(Originally published on www.timothyagnew.com)

In 1971, 19-year-old Ian Waterman awoke and discovered his body had disappeared.

He could see his physical body, yet he was unable to move or feel it. Immobilized by a rare neurological illness caused by a rare autoimmune response, his immune system attacked the sensory neurons from his neck down.

He could not feel any sensation below the neck, yet he was not paralyzed in the traditional sense. When his mother tried to help him stand, he collapsed to the floor because he could not control his limbs in gravity. Waterman lost the ability to sense proprioception, or where the body is in space. It is this “sixth sense” that many take for granted, and one that most don’t know they have.

Mind Over Matter

Waterman lost the basic ability to sense himself and the presence of his own body, and he began to feel that he did not exist. The information that Waterman lost is a complex system of neural pathways that subsist throughout the body, specifically in the joints, tendons, and muscles. Standing, balancing, performing coordinated movements, and maneuvering through crowds are all done using proprioception.

Refusing to live life in a wheelchair, Waterman, once a butcher by trade, where intricate movements were part of his skill, began to visualize his movements as though he were performing them. One day while lying on his back, he imagined the physical act of sitting up. He began to do this daily and started to see small movements, even though he still felt nothing. Finally, by using intent for the physical action, he was able to sit up.

Waterman taught himself how to regain his movements again by consciously controlling and visually tracking every action. The visual component was vital, and if the lights went out suddenly, he collapsed to the floor as though he were unplugged. If the lights were restored, he could move again and stand.

Dr. Jonathan Cole, who practices at Poole Hospital, England, and Southampton University, was the first physician to recognize what Waterman had begun to do in his self-training protocol. He wrote about it in the book Pride and a Daily Marathon, which tells Waterman’s incredible story. “Before I met Jonathan, I often thought I might be mad,” says Waterman. “No one understood what was wrong or why life was such a struggle.”

The Importance of Proprioception

Waterman’s experience resonated in the medical field, as physicians were fascinated with Waterman’s ability to compensate for his loss. While others with the same condition often refused to learn to walk again, Waterman did not surrender.

Yet his case also emphasizes the critical importance of proprioception and touch, according to psychologist Michael Turvey, Ph.D., who researches touch at the University of Connecticut. “The haptic senses underlie almost everything we do that involves movement,” he says. “At the same time, Waterman can do more than many theories of touch and movement would predict.” The case also presents a unique moment to test theories of movement and proprioception that would not be possible otherwise. Never have researchers been able to examine precisely how a complete lack of feedback from the outside world affects a living human.

The existence of specialized proprioceptors was not recognized by 19th-century physiologists. They questioned the origin of ‘muscle sense,’ a term credited to the Scottish physician, scientist, and neural system researcher physiologist Charles Bell, who first distinguished motor from sensory nerves.

Proprioception in the body is governed by mechanosensory neurons distributed throughout the body, also known as proprioceptors. This wasn’t always known; early physiologists assumed all awareness of body position is central and controlled by the brain only. In the late 19th century, neurophysiologist Charles Sherrington proved that a peripheral source of sensory receptors was located in muscles and tendons and that the nervous system, including the brain, is a single interlinking network.

Sherrington created the term proprioception, which he defined as the feeling of stimuli that “are traceable to actions of the organism itself.” His sensory theory was based on what he called exteroception or stimuli existing outside the body, and interception, the sensory signals from the internal organs. While other physiologists like Kuhne and Ruffini had defined proprioceptor organs, Sherrington was the first to apply sensory neurons influence on innervating organs and muscles for posture and movement control.

Today, the study of sensorimotor control still centers around Sherrington’s initial model of the proprioceptive system, especially his focus on ‘reflex’ pathways that guide proprioceptive feedback into motor output. How do these receptors help suspend us in gravity? The body has three distinct types of sensors located in the joints, in the connections between muscles, and in the muscle fibers. Without them, after hip surgery for example, a patient would not be able to sense where her feet were in relation to the hip. This would make physical therapy impossible.

How He Got His Body Back

A muscle spindle includes four different nerve endings that spiral around several muscle fibers. The small sensor, only a centimeter long, is enveloped in cone-shaped fascia that divides it from the rest of the muscle. The proprioceptors connect the neuron’s varied signals with changes to a muscle.

They also remember the position they were in previously when a muscle is motionless. For Waterman, all of these connections were lost. He had to think of movements and have vision to monitor their actions. His case was unique in that he was the first patient to lose his body and teach himself how to walk again. He relied only on the sense of sight and conscious orders to make his legs move.

Waterman has perfected his strategy to an astonishing degree. Since his movements require constant visual contact with the environment and space, he must “plan” his walks. Every movement is choreographed previously, including calculations of the force and direction, and the movements are monitored as he ambulates.

He calls his slightly lumbering gait “controlled falling.” While most of his gestures are planned and monitored, research conducted by The University of Chicago’s David McNeill demonstrated some are not. McNeill’s research on Waterman showed that the human brain orchestrates communicative motions in the absence of proprioception.

What McNeill discovered through experiments in voice and hand movement is that Waterman uses a thought-language-hand link to modulate some of his hand gestures.

His gestures modulated with the speed of his speech. If he spoke slowly, his gestures slowed too. Yet the speech-gesture synchrony was exactly preserved. Waterman’s case suggests that control of the hands and the relative motor neurons is possible directly from the thought-linguistic system. While Waterman had reworked his motion and control system, the thought-language-hand link system in the human brain survived his neuronopathy.

Despite his disability, Ian Waterman has taken his life very seriously, always attempting to do the best he can. While he doesn’t care about the science of his illness, he has helped change it with hours of lab experiments. “We choose our own paths,” he says.

And he’s also proven what the mind is capable of when all seems lost.

The tree which moves some to tears of joy is in the eyes of others only a green thing which stands in the way. — William Blake

Along the African Savannah on a wet and foggy day decades ago, giraffes meandered along the tree lines, occasionally shaking their heads in the rain¹. They began feeding on umbrella thorn acacias, trees that produce many succulent leaves and pods that the giraffes adore. Suddenly, the animals stopped eating and jerked their heads up and down like unhappy children, as though having eaten something bitter. They began walking away from one tree, only stopping to eat from branches of another a hundred yards away.

Make Them Eat Ethylene

Scientists observing the animals that day later discovered the acacias had pumped toxic substances into their leaves to rid themselves of the large animals. The giraffes didn’t like the caustic taste and moved to other safer sources in the vicinity. The acacia trees produce ethylene gas that discouraged the animals and also warned neighboring same species trees that danger is imminent.

Immediately, all the trees also pumped the ethylene into their leaves to prepare themselves. The giraffes, however, were not deterred and moved to find trees too far away to get the warning message. Another option for them was to move upwind where the scent messages the trees pumped into the wind could not reach other trees.

Our Silent Companions

Trees hold a majestic place as the world’s oldest living organisms.

Since humans have occupied the earth, trees have been our silent companions, pervading our most enduring stories. Author Hermann Hesse called them “the most penetrating of preachers.” As the science of trees, or dendrology, expands, it’s obvious trees have a lot to teach us about communication, connection, and even love.

Trees possess a silent, complex language, one that shares information via electrical impulses, taste, and smell.

“There are more life forms in a handful of forest soil than there are people on the planet.”

― Peter Wohlleben

Indigenous people living in the forests across the earth understood the trees; they knew they communicated and could send chemicals into their leaves and scent messages into the wind. They understood that if an oak tree tumbled into a river, the water became acidic, encouraging plankton to flourish. As global arboreal research documents the role forests play in making our world a better place to exist, we’re only just beginning to understand arboreal consciousness. What the research shows is astounding — trees experience pain, have memories, and tree parents live together with their children.

Like humans, trees react to physical and emotional trauma. A lightning strike, lack of nutrients, or even the loss of a family member cause trees to form hyper-proliferated wood tissue called burls to stop the damage. Burls resemble large warts, or cancer-like bumps enclosed in bark, the human equivalent of a goiter. While burls don’t harm the tree, they often distort the posture of the base or its branches, and woodworkers cherish wood with burls as it changes the swirls of the flesh to form unique patterns.

And trees talk to each other.

“All the trees here, and in every forest that is not too damaged, are connected to each other through underground fungal networks. Trees share water and nutrients through the networks and also use them to communicate. They send distress signals about drought and disease, for example, or insect attacks, and other trees alter their behavior when they receive these messages,” says Peter Wohlleben, a German forester and author. Because of his work in tree research, a broader audience was introduced to the field, and science better understands their behaviors.

The latest arboreal studies, conducted at universities around the world, confirm what Wohlleben has long suspected from practically living in the forest — trees are conscious, social, deeply sophisticated, and even intelligent.

What Love is to The Trees

Wohlleben slushes through thick fresh snow with enormous black boots in a mountainous forest in western Germany. He stops at two large birch trees and points into their branches.

“These two are old friends,” he tells writer Richard Grant with the Smithsonian Magazine. “They are very considerate in sharing the sunlight, and their root systems are closely connected. In cases like this, when one dies, the other usually dies soon afterward, because they are dependent on each other.”

It was long assumed that trees just existed, struggling for sunlight and water along with all the other trees. Wohlleben proved the opposite is true.

Trees of the same genus are communal and often form bonds with trees of other species, even an emotional connection. The evolution of forest trees shows them living in cooperative, symbiotic relationships, governed by communication and a joint intelligence analogous to an ant colony.

But the real connections occur underground.

Mycorrhizal networks consist of minute, hairlike root tips that unite trees together with microscopic fungal filaments to form an underground network. These networks appear to exist as a conjoined association between trees and fungi, and it’s believed they share nutrients like water and food.

In this cooperative environment, the fungi consume part of the sugar that trees photosynthesize from sunlight. The sugar feeds the fungi, and they forage the soil for nutrients consumed by the trees.

Every member of a forest is connected and works together to live.

Love Between Beech Trees

Wohlleben explains the time he discovered a gigantic five-foot beech stump in this forest, and he surmised the tree’s demise occurred 500 years ago. When he chiseled the surface with his knife, Wohlleben found something astounding.

The wood was still green with chlorophyll. There was only one possibility; the neighboring trees kept it alive with nutrients through the expansive network. “When beeches do this, they remind me of elephants,” he told the Smithsonian. “They are reluctant to abandon their dead, especially when it’s a big, old, revered matriarch.”

When other “family” member trees are sick or dying, the other trees help nurture them back to life through the root and fungi system. When they need water, they share their own. Trees are social beings that are never isolated from the ecosystem but keep a constant and broad connection to the environment they live in.

They communicate with fungi, grass, and even birds.

Wohlleben and other scientists tell us trees can detect scents through their leaves, and they possess a sense of smell just like humans. They also have a sense of taste. For example, when leaf-eating caterpillars inundate certain trees, the trees taste the caterpillar saliva and release pheromones that invite parasitic wasps. The wasps lay their eggs in the caterpillars, and the wasp larvae eat the caterpillars from the inside. “Very unpleasant for the caterpillars,” says Wohlleben. “Very clever of the trees.”

So, a forest is not merely a forest. Neighboring trees assist each other through their root systems, through a complex system of reciprocities. As if this is not incredible enough, these arboreal connections are even more complex.

