Disclaimer: I do not own the rights to Numb3rs or the characters therein. All characters are fictional, and should not be associated with any other person- real or imagined.
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Olivia sat in her office chair waiting for Don, Charlie, and Alan to arrive, writing down the rest of her notes before scanning them into her computer. The still x-rays from Don's exam were waiting in the viewing room located next to her office- a central location shared by herself, two neurologists, and the radiologist.
The Eppes men were at the exam/dressing room located down the hall from Olivia. Upon entering, Charlie pulled Don's hospital gown off and slowly, carefully un-taped the chalk from under his boxers, putting the three pieces into Don's jeans in full sight of his brother, who was now sitting on a couch against the wall, wearing nothing but his boxers and socks. Alan stood patiently to the side, enjoying how his youngest son had immediately taken control of Don's care; he was proud that Charlie had not only kept himself from the security of his numbers and garage, but had been by Don's side almost continuously since they had first bonded.
Grabbing the t-shirt neatly folded on the exam table in the middle of the room, Charlie approached Don. Charlie tried to pull the shirt over Don's head, but was unsuccessful as Don kept moving his head about. "Sit still," Charlie ordered, again trying to slip the shirt on, but every time he attempted to place the stretched opening over his head, Don bobbed to the right or left, thwarting Charlie's efforts.
"Hungry." Don demanded. He looked at his father expectantly, a look that Charlie followed with a shrug of his shoulders as he tossed the shirt back on the exam table.
"Okay, okay" Alan gave in, reaching for the cooler bag he'd brought and handing it to Charlie. "I'll go talk to Olivia, you feed Don- then get him dressed. He can't be walking around the institute in nothing but his drawers."
Alan left the room, shaking his head. The doctor may have diagnosed that Don was limited in his ability to make decisions, but somehow he was still able to showcase his natural stubbornness in confronting situations he did want to participate in- and seemed to end up getting his way.
Charlie moved close to Don's left side on the couch, pressing their thighs together and opening the cooler to take out the bottles. After releasing air from each one, he put his right arm around Don's back for balance, and held a bottle to his brother's eager mouth with his left hand. Don sank against Charlie, his left arm loosely crossing his back while his right one circled Charlie's waist, Buddy squeezed between them; Don's body was oddly folded up as he laid his head on his younger- and shorter- brother's shoulder, his eyes shut while he drank, his face turned upwards toward and under Charlie's chin, while the bottle rested across Charlie's neck, expertly tilted so Don could be as comfortable as possible. Slowly, Don curled his legs up onto the couch, resting his body on Charlie. The brothers sat quietly, each lost in his personal thoughts.
Charlie was listening to the sound of his brother's light sucking sounds, no longer bothered by them. He could feel the heat coming from the breath Don panted through his nose onto his chin, the rhythmic thrust of air tapping a pattern on his skin that relaxed Charlie as he sank deeper into the couch, pulling Don with him. Taking a deep breath, Charlie could smell the baby powder he had dusted Don with earlier in the day, right before dressing him, along with the slight hint of soap from the bubble bath Don had taken; instinctively, Charlie planted a small kiss on his brother's forehead, smiling when he saw Don's eyes ripple open briefly before contentedly closing again. Relishing the warmth of Don's bare skin against his arm, Charlie wondered if this was what it was like to hold a baby- the touch of warmth and silky-soft skin, the smell of talcum and bubbles, a slack and innocent face to look upon, sounds of nourishment being received, the taste of clean skin that lingered after a kiss, the desire to love and protect that filled the heart and every moment of life; if this was what it felt like to have children, Charlie finally understood why his father so desperately wanted his sons to have some of their own. Sighing, Charlie fell further into his cuddle with Don, feeling a twinge of regret that these would be the last bottles he could feed Don, but knowing it was for the best; replacing the first bottle with a second, Charlie unconsciously began to hum a lull-a-bye their mother used to sing them, offering comfort to both Don and himself as his brother continued to drink.
