Stories of Kindness from Around the World

Michael was 16 years old when his life changed. How much worse could it become? Mental retardation had allowed him only one great pleasure — his bicycle — and even that was taken away when he was hit by a truck while riding.

The resulting head injury caused multiple behavioral changes. Once sweet and soft-spoken, he became disruptive and violent. No community environment could manage his repeated bouts of agitation, lack of control and aggression.

I first examined Michael in the mid-1980s, when he was a 30-year-old patient in a maximum-security hospital for the criminally insane (though there were no criminal charges against him). He would stay in his room all day long for weeks on end, uncommunicative, with periods of extremely hostile behavior toward anyone who came nearby.

Psychotropic medications worked to decrease his agitation. But they blunted his emotional expression and caused restlessness, muscle stiffness and tremors, along with even more distressing side effects that he was unable to express at the time: dry mouth, blurred vision, constipation and urinary retention. Those symptoms, unknown to anyone, made his uncontrollable behavior even worse.

I moved on to another hospital, leaving Michael behind — until two years ago. Under a court order mandating the removal of noncriminal patients from prisons, he had been transferred to a difficult-to-manage unit in a state institution. From there, he went on to an intermediate-care unit. That was where we met again.

His condition did not appear to have changed. He stayed in bed for weeks, except for abrupt trips to the nursing station, where he yelled, screamed and banged his fists on the wall.

Moved to see him again, and frustrated that nothing had improved, I began an obsessive quest to help him. In search of clues, I pored over his 36 years of medical records — treatment plans, medications that worked or did not work, behavioral plans, risk reviews — and read every single note in his chart. I juggled with court-approved medications and interventions, and struggled with justifying medications not considered or not approved.

Six months ago, at age 52, well groomed and well dressed, Michael started going out to the mall and on trips, and attending meetings and programs. He underwent hernia surgery without incident, and became eager to approach anyone who paid some attention to him and had the time to talk.

About a month ago, I experienced a personal loss, the end of a long-term relationship. I was devastated, but I maintained my usual demeanor and activities, making every effort to keep my emotions from my patients. It was difficult, but I thought I was succeeding.

One morning, as I entered the ward, Michael was standing by the door. He walked over to me and pushed his right hand onto my left shoulder, forcing me to stop.

As he stared straight into my eyes, my heart started beating fast. What would he do?

Suddenly, any fear subsided, and I felt calm. For in his perplexed, piercing blue eyes, I found the most compassionate look.

“Dr. D., Dr. D., you been sad for days now,” he said. “You gonna be all right. You gonna be all right.”