Trees seem to recognize their roots from those of other species and even of their relatives. So, like humans, a tree is only as strong as the forest that surrounds it.

There is something to learn from that, and we should begin to listen.

¹WOHLLEBEN, PETER. Hidden Life of Trees: The Graphic Adaptation. GREYSTONE BOOKS, 2024.

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Healthcare leaders who recognize this shift early align their organizations to deliver better outcomes while managing rising costs.

Clinical depression has surpassed the boundaries of behavioral health.

Today, it affects roughly every aspect of healthcare delivery—from chronic disease management and workforce productivity to healthcare spending and benefit-based reimbursement. Organizations that continue to treat depression as a stand-alone behavioral health condition might overlook a significant motivator of patient outcomes and healthcare costs.

What Statistics Reveal

Approximately one in six Americans today take psychiatric medication, with antidepressants part of a significant contribution to those prescriptions. The COVID-19 pandemic influenced the mental health crisis, elevating depression rates to unprecedented levels across every demographic. Adults, college students, children, and adolescents experienced sudden surges in depressive symptoms, emphasizing depression’s population health concerns rather than divided clinical diagnoses.

Yet prevalence illustrates only part of the challenge.

Unresponsive Treatment

Approximately 30% of individuals diagnosed with major depressive disorder don’t respond to conventional medications, placing them in the category of treatment-resistant depression. These patients not only experience weaker clinical outcomes, they consume substantial healthcare resources. Annual healthcare expenditures climb by thousands of dollars for patients with depression and increase exponentially when conventional treatments fail.

For healthcare executives, these trends demand more than modest improvements in clinical care. They require a strategic reassessment of how organizations identify, engage, and treat depression across vast populations.

Fortunately, innovation is reshaping the treatment landscape.

Psychedelic-Assisted Therapies

Ketamine has rapidly emerged from an unconventional therapy into a clinically validated option for treatment-resistant depression. FDA-approved esketamine, expanding Veterans Affairs programs integrating esketamine into specialty behavioral health clinics, and growing implementation within specialty behavioral health clinics express how rapidly healthcare practices accommodate novel therapies when evidence supports their effectiveness.

Psychedelic medicine represents another emerging frontier.

Clinical research in the United States on psilocybin continues to produce encouraging results, suggesting that carefully supervised psychedelic-assisted therapy may provide reliable symptom relief for patients who have exhausted traditional antidepressant options. Oregon, the first state to legalize controlled psilocybin-assisted therapy for adults, opened its first licensed service centers in 2023. Colorado approved regulated therapeutic use of psilocybin in 2025.

Some countries in Europe are further along. In 2025, Germany became the first EU nation to establish a Compassionate Use Programme for psilocybin, administered by the Federal Institute for Drugs and Medical Devices (Farm). While regulatory questions remain, the scientific conversation has shifted dramatically, from questioning whether these therapies work to determining how healthcare systems can safely integrate them into clinical practice.

Digital Medicine

Digital therapeutics are redefining how providers develop behavioral healthcare beyond traditional office visits.

Artificial intelligence, mobile applications, and prescription digital therapeutics support treatment cohesion, personalize care channels, and improve patient engagement. Rather than replacing clinicians, these technologies enhance care delivery by expanding support between appointments and providing continuous behavioral monitoring.

Neurostimulation technologies are thriving. Advances in transcranial magnetic stimulation (TMS) confirm that precision neurostimulation can produce impressive results for patients with difficult-to-treat depression. As the FDA clears additional devices and clinical evidence becomes empirical, TMS will probably become a routine component of global depression treatment strategies.

Lifestyle Intervention

Research underlines something clinicians have long recognized: lifestyle interventions matter. Lifestyle interventions in treatment protocols show a positive change for the type of advice physicians offer their patients, shifting from medications to exercise. Yet, in 2016, NHANES data revealed that merely 2.7% of the US population satisfies the standard criteria for a healthy lifestyle, for example, eating a high-quality diet.

Even modest physical activity substantially lowers the risk of depression, and behavioral health strategies must integrate prevention with treatment. Community health programs that encourage physical movement, social connection, and a healthy diet may bring measurable clinical and financial yields.

Evidence-Based Modernizations

As an encapsulated whole, these advancements reveal a bolder transformation.

That transformation involves a multi-disciplinary strategy. Depression emerges from a condition managed almost entirely with medication into one focused on precision medicine, digital health, neurotechnology, lifestyle interventions, and integrated behavioral care. Healthcare leaders who recognize this shift early align their organizations to deliver better outcomes while managing rising costs.

The strategic implications become even more impressive when viewed through the lens of chronic disease. More than half of individuals living with chronic illnesses also experience moments of depression, reinforcing that behavioral health is an essential component of efficient chronic care management. Hospitals cannot maximize outcomes for diabetes, cardiovascular disease, cancer, or other conditions without addressing mental health as a component in treatment.

Healthcare systems that prevail over the next decade will move beyond managing depression as an isolated diagnosis. Medical industries will embed behavioral health into every aspect of care distribution, leverage developing technologies ethically, and invest in evidence-based modernizations that improve both clinical results and fiscal prosperity.

References

• U.S. Food and Drug Administration

• JAMA Psychiatry

• National Institutes of Health

• American Psychiatric Association

• The Lancet

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“I have come to think of psilocybin as a convergent methodology for investigation of the nature of mind. It wakes people up to the extent to which the normative way they hold reality is just one way of holding reality.” — Dr. Roland R. Griffiths

If You See a Monster, Don’t Run

In the shadows of other office spaces along Kings Street W. in Toronto, Canada, a Canadian life sciences startup focused on developing psychedelic pharmaceutical products to treat mental disorders, recently raised $34 million to fund the company’s clinical trials.

The goal? How its product — a sublingual film made with the chemical psilocybin that dissolves under a patient’s tongue — might treat major depressive disorder. The focus is not for home-based use, but for psychedelic-assisted therapy that requires patients to be “guided” through a four-to-six-hour psychedelic trip in a therapist’s office.

The therapist provides the “flight plan” that includes advice: “If you see a monster, don’t run. Face it!” as well as eye shades and a choice of soothing music. It will also require multiple therapy sessions before and after treatment.

Cybin’s lead program is targeting major depressive disorder, and it’s a huge market, given the unreliability and side effects of current antidepressants. Yet Cybin’s program is just one example of how the expansive, and re-birthed, psilocybin market is thriving. (And it could be growing in your backyard.)

Fantastic Fungi

In the early 1960’s, psychonaut and Harvard professor Timothy Leary began experimenting with psilocybin, a synthesized form of the hallucinogenic chemical found in certain mushrooms and truffles. He surmised that psychedelic drugs might help transform personalities and expand human consciousness. And as the current research demonstrates, he was spot on.

In addition to Leary’s controversial Harvard experiments, several other studies were conducted in the late 1960s and 1970s that showed psilocybin proved effective in treating mood disorders in cancer patients. (Then it was outlawed in the Controlled Substances Act of 1970, abetted by Richard Nixon.)

Imagine where fungi science might be if that Act had never been written.

60 years later, psilocybin research and its effects on the brain have charted new territories for how we treat mood disorders and dementia. In 2016, Johns Hopkins University scientists mirrored the previous research in this study. It examined psilocybin used to treat anxiety and depression in cancer patients.

Yet until recently, millions in the United States had never heard of psilocybin, but in Denver, Colorado, psilocybin is in the political spotlight. Earlier this year, the voters narrowly placed a ballot initiative that decriminalizes psilocybin, and its use or personal cultivation is now considered a minimal crime.

Other states are not far behind. A measure legalizing psilocybin therapy was passed only days ago in Oregon, and proponents in California are canvassing for its use. But what exactly does psilocybin do? And does the same guided treatment work for other disorders?

Psilocybe the Brain Hack

Imperial College London researchers used psilocybin to treat a small number of patients with depression and tracked their brain function before and after the dosage. CAT scans of patients’ brains showed remarkable brain activity associated with reductions in depressive symptoms.

These brain benefits were recorded as lasting up to five weeks after treatment. Psilocybin has shown it “hacks” the neurological activity of key brain circuits known to play a role in multiple brain disorders, again mirroring the studies done by Leary in the 1960s.

The researchers were astonished to find that psilocybin, which they assumed would amp up brain activity, actually negated it, but only in a specific area called the default mode network. This neurological pathway is involved in a range of “metacognitive” processes, including self-introspection and mental time warps (time that is distorted).

This default mode network is active when the mind drifts. Also known as daydreaming or ruminating, it is this default that is calmed after ingesting psilocybin.

Functional MRI imaging also revealed less blood flow in certain areas of the brain, including the amygdala, the small, oval-shaped region of the brain proven to be involved in processing emotional responses like stress and fear.

Dr Robin Carhart-Harris, Head of Psychedelic Research at Imperial, who led the research, said, “We have shown for the first time clear changes in brain activity in depressed people treated with psilocybin after failing to respond to conventional treatments. Several of our patients described feeling ‘reset’ after the treatment and often used computer analogies. For example, one said he felt like his brain had been ‘defragged’ like a computer hard drive, and another said he felt ‘rebooted’.”

How to Change Your Mind

Michael Pollan’s recent book, How to Change Your Mind: What the New Science of Psychedelics Teaches Us About Consciousness, Dying, Addiction, Depression, and Transcendence, has brought focused attention to psychedelics, and it also changed perspectives on psilocybin’s ultimate serving purpose in society.

Is it strictly for professional therapeutic benefit or can everyone benefit? Research demonstrates that psilocybin has value for everyone. Properly dosed, a psilocybin journey shows lasting, positive effects on brain health, including an “openness” and unique new perspectives on things never realized before. Users also report increased empathy and patience for weeks after ingesting it.

As Pollan makes clear, now that science has made this incredible progress in psychedelics, there is the risk of propagating the sort of political backlash that occurred in the late 1960s, which of course stalled research into psychedelics for decades.

“Think of what we might know now, and the suffering that might have been alleviated, had that research been allowed to continue,” says Pollan. And this is precisely why he insists we need to be cautious with how it’s presented in science.

In many ways, psilocybin is a remarkably benign drug that has no lethal dose, and it is nonaddictive. As with any drug, the risks involve how it’s used. For one thing, it’s not a party drug.

It’s true, for example, that someone on a concentrated dose of psilocybin could have badly impaired judgment and, without guidance, could do something dangerous, like climb a palm tree and fall. Yet as research shows, carefully guided “trips” have enormous potential in how we treat in psychiatry, and how we might be able to dose ourselves.

Why It’s Growing in Your Backyard

Many fungi experts claim the soil and climate of Fulton County, Georgia resembles that of the Périgord region of France, making it an ideal place for psilocybe truffles, a fungi related to mushrooms, to grow.

While mushrooms grow amply above ground, truffles grow underground and only in specific conditions. At the tributary of the Chattahoochee River, in a mossy patch of land, psilocybe Atlantis can often be found. Psilocybe truffles are measurably more potent than psilocybe mushrooms, so plan your trip carefully; after all, psilocybin has something to teach all of us.

