May 3rd, 2017

Mind On The Run: Thursday’s Pap

By Anthony Kovatch, MD, Pediatric Alliance — Arcadia


“Images of broken light which dance before me like a million eyes,
That call me on and on across the universe…..
Nothing’s gonna change my world,
Nothing’s gonna change my world.”

— “Across the Universe” by the Beatles. (Covered here by Kurt Cobain.)


“Sometimes the past deserves a second chance.”                                 — Malcolm Gladwell.












Part 1:  It took a long time to start writing this story because it took a long time for the ending to be determined — and, even now, I remain uncertain if the final act was nothing more than an illusion.

As I settled in on the “back nine” of my professional life, it became apparent that a second job was necessary to help defray the cost of our younger two sons’ higher-and-higher education. In spite of a six-year gap which existed between the final two children as a result of a second trimester miscarriage from which I had never completely recovered, the expenses were difficult to get ahead of. At least that was the explanation I gave to outsiders — the relatives, the IRS, the corporate bosses, and even to myself when in a rational state-of-mind — and the others from whom I had become estranged as a senior citizen.

Inside, there was a calling — like a siren from an inner chamber — to break loose from years of compliance and the “dogmatic slumber” of cynicism and venture into the “heart of darkness” of mental health at the institutional level. So when a vacancy arose, the wise fool — skilled in the arts of cerumen removal and parental reassurance — cometh.

The institution — like the Gaul I had read about in high school Latin class — was divided into three parts. The hospital proper temporarily housed children and adolescents with acute psychiatric disorders who had to be made aware that their conditions were serious or who needed a psychological “tune-up” or an overhaul of their medications. Most of these patients had the capability of being the heroes of their own lives. One residential treatment facility (previously referred to as “the Lesser House of God” — see The PediaBlog, April 17-18, 2014, “Innocentia and the Autistic Boy” Part 1 and Part 2) housed boys with bipolar disorder and severe ADHD and oppositional defiant disorder; the rehabilitation of these patients was complicated by the fact that they were otherwise mentally normal, were often hard-boiled and devious, and had families with the same problems (or worse); with months of intense therapy, they were capable of being the heroes of their own lives.

The second residential treatment facility (RTF) — where I spent the lion’s share of my Thursdays off (stealing energy from my primary pediatric practice duties of cerumen removal, etc) — housed boys with Autism Spectrum Disorder of various ages and severity. Many would be residents for years until they transitioned to an adult facility or, if miracles were in the wind, were adopted or recovered enough normality to return home to their parents. It is fair to say that none of these inmates would be the heroes of their own lives. I frequently mistakenly referred to this building as a residential “training” facility, not because of the education provided within, but because the commotion and chaos produced within felt like a “freight train running through the middle of my head.”

The personalities of the boys in the RTFs were as diverse and striking as their psychiatric problems and as intense as the pitiful Charles Dickins-esque psychosocial dramas which had created their destinies. Physical and sexual abuse were universal. Some had been abandoned or had survived attempts at extermination by their parents after birth. Many of the parents, step-parents, or paramours of the primary caretakers were incarcerated. The ages, extreme caretaking demands, and virtual unlovability of the boys made adoption or guardianship unviable for even the most compassionate of folks.

“Nothing’s gonna change my world”

To be continued…


2 Responses to Mind On The Run

  1. Wow! You left me hanging more than the “who shot JR” episode! I want to keep reading and learn more because I’ve often wondered about the people who choose to work in these facilities. I spent some time during my education in places like these only to realize that I couldn’t do it and it takes someone much stronger than myself. I’ve often thought people work here because they feel they can make a difference or is it to help them escape as well from whatever torments them? Whatever the reason I’m grateful that they are there.

  2. Thanks, Nancy! My opinion is that both happen at the same time.
    With the picture of the condemned dwelling and the caustic singing of Kurt Cobain, I tried to set the stage for the pathos that will follow. To what degree and by what efforts can pathos be reversed? Or for those older folks familiar with the movie—will Little Sheba ever come back?


    Ned Ketyer, M.D.

    Ned Ketyer, M.D.

    Dr. Ketyer has special interests in developmental pediatrics and preventative medicine, specifically how nutrition and the environment affect health. He earned his bachelor’s degree from the University of Vermont and his medical degree from Northwestern University Medical School. He completed his residency at Children’s Hospital of Pittsburgh.

    As one of the founding physicians of Pediatric Alliance, PC, Dr. Ketyer served as its president from 1997-2004. He has been practicing general pediatrics at Pediatric Alliance since 1990. Dr. Ketyer and his wife have three boys and live in Pittsburgh's South Hills. 

  • Note: The information included in these posts is for educational purposes only. It is not intended nor implied to be a substitute for professional medical advice.

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