confused and a bit indignant by now.
      "I think you have done a really good job with him, bringing him up.  He is a very polite, and a very intelligent young man.  Do you think it is normal for him not to have friends?"
     "That's my fault, Dr. Epstein.  I should not have rented out in the country.  I should live in a neighborhood with kids around.  Daniel is older.  His friends have cars and stuff.  Daniel is legally blind, you know, but his friends have drivers licenses.  No I think you are mistaken."
     "Did Daniel have friends at Nick's age?" Dr. Epstein seemed to be challenging her she felt.  She did not care for him or what she was hearing.  She thought he must be a quack, even if he was considered the best in all of New Hampshire and Vermont, Rhode Island and Maine.  These were small states.  She should take him to Boston.  'Screw this', she thought.
     "Elizabeth, I understand you being upset.  I might be wrong.  I just want to know if Daniel had friends before they were old enough to drive, his friends I mean?  Did you live in the country then too?"
     "Yes, we have lived near Vershire Center for ten years now.  I got a great deal on a lease on a big house, we could otherwise not afford.  Yes, come to think of it, Daniel did have friends come over a bit, and was invited places, but when Nick was little, he had some friends, play dates, birthday parties, you know, all that.  To be honest, Dr. Epstein, I am so busy working all the time, and with my kids, I don't even have friends.  I don't have time for friends, not to mention not having any energy."  She thought about the fact that she had Charlie.  Charlie was her best friend, she supposed, even though she did not love him the way he loved her. Then she snapped back to the reality that this was not about her, but Nick, and his well being.  
     "I think", began Dr. Epstein, "when children are younger, their parents are more involved in their social lives, making play dates, sleep overs, parties, etc., but for teenagers it is harder.  They have to fend for themselves, make friends on their own.  I am saying as a friend to you now, even though we do not really know each other, and not so much as a doctor, but a guy who happens to be a doctor, that I feel that Nicolas needs to make friends.  It is not healthy for him to isolate at this age, for whatever reason."
     'I suppose Dr. Epstein is my friend now,' she thought, sarcastically, perhaps a bit sardonically.  'I suppose he feels sorry for me.  Stop thinking about yourself, Lizzy.  It's about Nick,' she thought to herself, feeling guilty for her attitude about the situation, and for being so upset about all this, and at the same time feeling very skeptical, of this great, renowned doctor, but a part of her thought he might be right.    
     "Are you saying I should move to a town?  To the city?  I mean, Nick likes things to stay the same.  He doesn't like change."
    "I don't know.  Actually, not being okay with change is also symptomatic of this condition.  It could be difficult for him, so I am only suggesting it, not insisting on it.  It may be hard for him, hard for you.  That is up to you.  I think it may be helpful.  On the other hand, living in the country could shield him from bullying or later on getting involved with drugs, alcohol, or other things that kids get into, especially in urban areas."
     She thought, 'if only you knew, Doc.  Even the country doesn't shield kids from partying and alcohol, not with Daniel and the other boys.'  So far Nick had not gotten involved in any under age drinking or smoking, for which Lizzy had been grateful.
     "I will take that under advisement, Dr. Epstein."  
     She left his office with her son, Nick, feeling confused, not knowing what to do, except for getting his prescription filled at the pharmacy, on the way home, as well as some fast food, from the drive through at McDonald's.
She was not hungry, but she knew she had to eat, and Nick was starving.  Food would certainly help.  It always did, when she was feeling too stressed and foggy brained.
As always, it was, one foot in front of the other, one day at a time, baby steps.  Do what you have to do, the next right thing, and then the next, and the next, and the next, like an unending stream of responsibilities, things to digest, to take care of, to do, to take in, to deal with.  How much could one person take on?  How much before they broke, broke down?  She felt like she was at the end of her rope, one son diagnosed with retinitis pigmentosa, a congenital eye disease, which can lead to total blindness, at age five, and now Nick diagnosed with ASD, autism spectrum disorder, on top of the pseudo seizures.  


author's note: This is fiction and in no way representing anyone living.  Only bits and pieces broken up resemble certain experiences of mine, but certainly not to any exactness or sameness.  I say this so as not to create misunderstandings.