Don was lost in the warmth and strength he felt in Charlie's arms. Leaning his body further into Charlie's, Don did not tremble or shiver. Within his brother's embrace, he felt secure, and did not think any specific thought but focused on obtaining the nourishment that was offered and the sanctity he found whenever they were together. His mind shut down, his conscious thoughts overcome with his emotions and senses: the fear that was replaced by calm, the doubt that was replaced by confidence in Charlie and almost anything that he told him to do, the love that he felt for his brother that was developing into a dependence on him, the sadness of losing his mother starting to be replaced with a careful joy that he had found another family, the desire to please; and then the physical senses that assaulted him- the smell of his brother's aftershave as he breathed in and out, the warmth of Charlie's body wrapped around his own while the soft hairs on his brother's arm tickled his back, the sound of humming that filtered into his ears and touched a memory that he could not quite reach, the smiling face that looked down at him with kind and understanding eyes, and the taste of sustenance that flowed down his throat, offered by a loving and nonjudgmental hand. But, sadly, through it all, the underlying need to have his mommy holding him and taking care of him, her absence still undulating through his heart.
After Don finished his last bottle, Charlie allowed him to rest for a few minutes. Charlie did not want to get up himself, but his natural curiosity took over and he knew he wanted to hear everything that Olivia had to say about Don and any problems that he might have. So, reluctantly, Charlie nudged Don into a sitting position and began the task of getting him dressed. Though Don no longer resisted Charlie, he was beginning to fall asleep and it took a lot of effort for Charlie to put on his clothes, as he was working with what had essentially become dead weight.
"Come on Don, sit up so I can pull your shirt down," Charlie begged, but Don just leaned against the back of the couch, looking at Charlie through half-closed eyes and sucking his thumb. Charlie had managed to put Don's head and left arm through their openings, but Don's thumb sucking prevented him from placing the right arm in. Giving up on the shirt, Charlie grabbed Don's jeans and pulled them up his legs to his knees; he put Don's tennis shoes on, lifting his feet up just enough to get his feet in. After tying them, he stood in front of Don with his chin resting in the cup of his left hand, his right arm crossing his belly. "Hmmmmm," he commented, looking at Don's half-dressed condition. "This is a lot easier when you're awake and helping me." Don responded by closing his eyes all the way and starting a slow descent in an effort to completely lie down on the couch. "Oh, no you don't!" Charlie exclaimed, quickly sitting next to Don and gently pushing him back into a sitting position.
Refusing to give up, Charlie sat on the front edge of the couch, wrapped his arm around Don's back and used his leverage to lift Don to a standing position. Don waved back and forth before Charlie steadied him with an arm around his waist. "Don! Don! Wake up!" Charlie received a pouting frown, but was pleased to see that Don had opened his eyes. "You have to stay awake just a little longer- can you do that for me?" Hesitating at first, Don finally consented, nodding his head weakly. "Okay, we have to get you dressed. Put your arm on my back while I pull up your pants." Don did as he was told, leaning so heavily on Charlie that the younger Eppes groaned inwardly. When he had Don's pants zipped and buttoned, he stood up and carefully took Don's thumb from his mouth. Before Don could protest, Charlie efficiently pulled Don's right arm through his sleeve and pulled down his shirt, smoothing it at the bottom edges. Don's thumb popped back into his mouth.
Charlie checked the room for any of Don's other possessions, slung the cooler over his shoulder, placed Buddy under Don's left arm, and slowly led his brother down the hall to the speech therapist's office.
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"I was beginning to wonder if you'd ever get here," Alan greeted his two sons.
"Someone is a little sleepy," Charlie explained. Olivia went to a television and DVD that faced an overstuffed loveseat; she turned on a cartoon and indicated that Don could sit on the loveseat quaintly situated in the corner of the room. By the time Charlie stood behind his father, who was sitting in one of the two chairs in front of Olivia's desk, Don had already fallen asleep, a bundled ball resting on the soft cushions in an awkward fetal position with Buddy pressed to his chest.
"I keep the DVD player for when I have younger patients. It keeps them occupied while I talk to their parents," Olivia explained. "I think he'll be alright if you both want to come next door with me to look at the results of his exam. We should be gone no more than five minutes."
Charlie and Alan followed her next door. A line of photos sat in lighted holders on the wall, each one a view of Don's mouth and throat at different angles.
