Twilight Children (10 page)

Joy sighed. As the social worker, she had spent time trying to explore these various scenarios with Gerda, and Joy’s overall impression of the old woman was not one of a stroke victim so much as a very depressed individual. Depression, Joy said, is common among elderly patients who lose their independence and suddenly find themselves sleeping in strange beds, eating strange food, and having to live according to strangers’ rules. Joy was accustomed to dealing with that, but in this instance, it was grossly complicated by Gerda’s lack of speech. Joy had consulted the gerontologist supervising Gerda’s case and told him that she felt Gerda’s mutism might be largely psychological, due most likely to depression. The gerontologist put Gerda on Zoloft, which, if anything, had made Gerda even more subdued.

This lack of speech spelled bad news for Gerda, Joy said. Whatever the reason, it gave the professionals grave concern regarding her ability to resume any level of independent living. Joy had tried to explain this to Gerda, tried to stress how important it was to work hard on talking with people in the rehabilitation unit because otherwise Joy wouldn’t be able to stop a nursing home placement.

I asked, “Have there been any psychiatric problems in her past?”

“No. But then, she’s of that generation. Her son said that Gerda’s parents were homesteaders. Part of the German immigration about the turn of the century. If people suffered psychiatric problems in that era, they just toughed it out. No one sought help.”

“And what have they done with Gerda’s animals?” I asked.

“I don’t know what’s happened to the chickens and things,” Joy replied. “The cats they put to sleep, I think.”

“All sixteen?”

“Social Services went in after the ambulance took her. There really wasn’t much choice.”

“Were the cats poorly cared for?”

“No. Not really. It was spotlessly clean there. And in fact, they found more cat food in the cupboard than people food. But there were just too many of them. No one could be expected to house sixteen cats during such a long period of hospitalization. Especially as she well might not come back at all. It just seemed the better thing to do. Kinder in the long run, you know? Sixteen cats are too many to re-home.”

I didn’t say anything in response to that. Joy sounded depressed herself about Gerda’s case. It was a sad story in so many ways—the lack of connection, the familial disinterest, the isolation, the loss of independence—one of those small heartbreaking stories of small, heartbreaking lives, of people who don’t really matter to anyone. What struck me as the final cruelty, however, was the decision to put her cats to sleep without giving her any say, without any warning, without any opportunity to change things. To Gerda when she found out, I’m sure it was as if they’d simply said, “We’re sorry but your loved ones were too much work for us while you were ill, so we’ve gassed them all.” And now she genuinely did have no connection with this world. No wonder she was depressed.

Joy went on to say that this was the point they were at when she ran into Dave Menotti. During their conversation together, he had mentioned my interest in language disorders and said perhaps I could offer an opinion on the extent to which Gerda’s poor speech was physiological or psychological. Would I be willing? she asked.

Ah, I said. This was all very interesting. And very sad, too, and I genuinely wished I could help. Unfortunately, I had absolutely no experience working with the elderly in any capacity beyond funding my college years as a nurse’s aide. I had never worked with language problems in anyone who was over sixteen. Indeed, my recollection of the academic literature was that there was very little information available regarding adult elective mutism. When such behavior occurred in adulthood, it tended to be associated with much more serious psychiatric problems, such as schizophrenia or other psychoses, and was not usually treated as a disorder in its own right.

Down the phone line I could hear Joy make that soft click of the tongue, that faint noise denoting hopelessness. A small silence followed. Then she said, “You wouldn’t want to just have a look at her, would you? She’s in the Oakfield Rehabilitation Center. It’s only about three blocks from the hospital. If we could just get through to her, just get her to understand how critical it is she cooperates, if she wants any chance of an independent life. Dave thought maybe you’d at least have ideas.”

That evening I spent a couple of hours at the library on a nearby university campus searching for information on adult mutism. I found nothing except the references I already knew about regarding psychotic mutism and a few others regarding advanced Alzheimer’s disease or obscure brain tumors or anomalies. Joy’s plea, however, stayed with me. Consequently, I finally decided I would stop by on my way into work and see Gerda. Not because I had any qualifications. I didn’t and I knew I didn’t. And certainly not because I had any magic. Truth is, I had no real good reason. I did hear way back in my mind, however, what a mentor had said to me at eighteen when I had protested at being too ill-equipped to work with a seriously disturbed child: “When things are hopeless, nothing you do will make it worse. So it’s always worth taking the risk to see if just, just possibly something you do will make it better.”

I
walked down the long corridor of the rehabilitation center, dank with disinfectant and the steam-andmusk mix of institutional food and bodily fluids. It was early. Breakfast trays were only just being cleared away. In some rooms, nurses’ aides were still spoon-feeding patients.

Gerda’s room was second to last on the right. As I approached, I was aware of feeling nervous. What on earth would I do with her? I could hardly pop open my box and pull out the puppets or crayons.

She was sitting up in bed. Her breakfast tray had been removed, but the little adjustable bed table was still pushed across in front of her.

I don’t know what I’d expected but it was something different than I saw. She looked unexpectedly young. Or, I suppose said better, she looked unexpectedly “not old.” Her hair, which was completely white, had a yellowish cast that could almost have been mistaken for a pale blond, and it was loose around her shoulders. And long. Longer than mine. No doubt she normally wore it pulled up in a bun, and such a style would have given her a more predictable little-old-lady look, but the way it was here now, parted on the side—long, loose, and straight—she seemed ageless as an ancient sculpture. This sense was enhanced by her skin. Though it had the fragile crepeyness of age, she had few wrinkles, especially across her forehead, which was smooth to a point of being almost waxy looking. She was of obvious northern Germanic heritage, with pale eyes and prominent features. Although she was not overweight, her bones were big and blunt, giving the impression of a tall, sturdy woman.

