Chapter 14

The next morning, Dr. Ross went over the test results with John and Dean.

– Dean had good results. Some changes were identified, but they are within expected limits. We identified slight hypotonia in the detrusor muscle. – Dr. Ross turned to speak directly to Dean – To explain it more clearly, your bladder also has muscles. Just like the muscles in your arms and legs became weak and needed training to regain strength, the muscle in your bladder also became weak. This can cause the episodes of incontinence you experienced. Your physical therapist has already been working with you on exercises to improve this. She told me you've already seen some improvements, right?

The doctor waited for a response, but Dean barely nodded. John thought it was better to respond for him. Dean had been maintaining his silent treatment with everyone.

– Yes, that's true. He already feels the need to go to the bathroom without needing the alarm. However, it's usually when his bladder is already full, and that gives us little time.

– This is called urinary urgency. It's another consequence of the muscle weakness. But as you've observed, we've already seen improvements. If you continue like this, I'm optimistic that this problem will soon be resolved.

Dean still didn't respond, and the doctor asked John to step outside the room so they could talk more privately.

– Mr. Smith, what's happening with Dean? I can see that this last issue affected him more than the others. Given his age, this is somewhat expected. I imagine he feels quite embarrassed. But I'm starting to worry about his psychological state.

– This isn't the first time this has happened. In very stressful situations, he shuts down and doesn't say anything. The first time this happened was when his mother died. He didn't speak for weeks.

– I can see that he is depressed. I'll arrange a consultation for him with psychiatry. He's been through a lot. I believe a psychiatrist can help him.

– Dr. Ross, I've been trying to avoid this question. But have we reached the stage of sequelae?

– I don't know if I'd call it that. Nothing seems very definitive in your son, which makes us optimistic. The problem he's having could predispose him to future urinary infections. We'll need to be vigilant about that. His mood changes could also be temporary. But there are indeed reports of this becoming a long-term issue. The point that seems most likely to be a sequela is the headache. Dean has been complaining more about them. I believe he is developing a migraine condition, which clearly worsens during stressful moments. But honestly, Mr. Smith, this isn't serious or even close to it. It will require some lifestyle changes and might interfere with some activities during the crises. However, it's not alarming, and there are ways to manage the issue. – Dr. Ross's optimism calmed John a bit.

The psychiatrist visited Dean right after lunch. Dean had not been sleeping well due to anxiety about having another accident. His eating was also affected. He was so depressed that he didn't want to eat anything. John also noticed that he was avoiding drinking any liquids. After the consultation, the psychiatrist spoke with John.

– Based on the evaluation and what you told me, Dean has a case of selective mutism and early childhood depression. I don't think this is a surprise to you. As you mentioned, this issue tends to resolve itself over time, as he begins to deal with the situation. In the meantime, don't force him to speak or do anything. He's trying to process everything that has happened and all the changes he's gone through. He needs patience and support. There are ways you can communicate with him through gestures and signals. This will help him. I'll provide you with some of these communication methods and will prescribe medication to help with his sleep and depression.

After school, Sam came to the hospital. He was excited and radiant, wanting to share the latest news with Dean. He also brought some notes that Dean's classmates had prepared for him.

– Dean! Look what I brought for you. – Sam shouted, bursting into the room.

Dean opened his eyes, looking disheartened and not reacting.

– Sam, let's go outside. I need to talk to you. Dean isn't feeling very well. – John said, pulling Sam by the hand.

John had thought a lot about what to say to Sam. But he couldn't hide this from Sam. It would only create more frustration for both boys.

– Sam, you know that Dean has been through a lot... – John sat Sam down on a sofa and sat in front of him.

– Of course. I was there...

– That's right. Dean hasn't been feeling very cheerful these days. I need you to be patient, just like I'm trying to be.

– What do you mean, Dad? What happened? – Sam dropped the notes in his lap and put a finger in his mouth.

– Many things that Dean has been going through make him sad and upset. He can't do many of the things he used to do. And that makes him feel embarrassed. Especially in front of you. Dean loves you. I know you know that. But we need to help him get through all this. Do you remember how he used to take care of everything? For me and for you? It's hard for him not to be able to do that now. It's nothing for you to worry about. I just want you to understand that Dean might not want to talk or do something right now. – John tried to find the best words so that Sam would understand without revealing things Dean didn't want Sam to know.

– We can take care of him. Just like he used to take care of us. – Sam spoke as if he had found the solution to all problems.

– Yes, that's what we're doing! You've been doing that very well, and that's great. But there are things that I need to do because I'm the dad here, okay? And you need to accept that. There may be days when Dean needs to be alone. I know you miss him, and believe me, he misses you a lot. It's just that he hasn't been able to understand very well what he's feeling. But it's not his fault and it's not yours. I need you to understand that.

– Will he be okay? – Despite John's careful words, Sam was worried. – When is he coming home?

– Soon. I want him out of here too. The doctors are taking care of the last details so we can have Dean back.

– Okay. Let's go back inside. He needs us.

John smiled at Sam's words. He had noticed that since that fateful day when he found Dean on the bathroom floor, there were moments of a certain role reversal between the boys. Dean continued to assert himself as the "older brother" and acted that way most of the time. But it was interesting to see how Sam understood the moments when he needed to be more mature. John could glimpse the man Sam would become in a few years.

Sam entered the room, went over to Dean, and kissed his brother's cheek.

– I missed you, Dean.

Dean blinked at him, and a sad smile escaped his lips.

– Let's watch some TV. Dad will put on the superhero show you like. – Sam said resolutely, without waiting for a response from Dean. He climbed onto the bed and sat next to Dean. The two of them didn't speak, but they shared the same space. Sam had missed this so much. And right there, he realized that as long as Dean was with him, he could handle anything that came their way.