We may be in the Universe as dogs and cats are in our libraries, seeing the books and hearing the conversation, but having no inkling of the meaning of it all. –William James

As I paced the frenetic retail lot on a ninety-plus degree day, I knew heat inside the vehicle had become an oven. While the back windows were partially down, the dog panted excessively, and viscous saliva drooled from the corner of her mouth as she sluggishly visited each window for air.

Perhaps it was the Law of Truly Large Numbers, a statistical observation that when enough of the same moments exist, inferior coincidences are almost always bound to occur. Of the hundreds of cars in that busy parking lot, coming and going as though from a hornet’s nest, wasn’t it inevitable, mathematically, that one person would encounter an animal in distress?

Or Kantian Deontology suggests that actions become moral if performed out of a universal noble obligation to preserve life. Could I not smash the rest of the vehicle’s windows out of moral obligation to preserve life and suffering, or perhaps only one to rile the dog’s owner? After all, the Good Samaritan law says I could.

In my case, it was simply that dogs found me.

Dogs fortified my life since childhood, first with a part-lab miscreant named Rags, then with long-haired dachshunds, a golden retriever, a Jack Russel terrier, and my last, a pit bull terrier named Yogi.

I’ve always had a natural, energetic inclination towards animals—deer follow me in the canopy, red-tailed hawks perch just feet from me, other people’s dogs follow me home—yet dogs were my weakness. It was mutual, as dogs always saw me.

When my marriage of twenty-some years ended, dogs rescued me. It began with a stapled poster on a utility pole on a busy street. Thousands walked past that poster and never gave it another thought, if they saw it at all.

A Hispanic family could no longer have pets in their condominium, so they needed someone to give their rescued dog a new home. “Yogi”, a gorgeous pit terrier, smiled at me on the poster, his enormous head resting on a coffee table as though posing for the picture, something he habitually did, whether it be a lap, couch, or chair. I later would say he needed to rest his big head frequently but soon learned it was just part of his personality.

I called the number on the poster and told the family I’d be happy to help search for a home and keep him while I did.

Yogi never left.

Like most rescue animals, Yogi’s life had a sorted past. Abandoned many times and physically and emotionally abused, I pledged to give Yogi a secure, loving life, complete with dog orgies and plenty of treats. And I promised I would never abandon him. I kept my promise, and he kept his.

For six years, Yogi remained at my side, a constant shadow no matter the storms that ravaged. When I traveled locally, Yogi went with me. I found pet-friendly stays and once almost brought him on a plane. At my sports medicine clinic, he became the mascot, and he spent the day greeting my patients and snuggling with the ones he knew needed it. His forty-five-pound frame leaped onto the therapy table to nestle close to a patient, his head resting on their chest.

During the emotional turmoil of my separation, Yogi nuzzled me with his snout or extended a paw for comfort. He recognized the mistrust I had developed—something I knew he experienced more than once in his own turbulent life—yet his comfort and incredible perception taught me forgiveness. Above all, Yogi taught me how to be alone and just exist.

Much to Yogi’s chagrin, I walked shelter dogs as a volunteer. It distracted me and provided comfort, the canine energy that spiked my oxytocin, and the combination of movement and companionship helped settle my brain. Untrained shelter animals presented challenging walks on leash. Most were physically and emotionally wrecked, with behaviors that were both dangerous and lovable. With each walk, the animals either licked me to death or nearly mauled me.

Weekly, I arrived home with bruises and deep scratches along my arms that were so graphic that when I gave blood, the nurses gasped as though I were a drug user who woke up in an alley. Worse, Yogi sensed the dogs on my clothes and pouted, then began tossing his food around the kitchen.

Mostly, the excited animals craved physical exercise after being in a crate all day, so they pounced and pulled and bit, and I realized I welcomed the bruises and bites as a bitter medicine that snapped me out of self-pity. My arms still bear the dog “tattoos” as I call them, white lines spidering across my forearms.

Each shelter dog became a character to me, and each dog brought me closer to peace. Duke, a black miniature dachshund with a healed fractured spine and scars along his chin, at first refused to come out of his crate.

Every visit, I’d bring treats and sit outside his open door, watching his sunken eyes glare at me from the corner. Soon, he circled the crate, stuck his head out, and eventually took a treat from me.

After a few visits, he met my hellos with uproarious bursts from the crate where he’d eventually settle in my lap, staring lovingly into my eyes. Duke knew what broken was, and we both understood we couldn’t break any more than we already were.

Hank, the 145 lb. Irish Wolfhound was a beast that stood thirty-two inches, which, at my seventy-two inches in height, placed him above my hips. Hank still had scars on his snout where abusers had wrapped plastic bags with chicken wire.

Released from his pen, his first inclination was to place his front paws on my shoulders, something that nearly took me to the ground on my first introduction.

A gentle giant, I eventually trained Hank to sit when released from his crate, and to “hug” only when I gave him permission. And hug he did. It became our ritual before we walked, his enormous paws wrapping around my neck.

I taught Hank to walk at my hip, and his proud, mightier-than-thou strut was hilarious, as though he were at the Westminster Kennel Club Dog Show. He’d occasionally lift his chin to me and make eye contact, something dogs do in trust.

When we finished our walks, Hank often refused to enter his pen alone. Obviously affected by abandonment issues, I’d crawl into the pen with him, and we’d sit together for a time. As I sat and stroked his beard, I wondered what his full story was and how humans could abuse and abandon such a gentle animal.

His unequivocal love and trust in humans were profound, a trait that shattered my inclination for grievance and instead embedded fortitude in my nervous system. It was something that made animals god-like in their perceptions, unworldly beings that shouted this is how you love and forgive.

Yes, the parking lot.

I had entered the chaotic retail shopping center where the only available spot was next to the vacant-with-a-dog-in-the-back-seat Honda. That one spot. Available to me. Quantum mechanics offered different versions; five seconds later, someone else occupied the spot, and ten seconds earlier, the Honda had not yet arrived at all. Perhaps the owner had a flat tire and never made it to his errand at the shopping center. Better still, perhaps he experienced a prudent moment of clarity and realized it was too damn hot to leave his pet in a car.

I called local police to report the dog, then paced near the vehicle, waiting. Perhaps the owner would return to his car, and I could walk away and forget it all.

After thirty minutes, a police car circled the lot, zigzagging between the lines of cars vying for a space. I waved, and eventually the squad car found me.

“This it? Least the windows are down,” the police officer said, peering into the back seat. The dog never barked or made a sound at us, just sat poised, waiting for her owner to return. The officer saw the strain on my face. He looked at the retail shops in the mall, stacked like decks of cards. “I’ll call the owner from the tag info to get her out here.”

I found it interesting that the officer addressed the owner as a female—an accurate reminder that both sexes make poor choices, whether it’s pets left in hot cars or worse, children. My bias reflected Yogi’s previous male owner, who indeed had abused him.

Cars honked, impatient humans in an endless row as shoppers dodged cars carrying bags of food and clothes and things that might not fit into their garages and that would one day end up in rented storage units. Snow skis and skateboards and fishing poles from the outdoor store. On their phones, they scurried past the Honda with-a-dog-in-the-back-seat then a little girl eating ice cream paused behind her mother and smiled at the dog.

“Mommy? Can I give the doggy the rest of my ice cream?”

In a universe where I decided that the car and the animal inside were invisible, there was this.

Good day brilliant writers, I’m proud to introduce the Fiction Writer’s Clinic.

Are you a serious short story writer? If you’re on Substack, you’ve seen the “article” option when composing a new piece when it should say “story.” Let’s change that.

As a published author and short story writer who has experienced the struggles of publishing in my career, one of the most prudent tools to fine-tune a story for submission is peer-to-peer critiques of your work. Getting that, however, remains elusive—unless you have a community of writers willing to look at your prose.

While story reviewing platforms exist, most are too noisy and the reviews are usually subpar. The Fiction Writer’s Clinic is a private reviewing space here on Substack (there will be kinks, but bear with me).

If you have drafts you want polished for submission, this is the arena to make it happen. Free.

Here’s how the Fiction Writer’s Clinic works:

1. We are only accepting limited writers for now. Go here to sign up: https://fictionwritersclinic.substack.com/ or click the button below.

2. Include a link to a story on Substack and tell us where you’ve published (if you haven’t, don’t worry). This is only to get a vibe on your style and to better match you with reviewers. We will notify writers if we select them. We plan on accepting more writers as this concept grows.

3. All members will critique 1-2 curated draft stories per month, and we’ll have one meeting per month to discuss your work. Submitted stories will use Google Docs’ links to keep your work private, and they will not appear in Substack or Ink Outside the Margin’s homepage, unless you publish them.

This is a private writer’s roundtable to help make our work better and help get you published. I look forward to reading your work.

Fiction Writer’s Clinic

A private space for serious fiction writers to get stories critiqued by peers, refine prose, and get published, guided by author Timothy Agnew.

By Timothy Agnew

The Fiction Writer’s Clinic Guidelines

Welcome to the Fiction Writer’s Clinic. Our concept is simple: to help each other become better writers through reflective reading and genuine critique.

Critique the Work, Not the Writer

Respond to the writing itself. Avoid biased judgments, assumptions, or commentary about the author.

Be Truthful and Polite

Reflective criticism beats praise alone. Offer observations, but with respect and generosity.

Support Confidentiality

Do not distribute, repost, or share another writer’s work without permission.

Leave Your Ego at the Door

Writers are here to learn. Provide curious feedback, be inspiring.

Our Philosophy

We are not here for compliments, but to develop as writers. Respect words, be generous.

Get to know me, read my work, subscribe to my publication—it’s free.

(Originally published at timothyagnew.com)

Stamford wobbled into the spare bedroom after Se Chan left, his thick body silhouetted against the window as he stood over her like a gargoyle.

She had her eyes open in the darkness, studied the stencil of his hunched form, the wiry hair dancing at the edge of the phosphorus moonlight, as though it might tell her something more, reveal the truth. She smelled the wine and unfiltered cigarettes he smoked when Se Chan was around.

She waited, listened to his labored breathing. If he moved on her, tried to press his body into her side, she would push him away. He wouldn’t persist, not now. When he finally stumbled out of the room, she gazed out the window at the night sky. She heard the hollow timbre of villagers pounding kava plants into the balsam rock, and she imagined it resonating from the stars.

The white hump of the sandbar was more visible now, the relentless tide sucking the sea out, puffs of seabirds speckled across it. Black anhinga’s posed on the dock piling near the skiff, exposing their wings to the wind like muddy crosses.

Though it was calm here, the tide was fierce, swirling in small circles out beyond the dock. Marcella heard the shuffle of the pandanus trees, knew he was behind her. He handed her a glass of orange juice, stood there with his gauze shirt open, exposing his white belly. She ignored him, and he set the glass on the chair arm.

“An empty bed last night. Again. Look, why don’t we go somewhere, get off the island for a while? I will probably take a sabbatical until the girl comes to her senses.”

“You might not have a choice.” She turned her head away, searched Skiken’s rock above them, its green lava hills rising to the clouds.

He followed her gaze. “Children sleep forever in the village.”

