Brian was a ten-year-old boy who came into the pediatric clinic one day with both of his parents.  I glanced at his chart.  Nothing significant in the notes.  Just normal shot and sore throat visits.  I handled it over to Dr. Barton, with whom I was seeing the patients.

“Oh, this will be good for you to sit in on,” said the good doctor.  “He’s here for evaluation of ADHD.”

For this, Dr. Barton had set aside an entire hour to fully digest the case and discuss it with Brian and his parents.  We entered the room.  Brian was white, blond, slender in build and wearing gold-rimmed glasses that were just a little too big for his face.  I had begun this description in my head instantly with a quick glance, a skill that was becoming second nature, even as a relatively inexperienced second-year medical student.  But my immediate impression of Brian actually went far beyond this.

I considered his whole life and guessed at it as best I could.  “Hmmm.  Ten years old, probably fourth grade, fifth maybe.  I bet he’s a good student, but not perfect.  He probably has friends, but not a lot.  Three or four close ones, likely.  He wants to play sports, like most ten-year-olds, but he’s not gifted at them.  No matter, you don’t have to be great at ten, just passable.  He hasn’t noticed girls yet.  Probably very interested in a specific hobby.  Could be video games, maybe baseball cards, possibly music.  It doesn’t really matter which one.”  I decided right away.  I liked Brian a lot.

I introduced myself, then faded into the background, a mere shadow, contributing nothing, just observing.  I often kept completely silent while Dr. Barton talked to and examined patients, trying to make them forget I was even there, which they invariably did.  I didn’t want them to hold anything back, which they might in the presence of a new face.  Those little exam rooms are incredible, like a sort of neo-confessional, except even more personal, because after sharing their most private stories, people share their bodies.

Brian’s parents were very nice.  Also very neat and organized.  Good people, I decided, for at least one reason: they were both present.  That was big in itself.  It was clear that they both worked, judging by their professional dress, yet somehow both had found the time on this weekday afternoon to come in with their son.  Brian was their only son and they had built a pretty nice world for themselves.  But now, there was a small problem in the world and it needed to be addressed.

They were well spoken and presented their case efficiently, first with their observations of Brian’s behavior, then with those of his fifth-grade teacher.  The proper boxes had ben checked on the appropriate forms.  The evidence satisfied every definition of attention deficit hyperactivity disorder, even the DSM in its fourth edition, much improved from the first three, mind you.

Brian sat quietly throughout the discussion, politely answering questions when asked.  But he didn’t have a chance.  He was a goner before he even walked in.  There was just too much evidence stacked against him.  The jury came back.  It was unanimous.  Dr. Barton, mom, and dad returned the verdict.  Clearly ADHD.  Sentence, Ritalin.  For how long?  Who knows?  We’ll play that by ear.

“What do you think, Brian?”  asked Dr. Barton.

I waited in anticipation.  I, too, had heard the evidence, but I was not convinced.  As a second-year student, I didn’t even know that a DSM existed, let alone in its polished fourth version.  All I had was my pure observation for that one hour, and bits of the story.  What I saw was a ten-year-old who sat still throughout the entire grueling hour. Even I was getting antsy.  Not to mention his A and B grades at school.  What do they want, perfection?  But I had no seat on that jury, and, in my ignorance of the correct way to diagnose, had not earned one.  So I kept it buttoned, and waited, helpless.

Brian paused, then spoke, “No.”

“What do you mean, no?” asked mom.

“I don’t wanna take Ritalin.”

“Well, can’t you try it?  We think it might help.”

Another pause.  “No.”

I was so damn proud of that kid.  I could hardly contain myself.  I wanted to hug him, pick him up, and run out of there.  Maybe go shoot some hoops or ride dirt bikes.  He had confidence.  He was bold.  He was just young enough to have a clear, unbiased view, untouched by the medical world and DSMs.  That kid was my hero.  He embodied everythign I loved about kids, and everything I wish I could have been at ten.  Man, it was great.

After a few tense minutes trying to change his mind, the family left, without Ritalin, but with a concession that Brian would think about it.  “Don’t think too much,” I wanted to tell him.  “That’s what you’re good at.  Not thinking too much.”

I thought about Brian on my way home.  “Fabulous kid.  Fabulously average.  Wonderful.” I thought about ADHD.  “Cool stuff.  Diseases of the mind.  Very cool.  Very tricky to figure out.”  I returned to classes the next day.  Back to the grind.  I thought about microbiology.  “Little bacteria going nuts.  That’s awesome.”

Four weeks later, I was back for my monthly visit with Dr. Baron.  I had not forgotten about Brian, although I didn’t expect to see him again, given my limited time at the office.  But by pure coincidence, Brian had an appointment that day.  I picked up the chart.

“Hey, I remember him from the last time,” I said.

“Oh, that’s right, you were here,” said Dr. Barton.

“What’s he here for?” I asked.

“A prescription for Ritalin.”


Patrick O’Neal, Class of 2001