"From what I can see, Don has three main problems when swallowing. The first two problems we see at the oral preparatory stage." Olivia pointed to one of the photos. "See, here, Don is not chewing his food correctly. This is one reason he is having difficulty swallowing- the bolus, or mound of food, is much too large to comfortably and effectively pass down his esophagus. The second problem is his tongue- it is getting in the way of his chewing, and he tends to push his food into the pocket of his cheek, away from his teeth; he needs to have more control over it. He can do exercises to solve both these problems."
Olivia walked to another set of photos, Charlie and Alan right behind her listening intently.
"Now, the last problem involves the esophageal phase of swallowing. Don is correctly passing food into the esophagus, but solid foods are not efficiently traveling to the stomach; instead, they are getting stuck." Olivia made quotation signs in the air when she said 'stuck'. "See, each time you swallow, the muscular wall of the esophagus repeatedly contracts and propels food down through to the stomach. Since there are no obstructions in Don's esophagus, then his motility problem may be caused by a restricted nerve supply to the esophagus' muscular wall or muscle weakness. I am going to have a neurologist look at his x-rays to see if further testing will be necessary. In the meantime, I believe you can use the stimulation and aiding technique I utilized with Don earlier, so that he may start eating solid foods immediately."
Olivia led Charlie and Alan back to her office. Once Charlie had checked on Don and was satisfied that his brother was sleeping peacefully, Olivia proceeded to lay out a therapy plan for her patient, speaking to the two men seated in front of her. Charlie sat rigid in his seat, his full attention on every word Olivia said, while his mind began organizing the information into neat compartments with cross-references that he would be able to access at a later date. It would be clear to any person that the efficiency of his genius was not limited to numbers.
"Let's start with the swallowing. As for the chewing, Don should have very strong muscles in his jaw."
"How is that possible?" Charlie asked. "He hasn't been eating for months- which means he hasn't been chewing. All his mouth activity has been limited to sucking his thumb and baby bottles."
Smiling, Olivia explained, "Actually, pursing your lips is a great exercise to strengthen the muscles in the jaws. All that thumb and bottle sucking should have developed Don's muscles, not weakened them."
"Then why can't he chew his food?" Charlie pressed.
"It may be a lack of coordination- moving the different parts of his mouth as one; we already see he has a problem with control of his tongue. But I think the overall cause can simply be attributed to lack of use. When he first received his injury, he may have found it difficult to chew, which probably assisted in his acceptance of drinking bottles; I'm not trying to make a psychological diagnosis, but it seems obvious that he is adverse to eating solid food. Over time, his muscles may have developed, but the up and down motions associated with chewing were not."
"And we solve this problem by?"
"By having Don practice chewing. Like with any other set of muscles, the best medicine in developing its use is to exercise it. Don will need ten minutes of chewing at the beginning of five specified hours each day. You can decide which hours." Olivia pulled several large, rubbery-looking straws from a drawer in her desk. "These are chew straws. Have Don chew on them so he does not damage his teeth. You want him to open and shut his mouth, extending his jaw open as far as it can comfortably go.Take it slow- your goal is ten minutes, but he may only have the patience to do it one or two minutes at first."
Charlie and Alan handled the chew straws, and then gave them back to Olivia. She put them in a tiny bag that she left on her desk.
"When Don chews on the straws, you can have him look in a mirror; this will be a visual reinforcer for the behavior. It will also help prevent him from biting his tongue. In addition, each time Don eats, try to have at least one of the foods on his plate be one that has to be chewed. Start with ground food and work your way up to ones that are completely solid."
"But he choked on the ground food," Charlie worried. He did not want Don to have to go through that experience every time he ate.
"True, but not so much when he ate the solid food, though the ground food should have passed through his esophagus more easily. The difference between the two times he swallowed was that one-we made sure Don chewed the solid food thoroughly, and two- I used the stimulation technique on him more quickly the second time. You are going to use that technique each time Don eats."
Charlie and Alan looked at each other doubtfully. It seemed more and more like it would be safer to just continue feeding Don the bottles.
"Since Don is obviously tired, we'll let him sleep while I go over the rest of his rehabilitative requirements. After you finish talking to his occupational therapist, we'll all meet together so we can show you and Don how to use any assistive and therapeutic devices we give him- and we'll have Don eat something, so I can teach you how to massage his neck while he's swallowing so you don't have to worry he'll choke."