She spoke to the water. “When I manage to sleep, I dream of them. That I stand with them on the rock, lifting my robe into the wind, waiting for it to take me over.”

She often watched the children playing on the cliff from the dock, the bright yellow and blues of their clothes blinking against the green of the atoll, spreading their robes like graceful birds into the forceful wind.

The best winds were before the typhoons, when they were building in strength. The wind lifted the children up, suspended them in the air like human kites. They used their robes like wings, folded them to their sides so the wind set them gently back on the ground. If it was strong enough, it tossed some of them into the sea.

She had treated many of them for bruised skulls, the ones that banged their heads against the cliff but didn’t go over. The lucky ones. Though many children had drowned, still they climbed the atoll. It was like playing on a playground filled with landmines.

She felt him staring at her face, knew the mountain’s shadow and the angled light made her skin appear like clay when it’s in the kiln, the pale amber glow a fever of clay. She hoped she looked ugly to him, unrecognizable, just a shapeless mass. “There’s a man on the sandbar,” she said.

“Where?”

He waved his hand over his forehead and squinted. “Birds.”

“No. Something moved—there!” She pointed.

He looked again. The image appeared to blur into the horizon as though seeing a mirage in the desert heat.

“The hell?” Stamford searched the outline of the sandbar for any kayak or small boat. There was nothing.

She knew what he was thinking. A person would have to swim through treacherous currents to get there, and a long way from a boat anchored yards off the sandbar. Jagged coral surrounded it like an enormous, gaping mouth.

“I think he’s been there all night. Poor drowned ghost,” she said.

Stamford sat. “He probably fell from some party boat that came up the channel. They’ll be back when the bridge on the east point goes up.”

She glared at him with disdain. “It’s Sunday. A boat won’t get through the channel until three. If Enic is conscious to raise the bridge.” She pictured the old man, flat on his back in the bridge shack, snoring in a rum coma. “That’s more than six hours in the sun without water.”

“How do you know he has no water?”

She folded her arms. “You’re right. He probably has all the amenities he needs.”

He squinted. “How do you know it’s a man?”

“I’ve watched the village boys.” She leveled her eyes at him, a jab to his nuts. “He moves like a man.”

“Shall we have breakfast down here or not?”

“I don’t care. He’s waving to us. He could be injured.”

Stamford stretched his legs out in the Adirondack chair. “Nonsense. Probably drunk. Morchodos’ hellions.”

“For God’s Sake, Jon.”

“He can swim to shore. It’s only four-hundred yards.”

“In this current? The reefs will make chipped beef of him. You know he won’t make it.”

He stared at her. “What do you want me to do?”

“Take the skiff out there.”

“Nonsense. Ignore him.”

She thought about what Se Chan had said last night. She heard stories, the Rai Cachone and their ships patrolling the islands, doing what they do, pillaging and taking, using the vortex of the Pacific to disappear.

They butchered their own when they had to, the rogues who betrayed them, that didn’t comply. Maybe the ghost man was a rogue, swam to the sandbar, and survived.

The ghost man was waving his arms in the air. She dismissed her thoughts as ludicrous and paranoid. Aiding and abetting didn’t exist here, not in island reality. The man needed help.

She stood up. “Fine. I’ll ask Kadek to get the boat ready and we will go.”

Stamford set his glass down and glared at her. “Marcella. I won’t be able to get within fifty feet of that sandbar before the coral rips the boat up. I’m not an Olympic swimmer, either.”

She moved toward the path leading up to the house.

“Goddamn, you’re stubborn. You don’t have to involve Kadek. I’ll figure something out.”

Stamford stepped onto the dock and to untie the ropes. Dried fish scales and blood covered the stern floor of the boat, and a nest of tangled fishing lines and barbed hooks.

“Kadek needs to clean up his mess. Haven’t we told him?” He climbed into the boat and checked the gas and oil, reached into the cabin trunk to remove an old life preserver. He found a coil of bloody rope, tied it to the life preserver and tossed it to the bow. He reached into the trunk again and jutted his hand under the ceiling plank. The rusted Colt Pistol was pitted from sea salt on its exterior, but he managed to open the chamber to see if it was loaded. He reached into the hold and pulled out a box of ammunition.

His hero act amused her. “How long have you been hiding that thing?” She didn’t like seeing it in his hands. It seemed unnatural, a clumsy deformity. She watched him slide 45 caliber bullets into the chamber.

He slipped the gun under the steering wheel hold. “Long enough that it probably won’t work.”

“You don’t even know how to fire one.” That got a smirk. “The ghost man doesn’t look dangerous,” she added.

“Regardless of your sarcasm, I will get your ghost man and bring him to the dock. He can walk to the village.”

“I will have the first aid box here when you return,” she said.

“Get the last rope.”

She kneeled and removed the thick rope from the rusted cleat. She tossed it into the boat as he started the engine. It choked a blue puff of oil into the air as he hit the throttle, his head bent into the wind. He had both hands clutching the steering wheel, guiding the boat like an inexperienced Captain Ahab. When he turned to her, she looked away.

The old boat sliced through the inlet, opening the water like a wound.

Marcella came over the slant on the sand path from the house, carrying the first aid box, pushing aside the enormous pandanus branches and palm fronds. Stamford had told Kadek to clean up all the dead fronds from the last storm, trim some of the larger live ones to lighten the house more.

She passed his shirtless, bronzed back bent over in the yard, hacking the thick branches with the machete. When she passed him, he stood up, his dark, sweaty face covered in sand.

“More house, no?” he said.

“More house.”

She asked Kadek to work his way down the path to trim the pandanus trees by the dock. Marcella continued on the path, then stopped and turned to Kadek. She studied him. He looked harmless, like a well-fed puppy. How could Se Chan tell them not to trust him? Kadek was from Popolon, the west end of the island, and lived in the village now. She was sure he had heard about the accusations against Stamford.

Kadek looked at the ground, then back to her, his wide cherub face drawn and head cocked to his shoulder.

She nodded. “Don’t worry.”

Kadek’s face widened, all ivory teeth flashing. “No worry.” He bent over and took long swings at the palm fronds.

It surprised her to see him swing the blade like that, to see his body become suddenly violent with tension, made him less innocent and revealed something hidden.

Kadek turned toward her again and grinned.

Marcella moved through the trees, and the turquoise water filled her periphery, the boat a velvet shadow floating just off the sandbar. A late morning haze had moved over it, blanketing the horizon like yellow silk.

She walked further down the path as coconut crabs and lizards scattered for cover. She stood for a moment when she reached the chairs, watched dolphins curl their slippery blue backs through the water.

Telamachus. It was what Stamford called the dolphins. It seemed like a long time ago when he said it, several typhoons ago, back before all this current mess.

When they first came here, Se Chan had told them about the legend of Telamachus, son of Odysseus, saved from drowning by a dolphin. The currents fooled even the village people. The islands were full of tales about dolphins saving swimmers from drowning.

The sandbar had grown in length because of the storms this year, and now ran a full length perpendicular to the shore. She saw the form of the man standing to the right of the idling boat some fifty feet away. She imagined the man would wade into the water, assumed Stamford would throw him the life preserver and pull him in.

Stamford would not get into the water if he could help it. The boat’s bow faced her, so any movement in the boat was impossible to see, blocked by the cabin frame.

She sat, tried to look away, think of something else. She would tell him when he returned that she didn’t want to do this anymore. She would tell him she doubted his innocence, that she thought he was guilty. She would go back to the States, maybe try to resume the life she had left behind. She could apply for the nursing license again, could do a lot of things. She needed sleep.

She rested her head against the chair and looked up at the sky. Decades went by. She felt alone. She thought about returning to bed.

She glanced back at the sandbar. A white heron appeared from behind her and landed at her side. The bird stuck its long neck out, jerked its head around, examining her. “I have no fish for you today, Henry.” She liked to feed the bird the baitfish that Kadek caught with the cast net. The bird coiled its neck back to a sink pipe and took a graceful step toward the water with its shiny black legs.

Quaker parrots squawked from overhead. A brilliant swarm of green painted into the blue sky, yellow beaks squabbling over food. Chunks of feijoa fruit hung in their beaks like freshly scraped flesh, and pieces scattered to the ground as they fought in mid-air. They settled in a mangrove tree, quickly dotting it with furious green puffs.

Lime feathers exploded as they leaped from the branches, batted the wind madly, and landed again, nipping at each other like angry cats. The caws echoed forever between the atolls, creating the illusion that millions of birds were in every direction.

Henry shrieked and leaped to the sky in a white mess. He looked clumsy when startled, all tangled in wings and legs.

It frightened her. What was happening? She leaned forward to the water.

In a surge, the parrots took flight, a burst of fury that dispersed, then came together as a mass of color floating across the blueness. She looked behind her to see if something had frightened the birds, but saw nothing.

She was confused. Why hadn’t the heron come back? It rarely left the dock for long if someone was here, usually circled anticipating a possible handout.

She examined the scene again. The boat floating in silence. The seabirds swarming the sky, haloing the sandbar. Where was the ghost man? She didn’t see him now. She stood and moved to the edge of the water, scanned the horizon for Stamford’s white shirt. She looked up at the atoll, then to her right, hoping to see the heron. Her head throbbed.

Now she understood. She saw the scene in her mind: Stamford holding the rusty gun gripped tightly in his wet hands. She saw the bullet leave the chamber and slice into bone and flesh of the ghost man. Then she reversed it, told herself maybe he was too old for that, that the ghost man was younger, agile.

Someone trained the ghost man to do this. It was his duty. She saw the ghost man take the gun away, saw Stamford stumbling into the boat. The ghost man would remain silent. He would not use the gun on him, either, for fear of frightening the spirits.

He would use a machete, swing it the same way Kadek had, exposing that hidden force. It would slice a leg or an arm and a vital artery, perhaps sever a limb completely. It was a preferred method of retort, letting the victim bleed to death. He would do it quickly, in silence, efficiently. This is what you get for the girl, the ghost man would say.

She was burning up. Whiteness flashed in her periphery. The heron returned circling above her, trying to decide whether to land again or not, and it darted off near the dock and disappeared over the atoll.

She almost called after it, foolishly having the name she had given the bird on her tongue, almost took a step forward as though to follow it. Her own movements were rigid, involuntary. There were small steps back toward the chair, the world of the islands tunneling through her eyes in a funnel.

The shadow of the boat, floating out there in empty space, the wide blue sweep of endless water. Marcella’s father had told her there was no such thing as empty space. Einstein had written that empty space contained gravity working in the opposite direction, not pulling things down but across and away, giving birth to alternative universes. Stamford had said there was no proof, but so what? Could it be that all of this was happening in reverse? That clay and all her pottery filled the empty space that was never really empty?

This is what happens in island time.

Fire. The sun burned through her pores, heavy on her eyelids, like some force in the universe pushing them in like dengue.

A tired engine drone vacillated across the water, the rusty propeller struggling against sand and water. She let the sound move through her, felt the wooden chair under her body, realized it was supporting her.

She heard his voice, distant, as though from another universe.

“Miss Marcella.”