“Hello,” I said. “My name is Torey. Joy Hansen has asked me to come see you. I work with people who have problems speaking. I’m not a speech therapist, so I won’t be doing those sorts of things with you. My work is more with people who are able to talk but find it hard to do so.”

Pulling over a plastic chair that was next to the wall, I sat down. Gerda regarded me. Her gaze was straightforward but not at all readable. I couldn’t tell if she was pleased at a new face, if she was appraising me, or, indeed, if she was simply watching me because I moved.

“How long have you been at Oakfield?” I asked.

She continued to gaze at me. Seconds passed, feeling like minutes. She didn’t respond.

Thinking perhaps this was the wrong kind of question, that age and the stroke as well as simply the loss of normal routine might make it difficult to recall how long she had been in, I changed to: “How was your breakfast?”

She gave me the same unflinching, unreadable stare.

And it was the unreadable aspect that was making things difficult for me. I was accustomed to being able to discern more information nonverbally than I was getting here. I genuinely could not tell if she was refusing to speak or if she was unable to speak or even possibly that she was not hearing me properly. Her expression was not so blank as to give the impression of nobody home, but there was a definite possibility that whoever was in there was not turning the lights on.

“What did you have for breakfast?” I asked.

She looked away then. It was done slowly, giving the action ever so faintly a feeling of misery.

Had the food been awful? Or something she loathed? Or was she simply fed up at having one more stranger in her room demanding stupid information from her?

“You must be tired of all this,” I said. “All of us coming and going. All of us keeping you to our schedules and our activities. When I was in the hospital, that’s what I remember as being the worst part. I especially hated the mornings. It’s so hard to sleep at night because they leave so many lights on and make so much noise, but then just when exhaustion finally takes over and you go to sleep, in they come at 6:30 and wake you up again. And for what? They’d always get you up, just so you could wait. I always thought, ‘Why don’t they leave us sleeping in peace?’”

She looked back as I said that, and her look was not guarded this time. I could easily read the quiet despair.

“All this change must be very upsetting for you. Has anyone talked to you about it?” I asked.

Gerda looked at me a long moment. It was a deep, searching look, and then slowly she shook her head. A sigh followed. Then she lay back in her bed and turned away from me.

“That’s what I’m here for,” I said. “Because what you’ve gone through is difficult and frightening. And if we can talk about it, perhaps we can put some things right.”

Silence.

More silence.

It wasn’t “working” silence, which was the kind of silence I could manipulate to bring words from reluctant speakers, nor was it the kind of silence that was my trick in trade because I’d learned how not to be uncomfortable with it. This was just silence. Total and immovable.

“How would you like me to address you?” I asked. “Shall I call you Mrs. Sharple? Or is it all right to call you Gerda?”

No response.

“My great-aunt was named Gerda,” I said. “I never met her because she lived in Germany, but I liked her very much. When I was small, she always sent me a papier-mâché egg at Easter with little gifts in it. Among the things inside the egg was always a tiny little wooden rabbit wearing lederhosen and playing a musical instrument. Each Easter it was a different rabbit with a different instrument. I have a whole orchestra of them now, each only about two inches high. So when I heard your name, it reminded me of my aunt. I cared for her very much. So, if you don’t mind, I’d like to call you Gerda.”

She had turned back to look at me while I was talking.

“Gerda’s a German name. Which part did your family come from?”

She didn’t answer.

“My family is originally from Emden. It’s on the coast, near the Dutch border. My grandfather grew up there. Gerda was his sister and she lived in Emden all her life.”

No response.

“Is your family from the north of Germany?”

She nodded.

“Which part?”

No response.

This conversation was hard work. Should I persist? Continue chattering one-sidedly? Ask more questions? Use the same direct, expectant techniques that had worked so well with the children? I was having a small crisis of confidence. What if she couldn’t talk? What if she felt under horrible pressure to do something she was physically unable to do? Who was I to be sitting here, trying to elicit speech from a stroke victim? I was overstretching myself and I knew it.

Unobtrusively, I tried to glance at my watch. My time was already up. I was supposed to be on the children’s unit in only five minutes’ time.

“I need to go now, because I work over at the hospital and I see I’m running late for my next appointment,” I said.

She had looked away already.

I felt bad saying that because it sounded as if I were trying to get away, so I added, “I’ll stop back, okay?”

She didn’t respond.

“Okay,” I said for her.

My next appointment was, in fact, Drake, and I wasn’t feeling a whole lot more confident about him. Ever since I’d left our unsuccessful session, he had been on my mind. I didn’t want to establish a nonverbal relationship with him, as this would make it more difficult to break the cycle of mutism; on the other hand, I also didn’t want to spiral into the kind of negativity that would make him fearful and unhappy in our sessions. If that happened, then anxiety would become the barrier.

Indeed, I’d been thinking quite a bit about anxiety in the interim, as anxiety lies at the root of elective mutism for many children. With some the mutism is a manifestation of social phobia. In these instances, the child tends to have an excessively shy personality and often comes from a family where one or both parents have also had a history of acute shyness in childhood, indicating that there well may be a genetic component at work. For other children, the anxiety seems to be more closely related to stage fright, to fears of performance and failure. With these children, the parents may be confident and outgoing themselves. Baffled by the shyness, they often put heavy pressure on the child to be more social, which exacerbates the problem.

Anxiety isn’t such an issue for the third major group of children displaying elective mutism. For these children, speaking is a control issue, and withholding speech is an expression of complex psychological problems similar to those found in anorexia or encopresis. These children tend to have strong-willed, perfectionistic personalities and often form tempestuous but symbiotically close relationships with a primary caretaker to whom they speak normally.