Olivia leaned forward in her seat, talking slowly and deliberately. "Now listen carefully- awareness of Don's frustration and energy levels is one of the most important parts of his therapy. If you try to make him do more than he can emotionally or physically tolerate, he may become oppositional and refuse to participate in his treatment. And patient participation is, of course, necessary for success."
Nodding her head toward the still-sleeping Don, Olivia continued. "Exams and therapy can be very exhausting. When Don wants to rest or even sleep, let him. You also need to make sure that Don has a set bedtime, wake up time, and a nap time- this will help make sure that his body is getting necessary rest, even when neither you nor he are aware that he needs it. This should be easy to do, as I read in the staff notes that he already has an established sleeping schedule."
"Actually," Alan admitted, "We were hoping to work on getting him away from that particular schedule."
"My advice to you is to keep it- for now. The speech and occupational therapy, along with the changes in Don's waking schedule, are going to be hard enough for him to adjust to. Eventually, you can change his sleeping schedule by adding or subtracting five minutes at a time, until you have him on the schedule you want. But it is extremely important that he gets a lot of rest. Therapy is a long and drawn-out process, and, again, the quickest way to come to a stand-still is to have a patient unwilling or unable to participate."
Olivia sat back in her chair. "Now that I've made that clear, let's discuss his tongue exercises. Don needs to practice moving his tongue- up, down, in, out, and side to side. Set up at least two regular times each day for him to practice, and then slip it in whenever you have a chance."
"Does he just stick his tongue out and move it?" Alan asked, nervously tugging at the knees of his pants.
"No. You have to give Don a purpose. Give him a Popsicle and have him lick it- but only using his tongue, not his lips. Or let Don lick the melted ice cream off the side of a cone- again, only using his tongue. For side to side movement, dab some peanut butter or other sticky food on either side of his face, and then have him try to lick it off. Sugarless suckers are also good. Really, he can use his tongue to lick anything that is in accordance with the dietary restrictions Dr. Wang gives you. Because this exercise involves taste and the immediate satisfaction that comes with it, you can slip it in by giving Don something to lick while he is doing other activities, like watching television, or reading."
"How do we assess when he has mastered his goals?" Charlie asked.
Olivia smiled. "I forgot you are a teacher, Professor Eppes. The objectives and goals are in the written instructions I will give you. For example, for the tongue exercises, our goal would be complete control of and fully expansive tongue movements; the objectives would include the individual movements, like moving the tongue side to side. One of his swallowing goals would be to pass the bolus without aide, and also without discomfort. Part of the assessment will always involve asking Don about his progress- does it hurt when he swallows, has he bitten his tongue when chewing, does it feel uncomfortable when he chews..."
"But Don isn't exactly talkative right now..." Charlie pointed out.
"Well, we are going to discuss that in a minute. Get yourself a timer so you can keep track of how long Don does each exercise; this will enable you to see his progress- or lack of it. Also, be observant; keep notes about how well he is performing each task. This is a simple but effective way of determining if he is progressing in his therapy. A last item might be a soft measuring tape to record how wide Don is opening his mouth each time he chews. Any questions?"
Alan stared at his hands, asking quietly, "You're sure we can learn how to keep Don from choking when he eats?"
"Yes, Mr. Eppes- I guarantee it."
Alan sat next to Charlie trying to comprehend the amount of work and time that would be required to help Don learn to eat solid food on his own again, nervously wondering if he was capable of meeting his son's needs. When Olivia began to talk about the other therapy that Don would require, Alan almost collapsed into the back of his chair, doubt in his own ability to help Don overwhelming him; then he felt a strong hand clasp his own. Looking to his left, he found Charlie smiling at him, a picture of confidence and reassurance. Squeezing Charlie's hand in return, Alan refused to let it go. He straightened in his chair and forced aside his fear for the magnitude of the tasks before them, refocusing his emotions on the satisfaction that would come from obtaining the goals. Never in his life had he felt so dependent upon his youngest son- and never had he been so grateful that the dependence was possible.
Addressing Charlie, Olivia said, "You state that Don is not talking very much?"
"No." Charlie and Alan answered.