He came up behind her, gripping the machete with both hands, his sunburned head titled to one shoulder, the blade a dichotomy to his kind face and smile. “The gods sent the birds away, a storm coming,” he said.

When she turned to face him, he wasn’t looking at her. His smile was gone. Kadak looked out to the sea, the skiff moving away from the sandbar, the engine choking then whining across the atolls.

The wind gathering fathomless power. The children. Brilliant yellows and reds blinked against the velvet-green rock, the children’s almond arms spread like feathers into the blue.

The colors danced until obscured by stark wisps of clouds.

(Originally published at timothyagnew.com)

Marcella lost track of how long she had been by the water. She knew she was here before the sun spilled through the atolls, and now the sun was above the rocks. She tilted her head back to look for the village children on Skiken’s rock.

It was too early yet. She looked out at the sandbar again. The light on the island played tricks on you. The man was more solid now, still abstract, incandescent.

Now she imagined the vision to be an Eni, a ghost of the ocean, the way the gray dawn light exposed him slowly, a translucent embossment on the horizon. She saw a similar illusion with the flocks of seabirds, the dawn angling the light so they appeared as giant white eyes blinking in the sky every time they changed directions in flight.

She knew Stamford would come to find her soon, would wake hung over and twisted in the sheets, his hands searching for her.

She did not sleep next to him again last night. She heard Se Chan and Stamford laughing well into the morning, found three empty bottles of wine on the table.

In exile since the accusation weeks ago, Stamford closed the world out. He ignored any calls, even refused to speak at length with Se Chan. He finally agreed to have him over for dinner last night. She had cooked the fresh mahi Kadek caught that day, seared it with olive oil and garlic, sautéed bok choy to go with it.

She told Stamford to get a good bottle of Bordeaux out of the makeshift wine cellar. Kadek had built it, removed part of the wood floor under the stairs to the loft, dug down into the soft floor and poured his own version of cement—lava sand, coral, and water—and created a hinged door that you peeled up and back, and it kept the wine a little cooler.

Stamford returned, cradling the bottle.

“You waste away in your seclusion.” Se Chan said.

Stamford squinted at the wine label and tapped his stomach. “I know the most effective secret diet in the world. Cease eating and drink fine wine.” He slid the bottle into the refrigerator. Mocks shipped them wine occasionally from the States since they came here, so they were never out of stock.

Se Chan grinned. “We will drink to Kadek and Mocks. Bless their very souls.”

“It will chill soon. Let’s sit on the porch. There’s a breeze tonight. Trade winds.”

Stamford slid past Marcella without touching her. She unwrapped the fish and ran her hand over the pink flesh. It was pillowy and fragrant. She waved her hand over the skillet. The olive oil expanded in the pan and gave off a light, fruity scent.

She reached to pour a glass of wine from the bottle she opened, moving her hand over the hot skillet. Her wrist brushed the side of it, and she jerked it away, sending the bottle to the floor. It didn’t break, but wine went everywhere.

“Marcella.” Stamford squatted to save the bottle. He stood and grabbed a towel, moved the skillet off the burner.

She held her wrist up and looked at it. It was red and burning.

Stamford went to the freezer to get ice. “Maybe I should cook. We’ll have wine left for dinner then.” He rubbed the ice over her skin, and she flinched. It wasn’t a gentle glide, but forced, hurried.

When they first met, he rubbed her sunburned skin with ice cubes, sat and stared at the beaded water on her flesh, and asked about her family.

She told him her father taught physics at a small college, told him how her father’s face resembled Einstein’s, the sad eyes and wiry gray hair, the sacs of skin under his eyes, the way his forehead did the Einstein furrow when he talked.

Now she jerked the ice from his hand. “No. Go drink your beer with Se Chan.”

No one wanted to discuss Stamford’s situation over dinner. It wasn’t like before, when Se Chan came to dinner and they sat around getting drunk on wine. The conversations were spirited and fun.

On Friday nights it was dinner and wine and lazy talk, island tales. Se Chan knew every Morchodo’s tale there was, told them with his deep, rhythmic voice, hypnotizing them. He was an adroit raconteur, and they often went late into the morning listening to him. She often wondered if he had the same effect on his students, wondered if he blended stories of the islands with marine biology.

Now the silence at dinner became unbearable, the sounds of chewing and forks scraping plates monotonous. She got up once to open the shutters, get the cross breeze going, purge some of the stagnant air. The tree frogs peeped in the trees, a chorus of sweet notes.

Se Chan looked at Marcella and grinned. “There was a man once, a simple Modol villager,” he began.

It made her smile. The timing was perfect. She had heard this one before, about a man in the village of Pampov who suddenly became very ill. All the villagers considered him a normal family man who worked hard carving furniture and musical instruments out of wood and raising his family under God.

At night, after a long day, he’d sit with his wife and watch his children play with the bamboo marionettes he made for them. When it was their bedtime, he helped tuck them in, told them stories of dolphins leaping through rings of fire, kissed them on their noses.

Yet all this was one life, separate from another. He lived a secret other life, one full of debauchery. On his deathbed he murmured that he was spinning away from the earth, falling into death.

“Meyoua en kepirepir. Literally ‘spinning death,’” Se Chan told them.

Stamford tried to rationalize it. “Why a spinning death? There are other ways. This island is fascinated with death.”

“Ah, but that is part of the fable. As a consequence of a poorly lived life. It is what the chiefs believed: that you were sucked into a whirlpool, that the soul would forever be spinning.” He swirled his wine. “It is not that this island is fascinated with death. They believe in living with it, embracing it. Americans have a difficult time with that.”

Stamford grinned. “Poor bastards. It’s not that we have a hard time accepting it, it’s just that we don’t have the time for it. We want immortality.”

She could not resist. “You seem fascinated by all this,” Marcella said.

“We are all fascinated by legends, no?” said Se Chan.

Marcella pushed the fork around in the white flesh of the mahi and glared at Stamford. “No, men are fascinated by a poorly lived life.”

This silenced them. Now she wished Se Chan had never brought up the fable. It made her want to discuss the matter at hand, get it out. She wanted to sleep tonight, wanted to know what was going to happen. She stared at Se Chan and waited.

“The good news is no one has come forward to say they saw you in the room with the girl,” Se Chan said.

“I was in the room with her. It’s no secret. I’ve said all along that the girl came to my office with a question.”

“You know what I mean. The girl claims another student saw her run from the office. Her blouse was ripped.”

“You mean she says it was ripped. Good God. The girl could have done that herself.”

“The girl, she comes from a prestigious family on the island,” Se Chan said.

“So I’ve heard. She behaves as such.”

“The word is they have ties to Rai Cachone.”

Stamford stopped chewing and looked at Se Chan.

“What are you saying?” Marcella said.

“That the Rai Cachone have their own way of doing things. You know this.”

“And?” said Stamford.

“Perhaps you should hire security until this is over.”

Stamford laughed. “Security? You’ve got to be kidding.”

“I am not. Things happen on the island, Jon. You are not in the States.”

“We have Kadek.”

“I would keep an eye on him.”

“This is silly. Kadek?”

Se Chan remained silent.

“What is the University’s stand?” asked Marcella.

“The University will support the girl, not an American professor.”

Marcella looked at Stamford. “Have you contacted Mocks?”

He set his fork down and picked his teeth. “What Se Chan is saying is that this will not go to a court of law. Not like in the States. Besides, you know what Mocks would tell us. Go home.”

“Then what? You are guilty with no proof, and these people decide how to handle this? Perhaps a hanging or a burning at the stake?” She didn’t know why she was pretending. She knew there must be proof. Perhaps Se Chan knew more than he told. She wondered if Se Chan thought he did it. She couldn’t read his face. Disdain?

“The matter has to be handled politically, through the right channels,” Se Chan said.

“There is no Embassy here, only Pohnpei,” said Marcella.

“It does not matter. Their advice would be that you should leave, go back to the States. It is normal in a situation such as this.”

She wanted to tell them it was fine with her. “And your advice?”

Se Chan waved his thin fingers around the room. “You would give up much. This can be handled in other ways.”

She wondered how. Going straight to the girl’s family? Paying them money? And lose what?

Tiny dots of sunlight ignited and faded on the opposite kitchen wall. She studied the open-sided shack with corrugated tin roofs made of thin wood and bamboo, a shack that the winds could blow to pieces this year.

She wanted to get up from the table. She wanted to leave for the States tomorrow and let Stamford work this out. Then she said it. “Has the girl been examined?”

Stamford dropped his fork and glared at her. His face was pale; he looked tired and old. “Marcella. The girl will be proven a liar.”

She looked at Se Chan. “Well? Has she?”

He waited, sipped his wine. “No. The girl refused. It is typical here. A fear of disrupting the spirit for future children. It is bad luck.”

“Bad luck? Well, that’s ironic. I’d say if she was raped she’s been disrupted.” She pushed away from the table.

(Next…part 3)

A man walking on the water.

When Marcella first saw it, she blinked her eyes. The morning light arched across the blue of the ocean, illuminating the sandbar like a mist. From where she sat, she could barely see the lip of it, so the man appeared to be hovering like a water phantom. It surprised her, this anomaly, and she felt relief that someone was out there.

Then she thought about it again. Stamford’s bulk forcing the girl to the desk, pinning her clawed hands back as he leaned over her. He was capable. She understood his strength, despite his age. The girl would go rigid, surrendering to the pressure of his fat hands vised around her wrists. The girl would feel his weight push against her pelvis, the ridiculous whalebone belt buckle he found in the village pushing into her pubic mound, his breath invading her face as she turned her head away.

Her stomach tumbled. For God’s sake, the girl was his student, barely twenty years old. Stamford had denied it, of course, said the girl was getting even, had some sort of grudge against him.

Every time she mentioned it, he refused to discuss it. Either way, something happened in that room, and it wouldn’t end well. He would probably lose his tenure. Perhaps face prison. They were primitive here. She envisioned a tomb, a dungeon. Or they’d have to return to the States, which was fine with her. And then what? She didn’t know. If he did it, this was rape. The girl would never be the same. How does anyone get over this? How do you keep from going mad?

The studio was an escape. Kadek built it from bamboo, expanded the shed that was already there. Left in splinters once during the typhoon season, Marcella found pieces of her pottery shattered like eggshells as far as the rear of the house. The assaults come from all angles, often disguised and always relentless. This is the reality in this tropical vortex, she thought.

The pottery was a hobby she started since they arrived, a way to deal with her insomnia. She used her hands to free her mind, squeezing the textured essence of something shapeless. There was something about closing your eyes and feeling whatever your hands formed, whatever mass of life was there when you opened them.

There was a ritual to it. Let the clay harden. Preheat the kiln. Watch the color of the clay change as it becomes hot, the metamorphosis of it. Clay never used to be cathartic, not before. Clay was just clay, a soggy, hopeless mass waiting to exist as something grander, like Michaelangelo’s La Pietà. Now it held universes, constellations, and suns. Clay was endearing now.

There were other things. She did plenty of volunteer work on the island, helped sew up kids who sliced their skulls open while swimming in the rough currents, assisted in births to the village women, but she was unsatisfied. It made her miss the excitement of big city trauma centers. The blood and the stress and the lack of sleep.

