Where Do the Screams Spring From 2

June 1, 2020

Robert’s screams arrive suddenly and unpredictably most of the time. They are not easy to deal with. We know that Robert is in discomfort, but we don’t know why. Even when he tries to tell us, we don’t understand. That leaves us powerless, unable to sooth him or help him.  Nonetheless, we have to try to find the causes of his distress. Understanding Robert’s reasons for screaming would allow us to either calm Robert, or calm ourselves (when the reason is not serious) or both.

Episode 1

Robert’s dad had a virtual doctor’s visit. He was using IPAD to connect with his physician. It was scheduled early in the morning when we expected Robert to be still sleeping or spending never ending time in the bathroom. But Robert was up and not happy. He didn’t want his dad to sit at the dinner table early in the morning and looking at Robert’s IPAD. He screamed. He was agitated.  He hit his cheeks.  We tried to explain that this was a doctor’s appointment exactly like the ones Robert had before. He had three already. Robert was not convinced. After all we used cell phones to conduct his appointments not IPAD.  He kept repeating, “Computer, computer”. Then he screamed as if something terrible was happening.  We were not able to persuade him to go to a different room, watch TV,  eat his breakfast, or just be quiet.  He couldn’t leave his dad in the wrong place with the wrong device.  “Computer, computer” he kept repeating between screams letting dad know that he should work on his computer and not on Robert’s IPAD. His screams interfered with the visit. The doctor was concerned.  But luckily, she knew Robert and she knew Robert’s issues with screaming.  She said, “Hi Robert.  How are you feeling? ” Robert stopped screaming.  He came closer and looked at the IPAD to check who was talking. He recognized the doctor.  He even said very softly, “Good, good”, calmed down, and retired to his room.

Robert was upset because the  morning routine was broken.  He tried to force us to act as we always did but we couldn’t. What calmed Robert was  the presence on the screen of the doctor whom he knew well.  Her presence explained and excused the changes to the morning habits. It was also beneficial that the doctor addressed Robert directly and by doing so she somehow changed the setting of Robert’s mind.

Episode 2

Robert was agitated. He made many grumbling noises. He said something. Whenever he says something I don’t understand I try to decipher that word through the context in which it was said. Since there was a letter on the table, I assumed Robert was saying, “mail”. Recently,  making sure that we send all the letters properly became Robert’s obsession. So, I said, “We will drop the letter in the mailbox later.”  That was supposed to calm Robert, but it only irritated him even more. He kept repeating his tangled sound louder with addition of sharp screams.

“Robert, write me what you want,”  I said.

And he did.  He wrote, “May”.

Now, I knew.  He was looking for a May page from a wall calendar. “Robert, it is in a recycling bag”.  Robert looked, but couldn’t find it. “Robert, it is on the bottom.” He looked again, found it, unfolded it, took a second look, folded it back and dropped in the recycling bag again. He was fine.

Robert gets very anxious when things disappear without explanation. For him this is a sign that there is something very wrong with the world. He also gets upset when his speech is misunderstood. Luckily, he can write. Not much, one word.  But that one word makes a world of a difference. 

Episode 3

Robert screams very loudly. He produces sudden, sharp screams.  He hits his face with short, quick movements.  His face is red even in the places he is not touching. The skin around his eyes seems swollen. There is no point of asking Robert to write.  He is not looking for anything, he is not trying to fix anything to make his surrounding compatible with his OCD rules. He is probably in pain. But the pain is something for which Robert lacks words. He know the word “pain” but he cannot use it.  I don’t know why.  He cannot say what hurts.  Pain is something attacking him from inside and that makes it impossible to describe.

I think he is in pain. But I don’t know what hurts.  I am not even sure he is in pain, I only assume.  Maybe this is asthma, so I give him inhaler. Maybe this is some more serious allergic reaction to something. (But what?)) so I give him Benadryl.  Maybe he has problem with gases, so I give him Metamucil Wafers and a glass of water. Maybe he has headache, so I give him Advil.

Then I wait.