"Well, part of my job description is to help Don with actual speech therapy." Olivia smiled, receiving no smile in return from the men who sat in front of her. Sighing inside, she secretly hoped they would be able to find something to smile about over the next months, because she knew they were probably in for a lot of the disappointments and heartaches that always attached themselves to rehabilitative efforts.
"Don's speech articulation is clear despite his lack of jaw work. This is probably because we use less than 20 per cent of our jaw muscles when talking, and he is able to use enough to speak clearly. However, he does have a fluency disorder. He says simple sentences of no more than four syllables, then stops for long minutes before he will continue his thought."
"You mean his speech is very simple." Charlie said.
"Well, yes; he does not always talk in complete sentences, and they are never complex. In order to help him with this problem, make him say a full sentence. If he says 'Want that', then tell him to say 'I want that'. But do not overtax him- I know I sound like a broken record, but if he becomes frustrated or tired- stop."
"How do we track his progress?" Again the teacher in Charlie appeared.
"There is a simple method to track this kind of behavior. Fill your right pants pocket with a number of pennies- say, twenty at first. Each time Don says a complete sentence on his own, place a penny in your left pocket. At the end of the day, count how many pennies are in your left pocket and record them. It will take a while, but you will eventually need to put more pennies in your right pocket, and at some point will even switch to counting complex sentences. You can use this method for other behaviors- if you like, each one of you can record a different one."
"I'll be the penny-pincher for the sentences." Charlie finally offered the speech therapist a small smile to go along with his awkward attempt at a joke. Olivia was satisfied that the professor was beginning to relax, though she continued to worry about her patient's father. Alan's left eye was twitching from his attempt to keep his nerves under wraps, his failure apparent each time the corner of his eye spasmodically squeezed shut.
"To increase his fluency, Don will also need to receive cognitive therapy."
"I think I know what that is." Charlie wrinkled his forward while he thought. "We're just going to help Don with his problem-solving skills."
"Yes, and much more. Don needs to exercise his brain with both basic skills and critical thinking skills activities. These things will help him develop and use a larger vocabulary, increase his ability to recognize problems and make decisions about them, help him control his emotions and behaviors, develop his ability to sequence, and most importantly, help him regain his memory. I have a few things I can send home with you, but I will also give you catalogues so you can buy other activities that you think will interest Don."
Olivia pulled out a set of small, square flash cards. Alan and Charlie sat forward in their chairs as she flipped through them; they could see that a simple household item was printed on each card, common things like a coffee mug, a broom, and a fork.
"First, Don should practice basic skills. You are a teacher, Professor Eppes, so I trust you can pick out a variety of activities that will interest your brother and will address his learning style."
"Yes," Charlie immediately chimed in, "I've always noticed that Don is a multi-sensory learner- he has always liked to have things taught to him through oral explanation, seeing someone else do it, and through hands-on experience." Charlie took the cards from Olivia, turning them over one by one. "But what if he recognizes all the basic items in this set of cards- and any others we use? And basic skills usually involves reading and math at lower levels- what if he knows those things, too? Should I just skip those things and go to the higher-level thinking activities? I mean, teaching Don basic skills might end up wasting a lot of time."
"No, don't think that way- pretend like you have all the time in the world, because it might just take that long."
Seeing the disappointed looks in their eyes, Olivia tried to reassure them, "I don't really mean it will take forever; I just mean that you can't start thinking that the little things can be rushed over or ignored."
Taking a card with a picture of a coffee mug on it, Olivia asked Charlie, "What is this?"
"It's a coffee mug." He started fidgeting in his seat. "See, I don't understand the point of asking..."
"What color is it?"
"Blue." He sighed.
"What does coffee taste like?"
"Well, I don't know...it's kinda bitter, and..."
"Do you drink coffee?"
"Yes, all the time at work."
"When was the first time you had a cup of coffee?"
"I don't remember...Wait, my mom let me have a sip when I was six."
"Where were you?"
"At my house." Charlie sat back in his chair, his eyes faraway as he pictured his mom standing at the counter in their kitchen. "We were in the kitchen, and I was complaining that I was old enough to drink coffee like her and Dad. She poured a little in a coffee mug and gave it to me. I remember thinking it was the nastiest stuff I had ever tasted."
"What did your mother smell like?"
"She...she...lavender..." Charlie stopped, the memory gone as he looked at Olivia. "Oh."