On the island she couldn’t find the right sublimation for the sleep deprivation, the right tasks to handle it. The irrational city time was so different from here. Island time suspended, eternal. It made her think about how disparate it could have been.

There were signs, red flags across conjoined landscapes. His assertiveness. She allowed it, allowed the soreness and the bruises for a time as a game. She knew they were treading perilous waters. The night he clasped his hands around her neck as he finished. When she told him she didn’t feel comfortable with it, he acted like it never happened.

And then the remarks he made one night when Se Chan was over for dinner, sauced on wine, about the dark-skinned girls in the village, how he’d like to share one with her.

It was easy for Se Chan to smile—he had divorced his wife in Taiwan years ago. She was sure he had plenty of village girls by now.

Later that night Stamford prodded her about it, slid up behind her in the dark. She couldn’t believe he suggested it. She pushed him away.

“Very well, then,” he said.

Very well then. She wanted to sting him, remind him of their age difference. She wanted to tell him about the village boys, that she thought about them when she couldn’t sleep. How they entered her in her dreams when she found sleep, three at a time, their bronzed skin enveloping her like dark cocoons. But she remained silent.

After that, it was the way he looked at her, anticipated her movements and words as though she were some stranger in the house. He had been visiting the pottery studio, his body half hidden behind the doorframe, as though part of him wanted to come in but the other half resisted. He stared at her a long time, watched her work the clay between her thighs, then turned away without saying a word.

The skiff moaned against the rotted wood pilings. She hadn’t slept again last night, and now every sound was ethereal, sedating. Kadek found the skiff in the village for Stamford, insisted they needed one, although he was the one who used it to fish.

Kadek was one of the rare benefits of Morchodos living. House servants were affordable and part of the culture. He was like family now, and Stamford relented about the boat.

“We need it, you say?” he said to Kadek, who dragged him into the village to look at it as though they were looking at new cars.

Kadek nodded and slapped the side of the ancient cedar wood stern. “To fish,” he said. He spread his arms out. “Big grouper.”

Stamford preferred the mainland, especially after he considered the age of the old wooden boat. The one time Kadek took him fishing, he became seasick, spent the rest of the day on his back eating ice chips.

The last storm nearly destroyed the skiff, tossed it onto the shore like a balsa toy. They were all doomed to wind up like that, blown to pieces by the typhoons or countless other maladies. She had survived so many things.

There was the accident last year. She had warned Stamford that it was a sign. The village woman said her body moved through the air in an arc, the machine sliding out from under her on the sea-shelled road. She later found pieces of shells in her hair and embedded in her arms and hands after she awoke in the hospital, thought they were giant lice and immediately began plucking them out until the nurse gently touched her hands.

The old woman had wrapped Marcella’s head in colored scarves as she lay on the road, had a cart full of them to sell in the village, leaned over her whispering “Kopwe chok!” in her native Chuukes tongue. The woman called her “Emon Mi Feioch” (Fortunate One) every time she saw her now, raised her fat arms in a wave to remind her of the way she flew through the air.

Stamford talked about how he had seen the scarves as he approached her body from the road, colors licking the wind like downed kites. The old woman insisted he pay her for them, said it took her months to make.

Stamford kept the scarves, said some goddamn thing about the quantum symbolism of the accident, that they’d keep them for good luck.

When she awoke at the hospital, the fool was wearing one, bright yellow stretched over his mass of gray hair like a pirate, even had the nurse laughing. Her eyes were fuzzy when she awoke, but she looked at them and asked for a margarita, no salt, asked the doctor about her hand, if she could make pottery still, is anything broken.

She was lucky that she healed quickly and did no serious damage to her brain. When she got home, she told Stamford she’d walk everywhere now, no more mopeds, even though the secluded house five miles from the village.

Then there was the dengue. Marcella contracted it earlier in the year, had the fever for weeks before the antibiotics ate the little parasites from her system.

Stamford had it before, so he babied her through the sweat-filled nights, the shakes, and the diarrhea. He told her not to worry, he found and squashed the pesky mosquito that gave her the bug, as if a single insect caused everything.

Perhaps it was true. There were many times she blamed everything on the dengue, decided that once you contracted it, you’re fucked, even though Se Chan told her it only lasts about two or three weeks and it’s gone.

The island doctor told her otherwise. It was a virus that could return like shingles at any time for a relapse, and without warning.

She asked Se Chan if any Morchodo’s fables existed concerning the fever, there had to be ancient Chiefs that were bitten by the day-biter mosquitoes, that sat in their huts sweating and moaning and shitting for days on end, but he said no. Yet she knew that once it crossed the blood-brain barrier, it implanted in your soul and changed the course of everything. She often thought that the dengue altered both of them, cursed them.

(part 2 coming soon)

Diluted seawater has nearly the same concentration of elements and minerals as blood plasma. —Nnedi Okorafor

(Originally published at timothyagnew.com)

Cielo

The almost 17,000 square feet BioLife facility in Duluth, Georgia, sits in a busy strip mall off one of the city’s busiest roads. As a hive of nurses and phlebotomists dart between oversized lounge chairs and whirling white apheresis machines, I find my way to the waiting area. These devices systematically collect blood, separate the plasma from red blood cells and platelets using a centrifuge, then return the blood components to the donor in a process called plasmapheresis.

When I arrived on a recent Tuesday afternoon, the waiting room was full, and on a far wall stand dozens of would-be donors waiting to be screened (a finger prick, blood pressure check, and body temperature) before donating plasma.

Eyeing the donors, I notice they are men and women aged nineteen to sixty-plus. Most looked like typical students, while others appeared weary and dressed in construction work clothes. There were dress suits, hoodies, boots, fancy dress shoes, and medical professionals in scrubs. All the faces seemed to have the same vapid expression, as though they were all lost in a forest and something was chasing them, but they didn’t care.

Many seem to know each other. An obese Black man using a cane hobbled over to an empty chair.

“Hey, man,” he says to a college-age kid, then paused because he’s out of breath. “I’m back. Gots to get that cash and eat. Didn’t see youz last week, where you be?”

The polite kid smiled. “Monday-Friday last week. You good, Cielo?”

Cielo grins with infectious energy. “It all good,” he says.

A Quiet Understanding of Necessity

Sonya Rache clasps her hands together on the white desk and squeezes her fingers tightly. “This is the first time I haven’t worked two or three different nursing jobs,” she tells me. “But now, this economy. We just don’t know what’s next.”

Sonya is the charge nurse overseeing new donors at BioLife. In her late forties, her Indian American complexion seems to glow under the fluorescent lights of her stark white office. She looks tired, and the clinic’s chaotic pace suggests she’s likely overworked.

She tells me to place my left thumb over a scanner to confirm the information I gave her.

“Ready to go down the rabbit hole? This is how donors sign in when they donate.”

I nod. I asked her what types of people she sees donate, even though I got a preview of the waiting room earlier.

“I’ve seen all of humanity. Lawyers, doctors, teachers, people with PhDs, single parents.” She adjusts her thick black glasses and purses her lips. “Then there are the folks trying to eat. That’s the thing about plasma. It’s a quiet understanding of necessity.”

The Science of Plasma and How It Became an Industry

Blood plasma, when separated from blood, forms the pale-yellow liquid portion and accounts for around 55% of its total volume. Composed of 92% water, it carries essential nutrients, proteins, electrolytes, and hormones that transport particles, regulate pH, and support immune function. A centrifuge (apheresis machine) separates plasma from blood cells by spinning the blood at high speeds, forcing the denser red blood cells downward and leaving the plasma on top. It looks like this:

Blood drawn → spun → plasma separated → red blood cells returned to body

While blood banking began in the 1930s after hospitals learned to store and separate blood components, the primitive methods of separating the plasma were laborious. After collecting blood in tubes with anticoagulants, practitioners manually centrifuged and extracted the plasma using a syringe.

During World War II, the importance of human serum albumin for battlefield casualties—just one of many vital components of plasma—proved invaluable. For severe blood loss injuries, albumin increases blood volume to maintain osmotic pressure in the body, yet albumin had to be separated from the plasma on the spot.

The method of isolating serum albumin fraction from blood plasma using cold ethanol (a process still in use today) was the brainchild of Dr. Edwin Cohn, and medical aids performed it on battlefields for rapid separation of blood plasma for quick administration.

By the 1950s, researchers discovered something unique, something that shifted donor plasma to supply chain: humans could safely donate plasma up to twice weekly.

The Liquid Gold

Plasma is big business. Pharmaceutical manufacturing integrates with plasma collection companies, and they don’t merely collect plasma—they convert it into lucrative biologic drugs. The Takeda Pharmaceutical Company, which operates BioLife, has a global hub and research center in Cambridge, MA., with sites spanning the U.S. in thirty-nine states.

Because plasma transforms into lifesaving therapies for people with unusual and complex incurable diseases, the medical field demands it, and manufacturers cannot synthetically produce it at scale. The answer? Paid donors.

Only a few countries allow paid plasma donations, making the U.S. the major global supplier. While plasma donation in the United States flourished in the 1960s and 70s because of the evolution of plasmapheresis and the rising demand for chronic disease therapies, paid donations scaled after 2006. Plasma donation centers expanded across the U.S., and by 2023, over 1,200 plasma centers strategically appeared in suburban and lower-income neighborhoods near pawn shops and payday lenders.

That market strategy works because it’s a lure for struggling households, and that’s the dichotomy: plasma donors are often financially challenged, while recipients rely on plasma for survival.

Reimbursement for Lost Time

Plasma donors receive payment for the inconvenience of time and not necessarily for the plasma, with the average donation taking around one to two hours depending on fluid flow (the more hydrated you are, the faster it goes).

Separated plasma, once fractionated (processed into the different key products for multiple therapeutic uses), is worth thousands of dollars per patient dose. Growing demand for immune disorders, emergency trauma care, and rare, incurable diseases keeps the market value higher every year. Products derived from plasma include:

• Immunoglobulins (IVIG) (immune deficiencies, autoimmune diseases)

• Albumin (burn casualties, trauma patients)

• Clotting factors (hemophilia patients)

Because plasma companies depend on consistent donors, they offer payments of roughly $50–100 per visit to keep people coming back. Across regions, many donors are under thirty-five, financially underwater, jobless, lacking savings, or navigating limited access to credit. Single parents and gig workers often rely on the income to fill paycheck gaps. Some studies suggest Black and Hispanic men emerging disproportionately among regular donors—not because plasma centers target any one group, but because economic uncertainty rarely occurs equitably across a city.

While plasma donation through non-profits such as the Red Cross is mostly altruistic-based, at for-profits like BioLife, donors survive on the “payroll.” Donations cover groceries and utilities or help pay the rent—and often donations help fill the void of paying for medications or food.

The weekly donations also help many avoid predator payday loans, where money is “borrowed” early against salaries. When plasma centers emerge in urban areas, payday loan usage drops. A University of Colorado study identified that young adults are 18% less inclined to seek payday loans after a plasma center opened nearby. Researchers contrasted the effect to raising the minimum wage by approximately $1 per hour locally.

