The child didn't have to say anything if he didn't want to; if any topic came up that he didn't wish to share with me, I'd tell him to just let me know and I would change the subject. Any time he decided to stop, the conversation was over. Over the years, I've only had one adolescent girl say that she did not want to talk. But later that week, she told the staff that the only person she would speak with was the "psychiatry guy with the curly hair."
When I saw Justin, I knew this case was going to be different. I needed to know more about him before I could approach him. I took his chart, went back to the nurses' station and read his old records, occasionally glancing over to watch him rock with his knees up by his chin, his arms around his legs. He was humming or moaning to himself, and every few minutes he would let out a loud angry-sounding shriek. The PICU staff had become used to this; no one even glanced his way anymore.
As I read through his records, it became clear that Justin's early life had not been normal. Justin's mother was a 15-year-old girl who left him with her own mother permanently when he was two months old. Justin's grandmother, by all accounts, was a kind-hearted, nurturing woman who adored her grandchild. Unfortunately, she was also morbidly obese and had related health problems that made her very ill. When Justin was about 11 months old, she was hospitalized and died several weeks later.