When my final patient of the week came in on a Friday afternoon in May, I was exhausted. It had been a long week with too many patients who were much too sick. It did not help that spring had not yet arrived in Vallejo, California. Clouds and fog clung to the land with gritty determination.
It came down to one last patient, Kenneth, a 43-year-old intellectually disabled man who lived with his mother. I had taken care of Kenneth for 10 years. He was massive, 6 foot 3, and he carried his 300 pounds close to the earth. Despite an intimidating appearance, he was a gentle man of few words. During a decade of taking care of him, I had never heard him say more than an occasional “yes,” “no,” or “fine.”
His mother, Maude, was also my patient. She was a different story. In her early 80s, Maude was short, built small, and talkative. She loved her son dearly and they were inseparable. Maude and her son cut a striking path wherever they went, walking arm in arm, and collecting stares as if they were escapees from a traveling circus.
Maude was also paranoid — clinically paranoid. For years, she believed a man had lived on her roof, spraying her and Kenneth with chemicals. The Vallejo Police knew Maude well. Years ago they had stopped responding to her calls. She had moved twice in the past ten years, but each time the poisoner learned where they lived. Maude also had seen a psychiatrist, but refused to take the medication he recommended. Since she was not a danger to herself or others, nothing more could be done.
Maude knew I was skeptical about her poisoner, so she had long ago stopped talking about him in front of me. We had reached an unspoken agreement to not discuss the poisoner on the roof.
That Friday afternoon, I finished my evaluation of Kenneth quickly. As always, updating his history was simple.
“Are you feeling OK?”
“Yes.”
“Any pain anywhere?”
“No.”
“Any trouble breathing, rashes, change in your bowels?”
“No.”
“So you’re OK?”
“Yes.”
I am still not sure why I then asked what I did. Maude had not mentioned her poisoner for years. For some reason, as I completed my final patient visit of the week, it occurred to me that maybe Maude had outgrown him. I turned and asked, “That fellow isn’t still on the roof is her?”
“Oh yes,” she said. “Just last night he was spraying us with chemicals. The police wouldn’t come. We may have to move back to Georgia to get away from him.”
I should have known there was no point, but I responded, “How could there a man on your roof. Look at the rain. No one could live up there.”
“Doctor, don’t you start in with me. You sound like the police.” Then she pointed to her son and said, “Kenneth will tell you. Kenneth knows he sprays gas in the window.” Turning to her son, she said, “Isn’t that right, Kenneth?”
For more than ten years, I had never heard Kenneth speak more than two words in a row. So I was startled when he said, “No, Mom, there’s nobody on the roof. Nobody’s spraying gas in the window.” He appeared sad beyond description and his eyes moistened. I was riveted. Kenneth had always seemed emotionless. I was never sure how deeply he understood the world around him, its imperfections and betrayals, its joys and its mysteries.
But Kenneth was evidently capable of responding to a complex world. Now I knew he could feel sadness. Kenneth had always seemed to be naïve, yet he resonated with the reality around him more deeply than I realized.
Kenneth and his mother looked penetratingly at each other, ignoring me. Maude said, “Kenneth, you know he’s there. He’s been there for years.”
Kenneth slowly shook his head and said, “No, Mom, there’s no man on the roof. You’ve got to stop that.”
They were both on the verge of tears. I was just an onlooker at this point, but I wondered what Kenneth was thinking? How did he interpret his mother’s beliefs?
After a few moments, I stood up, knowing this day had reached its end. I was drained from the week and unsettled by what had just happened. And I felt I had to tidy up the mess I had just made.
I escorted Kenneth and his mother to the hallway. “Kenneth, you have to have to take care of your mom. She needs you to watch out for her. You know what I mean?” And to Maude I said, “You need to take good care of your son. He couldn’t survive without you.”
Then, maybe, I overstepped my professional boundaries when I said to Maude, “I don’t know about moving to Georgia. That fellow might find his way there.”
Maude did not answer. She sadly squeezed my hand, then she clutched her son’s arm to brace herself as they headed out into a gray and rainy Friday evening. As they started down the hall together, Kenneth looked back, nodded farewell, and a Mona Lisa smile flickered across his face.
“You take care of your mom. You hear me?” I said.
Kenneth’s face lit up slightly, and he paused. He loosened his mother’s grip on his arm so he could put his whole arm around her for firmer support. With that simple act, Kenneth revealed the unconditional nature of a son’s love for his mother.
“Yes,” he said, and off they went into the cool damp night. Mother’s Day was Sunday, I realized, and I knew Maude would have a good one.
(May 2006)