Because over two-thirds donate to meet basic living expenses, plasma donation becomes routine survival behavior. Given that the plasma industry reportedly grew more than 30% since 2022 and Americans made around 75 million plasma donations in 2025—an average of more than 200,000 each day—it’s predicted that those numbers will expand again in 2026. In the U.S., five dollars a gallon gas, unaffordable healthcare, and outrageous grocery prices make plasma donation a valid option.

While the numbers show a painful reality, what Sonya Rache already sees is a cultural shift in who is donating. Middle-class, laid off professionals, individuals with PhDs and other advanced degrees, and even employed workers who still can’t make ends meet have superseded a younger population.

As I leave the facility that afternoon, the waiting room is at capacity because the machine respects everyone equally.

Cielo hobbles at the door as I hold it for him. A bright green gauze tape wraps around his elbow where the needle sat in his vein for hours. He nods to me.

“’bout dinner time, ain’t it?” he says.

This article is an addendum to my book, Invisible Parents: Hidden Secrets of Special Needs Parents: A Book of Hope, and my intention is to keep special needs parents current on thought and data. (Originally published at timothyagnew.com)

Autism Spectrum Disorder (ASD)is a neurological and developmental disorder marked by challenges in social communication, light, sound sensitivities, and repetitive behavior (Höfer, J., et al., 2017). It is the complexity of the disorder that creates misconceptions and myths that don’t facilitate growth in autism communities. As I’ve said often in previous pieces, special needs parents must fortify their parenting arsenal with truths, not falsehood. Let’s unravel this complexity, explore the varied experiences within the spectrum, and discuss what science knows about ASD.

Early Signs: A Parent’s Insight

Parents and caregivers often notice early signs of ASD before a child turns one. By the age of two or three, these symptoms become more apparent. Some children may show mild functional difficulties, only presenting in the classroom, while others show hearing impairment and triggered physical outbursts. Because of the varied and individualized aspect of symptoms, proper diagnosis is intricate. Early diagnosis, however, is vital and can empower the path to your child’s future.

Social Communication Deficits: Recognizing the Cues

Parents may see various cues, such as a lack of sharing interests, difficulty with emotional comprehension, and aversion to eye contact. Speech may be absent or unclear, and abstract ideas taken literally. Making friends is awkward because the child cannot establish normal social boundaries. A child might have hearing impairments, have difficulty with speech, or experience sensory processing disorders. Other symptoms may include:

• Rigid behaviors

• Hypersensitivity to sound, light, and touch

• Niche interests

• Resistance to change

• Behavioral outbursts

• Lack of displays of happy or sad

Risk Factors: Debunking Myths

To truly understand what ASD is, it’s necessary to clarify what it isn’t. In their seminal research, both Dr. Leo Kanner and Hans Asperger used a series of case histories to form clinical insight into autistic disorders that today helped formalize the autistic definition.

While the methods of representing and diagnosing ASD have changed, largely because of the work of Kanner and Asperger, stereotypes (and medical fallacies) in autism still exist (Rosen, N., 2021). Popular media represent much of what society learns about ASD, and this information is often false.

Often, media representations of autistic abilities contribute to a skewed divergence between the traditional image of autism and the clinical reality of the autistic condition. Here are some of the most prevalent myths about ASD:

1. Bad parenting causes ASD

A diagnosis of ASD in your child can be heart-wrenching, yet one of the most common emotions is guilt. While parents may feel a sense of relief that their child finally has a name for their dysfunction, they may also blame themselves for their parenting skills (Samadi et al., 2012; Selimoglu et al., 2013).

They may believe others will judge them as a poor parent once they learn of the diagnosis. While researchers developed theories supporting nurture as a possible factor behind ASD, parental styles do not cause neurodevelopmental disorders (Crowell, et al., 2019). Roller coaster emotions are perfectly normal, but the way you raised your child leading up to a diagnosis did not cause your child’s ASD. If anything, parents play a vital role in interventions to help their child.

2. Vaccines Cause ASD

Perhaps one of the most nefarious myths about ASD is that vaccinations are responsible. Studies show that there is no connection between receiving a vaccine and developing ASD.

The National Academy of Medicine (formally the Institute of Medicine) reviewed eight vaccines for children and adults. The review found those vaccines are safe, except for allergic responses and other rare disorders (Institute of Medicine, 2012). A 2013 CDC study supported that research showing that vaccines do not cause ASD (Pediatr, J., 2013).

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The CDC study focused on the imperative vaccine antigens given during the first few years of life. Antigens are particles in vaccines that enable the body’s immune system to produce disease-fighting antibodies. Vaccines use inactive parts of an antigen to trigger an immune response in the body. Current vaccines include a blueprint for the antigens instead of the antigen itself. The weakened version of the blueprint/antigen does not cause disease in a person receiving the vaccine but sparks their immune system to “attack” as it would on an actual pathogen.

The results of the CDC study demonstrated that the amount of antigen from vaccines was the same in children with ASD and those who did not have ASD. Many studies attempted to disprove this finding, but there is no evidence of a link between vaccines and ASD.

3. Autism can be outgrown or cured

The myth that ASD can be outgrown or cured in a child’s lifetime is a dangerous notion. If parents believe that ASD disappears as the child ages, a child may not get the proper support throughout their life (Jones, S., 2019). This myth can also lead to a lifetime of false perceptions for the autistic person; they may believe they are a failed neurotypical person instead of a successful autistic human.

This myth originated when studies showed that 7–9% of children diagnosed with early ASD had no symptoms of the disorder in later childhood (Shulman, L., et al., 2015). The explanation for all of this “outgrowing” were common misdiagnosis of ASD.

The Journal of Child Neurology examined the records of 569 children diagnosed with ASD between 2002 and 2013. It discovered that 7% no longer met the diagnostic measurements, and many were diagnosed with other behavior disorders such as attention-deficit hyperactivity disorder(ADHD), mental illness, or anxiety disorders (D’Agostino E., et al., 2019).

Masking

Some autistic individuals hide their ASD symptoms. According to the Diagnostic and Statistical Manual (DSM-5), some high-functioning autistic individuals with high IQs can mask their symptoms. In society, they present as individuals previously diagnosed with ASD that outgrew their disorder (Fein D., et al., 2014).

Masking takes an exceptional amount of emotional and physical energy. It often leads to burnout, exhaustion, and depression (Livingston L., et al., 2017).

4. Individuals living with ASD cannot show affection

Another common myth is the idea that individuals with ASD are bereft of empathy or emotion. What is true is that individuals diagnosed with ASD show emotions in very different ways that many don’t recognize. Most individuals with ASD have few issues expressing their emotions and processing the feelings of others.

Part of the stigma of this belief involves individuals who have another disorder in addition to ASD. Alexithymia, a condition that makes understanding one’s emotions difficult, is common in low and high-functioning ASD (Griffin, C., et al., 2016). Alexithymia occurs in different degrees of severity in 40%-65% of the autistic population (Young, E., 2019).

Individuals with alexithymia often cannot recognize facial expressions and other nonverbal emotional cues, such as tones of voice. In contrast, individuals with ASD struggle with the cognitive processing of emotions and feelings, but can perceive empathy and understand emotional levels. More specifically, ASD individuals grapple more with emotional competence and recognition of social cues (Shah, P., et al., 2016).

Further perpetuating the confusion is sensitivity to sound, light, and feelings. For example, an abrupt, physical embrace may overstimulate an autistic child and cause a perceived resistance to affection. There are, however, individuals with ASD that can express and understand emotion, and that have no issue giving and receiving affection (Catalano, N., (2020).

Conclusion

In the intricate journey of raising a child with autism, information is a guiding light. Learning what ASD is and understanding the continued myths help keep parents on an educated path. Debunked by peer-reviewed research, these exposed myths help the autistic community avoid dangerous decisions and make special needs parenting safer.

summer skies burn

yet a scotch mist

meshes the horizon

over a garden

tended with care

where no roots seek

matters beyond soil

a japanese lotus

yawns from

a hasuike

like a buddhist chant

whispered across

valleys of fear

a blushing

pierre rose

foils butterflies

in a dance of love

that settles

on the dawn

like a tear

Tobin arranged to look at the house the next day. The mothballs assaulted his nose again as he stepped through the door. He turned in the threshold and stared at the rock garden in front, dry and full of weeds, and ran his eyes down the green driveway. The green mailbox jutted out toward the sky, waiting for mail that was still being delivered and never opened.

Sam hadn’t heard him. He found her seated at the kitchen table, her paperwork on the house spread out before her. There were trash bags lined up on the floor, filled, he knew, with remnants of the man’s life.

She stood and looked out over the mess as though she had no idea how to clean it up. “I just want you to know you are my first showing and I don’t know what the hell I’m doing.” She took a breath. “The bank said they’d pay me $500 if I move all this junk out of the house.”

He turned to the window. The doves were outside again rolling in the dirt, an entire family now, the dust-haze rising up from the ground, feathers and beaks in a surreal plume of chaos.

He felt her behind him. “You know, they dustbathe about the same time every day. A circadian rhythm.”

One of the birds stepped out of the cloud and extended its wings and bristled.

“And what happens if the rhythm is broken?”

“If denied a dust bath, they’ll gradually want to do it more often. Like a drug.”

He moved through the hallway. “I’ll let you know if I need you.”

The house was dark, with few windows and a back lanai covered in tinted glass.

The hallway walls held poster prints of Le Miserables and Death of a Salesman and several others. He squinted to see them in the fragile light and straightened one picture frame.

Gordon had purchased various lithographs for their townhouse, had come home one day with three wrapped frames stacked in his arms. He unwrapped them and began eying the walls. He told Tobin to hold each frame against the wall while he placed his thumb where he thought the nail should go. He hammered nails clumsily into the drywall, stepped back and told Tobin to hang the paintings.

Gordon shook his head. “No.” He waved his arms, a signal to remove the paintings from the wall. This went on for an hour, Gordon hammering nails and his fingers, first in the living room then several places along the hallways.

Tobin knew better than to intervene, so he plastered the holes later and occasionally said things like “That’s a good spot” or “Perfect!”

Gordon finally decided on the hallway leading to the kitchen, the lithographs scattered along the wall in a zigzag pattern. He stepped back and put his hammered raw fingers under his chin. “Now that was easy, wasn’t it?” he said.

Now Tobin thought he felt a warm sensation over his right shoulder. There was a tingling over his ear, like a warm breath. He spun around, somehow expecting to see Gordon standing behind him.

“Hello?” he said, and then wondered why he said it.

“Do you need me?” From the kitchen, her voice was strained, as though she couldn’t find the breath to get it out.

Tobin leaned his head against the wall.

“No. I’m nearly done.”

He went to the desk in the large family room. He studied it, moving his eyes from its clawed feet to its base.

At home he searched for swirls of fingerprints on wineglasses or furniture, the indents on cushions and pillows, anything that held evidence of Gordon’s existence. At first there was a solace in this act. The objects were rooted in their place as life existed around them. In a peculiar way, they collected particles of existence and preserved them. But now it troubled him to have them around.

In the short moments of sleep, he’d dreamt of furniture and glasses and plates and silverware floating above the ground, uprooted, circling him in an orbit of disarray.