Nodding her head, Olivia knew she had gotten through to her student.
"Read a third grade book and ask Don if he remembers reading it before. Ask him for all the details he can remember. If the story is about a duck, ask him if he remembers seeing a duck somewhere else, or if he has a favorite animal. See if he remembers a pet, or if he had a favorite book when he was younger. Reminisce about everything you do- this is an activity that can be performed with the basic skills activities and during every type of interaction you have with Don, from playing a game with him to watching cartoons on the television. Go on and on- but only as long as Don will let you."
Charlie ascended to her reasoning. Olivia was correct, he thought, there would be no shortcuts.
"You also need to ask questions that pertain to sequencing. Ask Don if he knows how to wash a coffee mug, and then try to get him to give you specific details- in order. Record all that he remembers about an item, and record the procedures that you ask him about, including any task that is out of order. You may find that he will say to clean a mug and put it away, but after probing that he can not remember that he has to rinse and dry it."
Olivia rearranged a few things on her desk and took a deep breath before beginning again. She threw off an odd feeling that had assaulted her from the first time she had looked into Professor Eppes eyes- the feeling that he was a leech and was sucking her dry of every bit of information that she possessed about his brother.
"You asked about basic math. Other than reminiscing, Don also needs the lower math skills practice in order to regain or relearn his higher level skills. Remember, all mathematics start with one plus one, and if you don't remember that, you can't go any further."
Olivia raised her eyebrows in surprise when Charlie snorted a laugh.
Rearranging the household items cards into a neat stack, she proceeded. "IfDon is a tactile learner, there are many ways for him to practice his letters and numbers by tracing them on different textures with his fingers. Those items can be found in the catalogues I will give you."
"Am I to understand that all this basic skills practice will help Don remember everything he learned before his, uh, accident?" Alan was not sure he understood all of the reasons for Don to be practicing letters and numbers.
"Well, there are two schools of thought. One is that the patient is relearning his skills; the other is that he is remembering what he learned before. In either case, the basic skills practice will help lead Don to higher levels of thinking and behaving- whether it is relearning or remembering, the goals obtained are still the same. And because Don is a multi-sensory learner, this will be especially true if we teach him using all of his senses. So, I will have to insist that you buy a set of textured materials and either scented candles or sprays. Feeling and smelling items can bring back memories that simple talking can not reach. If they are available, you can even use old clothing or toys from childhood to help bring back memories."
"We have some things. But unfortunately," Charlie said wistfully, "my dad gave away my mom's clothing not too long ago- I guess we could have used that to help Don remember her."
Alan tried to look innocent as his eyes leapt at the ceiling, but Charlie recognized his father's guilt quite easily and he opened his eyes wide in surprise.
"You didn't give it away, did you?"
"Now, Charlie," Alan stuttered, reluctantly facing him, "You've never been married, and you wouldn't under- hell, what am I apologizing for. It's a good thing I put it in that storage unit, because now we can use it to help Don."
Charlie shook his head, returning his attention to a puzzled Olivia.
"Hmm, well, uh, as for the critical thinking skills activities- uh, let's see- you can find a lot of software and bookwork that addresses this need, but you can also play games like Scrabble, Boggle, and Chess, as well as do puzzles- crosswords are good, so is Sudoku."
"Well, now," Alan said, his twitch smoothing out; he happily rubbed his hands together, some confidence returning. "I think I might just be able to handle a few of these activities after all."
"Daddy?"
Alan, Charlie and Olivia all looked at Don, who was slowly sitting up on the loveseat with a confused look on his face, his eyes slowly blinking. Both Alan and Charlie rushed to Don's side, the speech therapist's presence lost to them as they quickly wrapped Don in their arms and started soothing him. Olivia stood and stretched, putting a copy of her notes in with the file she had made with the details of Don's therapy.
"Ahem," she said loudly, drawing the attention of Charlie and Alan, Don still half asleep. Pointing to the clock on the wall, she informed them, "I think its time for your next appointment. We'll be meeting again later, so if you have any further questions, you can ask me then."
Each of them with an arm through one of Don's, Charlie and Alan thanked Olivia as they walked carefully out the door.
Olivia shook her head. All that love and gentleness- and all of them single.
Now, she thought, how could that even be possible.