In the weeks after his death, Tobin tried to disrupt and change what Gordon had insisted was the perfect environment for living. He bought air purifiers and placed them in all of the rooms, hoping to filter the odors of sickness that he knew would stay with him for some time. He knew this when he purchased the purifiers, that the smell was not in the bed, furniture, or walls only; the smell was embedded in his own pores to remind him of his own mortality.

Yet he set them up and listened to their fans purr and tried to change the unchangeable. He moved the couch against the wall, the bed under the window. He took paintings off one wall and hammered them onto another. He stood in the center of the room as if waiting for a sign. When he felt no better he positioned the furniture askew all over the room. He didn’t go out of the house for days. He smelled and he liked that he smelled. For a few hours his reeking clothes obscured the tired molecules of sickness.

When the smell came back he decided to shower. He lost count of how many showers and baths he’d taken, how many different kinds of aromatic soap he used to scrub his pores empty. His arms and his legs were red he’d scrubbed so hard. He lay naked and raw in the bathtub as mail peeled through the door and fell to the floor. The phone rang and messages from his sister and friends filled the answering machine. He fell asleep like that, and in his dreams, Gordon bent over him rubbing chamomile paste into his pink skin.

He heard Sam talking on her phone and tried to ignore it. On the desk’s surface were several framed black and white photographs. He moved his fingertips over them and twisted his head to see them better.

A shirtless man held a little girl on his lap. The man looked down at her with a face that understood that the moment was gone as soon as the shutter clicked. The other frame showed the same little girl, older, standing next to a little boy. They were both barefoot and pruning their faces the way kids do. In the background was the rock garden, weedless and pristine. He heard Sam again, her voice louder and more distressed.

He waited and stepped into the kitchen. Her forehead was pushed into the wall as she spoke on the phone. She ended the call abruptly and turned to face him.

“Do you think he had any booze in the house?” she said.

So she searched the cupboards and found a dusty bottle of Remy Martin.

They sat on the stucco wall to the garden sipping from coffee mugs, watching geckos scamper after insects. Sam sat with her legs folded under her, ankle over ankle, her torso bent into a crooked C. Her phone rang but she ignored it. “Most people think those are geckos,” she said, eyeing a sunning lizard. “They’re actually green and brown anoles — anolis carolinensis.” One of the lizards exposed a red fan under his chin and it throbbed like a separate entity.

“See that? It’s called a dewlap. It means don’t fuck with me and come fuck me. When they fight, or something tries to grab them, the tail falls off. Instant escape.”

Tobin sipped from the mug and savored the cognac in his mouth, watching the lizard bob its head and do tiny push-ups. He felt like he was skipping school or something. “And that?”

“It’s all part of the show. See that other lizard? He’s warning it not to enter her territory.”

Tobin was amazed. He’d never considered these things.

Sam noticed his expression. “What?”

“Your knowledge of those creatures and the birds.”

She uncrossed her legs and sipped from her mug. “My father was a science teacher. It was brainwashing in my case. He told me everything could be explained by studying nature.” She took a sip of cognac and swallowed. “That didn’t work out for him. Epic contradiction.”

Her phone rang again. She looked at it in disdain. “Let’s get a refill.”

When he called Sam the next morning she used his first name. “Hi, Miles.”

“I’d like to look the house over again.”

“Of course you do,” she said. “Why don’t you just buy it. It will save us both a lot of time.”

When he arrived at the house Sam was standing at the doorway, posed against the orange shell of Mediterranean stucco. She wore a grey shirt and a black skirt and massive black boots with large, silver buckles. Tobin wished he could take her picture. He would ask her to stand in front of the garden and the mailbox and the driveway. He didn’t know whether he wanted to take the pictures to help him remember or help him forget.

They sat in the dark kitchen surrounded by worn black and yellow linoleum wall tiles. The floor was an eclectic checkerboard, with larger tiles spreading out to the walls. Some corners were peeling badly and the floor was incongruous with the Tuscany tiles in the foyer.

The kitchen was another thing he thought Gordon would change about the house. Tobin stood and went to the window. He opened the blinds, bathing the room in a yellow haze that was better than before. “The owner of the house, how did he die?” he said, sitting again.

“I don’t know. The same way anyone does.” She stared at her thin fingers fanned out on the table.

He had pulled a dark shadow over her and he regretted it. He closed his eyes as though it might make what he had said vanish.

He wanted to tell her about Gordon, that he’d had plenty of time to prepare for his death but could not. That the entire time he convinced himself that it wasn’t going to happen. He wanted to tell her that Gordon’s eyes wouldn’t close and that disturbed him. That he had bent over him and tried to fold them shut, that it was as though Gordon had gone into the end struggling to keep his eyes open so as not to miss anything.

“It’s a reflex,” the Hospice woman had whispered touching his shoulder.

“I don’t want a commotion. The neighbors,” he said.

The woman patted his arm. “It’s only an unmarked van. I’ve already called.”

They had wheeled Gordon out of the house in the late afternoon light and one wheel of the gurney was shot, like a bad shopping cart, so it rattled to the elevator. Tobin heard the elevator ding on the ground floor, then the gurney rattle through the foyer. He hoped no one would notice but he knew they would.

Then Tobin sat there on the couch. It felt good to sit, to rest his legs, to let go of every muscle. He didn’t have to listen to Gordon’s raspy breathing or count his pulse or wipe his mouth. He could just sit.

When the red morning sky bled through the east window eight hours later he was still awake. The horizon split and a river of color set the room on fire.

He wanted to tell Sam all of this but when he looked at her he felt she already understood. She smiled but something quickly fell away from it.

He pushed away from the table and the scraping of the chair made them both jump. “I’m just going to look again.”

“Of course you are. Looking for something that’s not there.” She stood and walked through to the foyer.

He could see her from the kitchen. She had her back to him as she gazed out the front door into the rock garden, the pale nape of her neck exposed and vulnerable as her fingers caressed her sternal notch. When he turned away he heard the front screen door shut.

Tobin moved slowly into the den. He peered around the corner before he let his body slide into it. He saw the photographs on the desk, the boy and the girl and the man forever encased in glass, and moved his eyes to the vacant wall above them.

He walked over and stroked the wall with his palm as though searching for a secret passage, then turned and faced the opposite wall. He surveyed the room from this perspective, seeing it as though he had lived here.

There was a painting on the far wall he hadn’t noticed before, and its glass reflected a light that flickered. He moved toward the painting and then stopped in the center of the room. From his periphery a soft light flashed, and he turned to it. It was in the hallway he had just come from, dancing along the shadowed walls.

He stepped into the hallway again. From where he stood he could see Sam in the bedroom. There was a door in the room that led to the outside of the house, and it was open, allowing bright tendrils of light into the room.

She stood there winding the antique clock, her body half-turned, uncertain. Dust particles danced around her body as they floated into the light, tiny constellations pulsing and fading.

Tobin stood over the deceased man’s mail fingering the envelopes on the desk.

The young woman was in the front calling out information about the house. It was the first time in the last twenty minutes that she had lingered behind and let him browse on his own. Perhaps that had been a mistake, letting him roam. Here he was snooping through unopened mail.

He heard her shoes click over the wood floor. He had forgotten her for a moment, forgotten why he was here, and he lifted his fingers off the envelopes. They weren’t his, so what the hell was he doing?

“The mail keeps coming,” she said. She seemed lost for a moment. “There’s a form you fill out — Deceased Do Not Contact — and you have to show a death certificate and that puts an end to it. You must write deceased on the right line or the mail keeps coming. It’s insane.”

Tobin knew this. He received Gordon’s mail at the house, which he stacked on the table in the hallway as if Gordon would eventually open it. Tobin squeezed his eyes shut and balled his fists like a child. She’d seen him looking at the envelopes and he felt like a fool.

“I guess the guy was some sort of badass set designer in the theater. He did all the woodwork in the house,” she added.

Tobin looked around the room, to the wooden tables and chairs, the dusty papers, the books on the shelves. He turned back to her and studied her profile. A small black stone of jewelry was pinned to a nostril and earlier he noticed a dragonfly tattooed on her arm. She was a child. He guessed she was in her early thirties. “It’s dark,” he said.

She turned to the windows, thin white arms reaching forward. “I can open the blinds. Here.” She swiped the air for the dusty cords, missed, and tried again, bending her frame in a desperate stretch.

Strings of dust webs tumbled into the air. Light burst into the room and Tobin squinted. “It was better before,” he said.

She closed them again and the light vanished.

He had seen the picture of the house in the Sunday paper. Something about the deep orange color of the exterior stucco, with its dark green shutters and green-painted driveway, reminded him of Gordon. He would have liked this sort of place. He would have cleaned the rock garden up, excavated the weeds, and re-painted the shutters and the driveway the same color. He would have admired the colors.

When Tobin had entered the old house earlier a wall of inert air stopped him. When he inhaled he smelled mothballs. The scent of old wood and mustiness crept in, a stagnant river of time.

“It’s oppressive in here,” she said. “I tried to air the place out.”

He had walked back to the front foyer and stood there a long time. The floor was covered in red, Tuscany tile. He removed his shoes and rocked on his socked feet. The floor was cold but it felt good in the humidity.

“The owner died suddenly,” she called from the other room, then stuck her head into the foyer. Her red hair seemed to have a life of its own, each strand going in its own direction. She held out a postcard with information about the house. “Oh, and call me Sam.”

Tobin took the postcard and noticed her name, Samantha Jools, then looked out the door into the rock garden. A few morning doves bathed in the dirt, their puffy gray coats partly obscured in wisps of dust. The walls groaned as the air conditioner heaved on. Mildew filled his nose. When he looked up at the air vent he saw a black soot fanned along the ceiling.

She followed his gaze. “That’s not good. It means there’s mold in the vents. Probably in the air handler, too.”

Her nonchalant disclosures about the house surprised him. Did she want to sell the house? Tobin put his shoes back on and moved into the living room. The doves’ cooing and occasional flutter filled the stillness and he looked behind him to see if they hadn’t somehow found a way in.

The right wall was filled with wooden shelves. The dark wood formed one solid frame and extended the full length of the room. Each wide tier of shelf seemed perfectly placed, as though the room were built around them. Magazines, books, and papers overloaded the frames. Tobin tilted his head to read the spines of the books.

She followed him into the living room. “The house foreclosed before he kicked.”

Kicked? He’d never heard that before.

“Of course, you know it’s an estate sale.”

A beautiful rocking chair in the corner moved slightly from the air conditioning draft, as though someone unseen were rocking in it. The chair made a scraping ping on the wall every time it went back, and suddenly he realized how tired he was.

He’d barely slept in the last few weeks. He had made up his mind to begin looking at houses. He couldn’t live at the townhouse any longer. It was as though gravity had released everything and nothing was rooted to the earth.

Gordon had spent days positioning the furniture when they first bought the place. He had taken a Feng Shui class in the city and Tobin never heard the end of it after that. The couch against the wall was too Yang, the chair in the corner under the painting too Yin. Gordon said there must be no dead air, no restricted energy, no Sha.

Tobin found him wandering around the house one night at three in the morning. “What are you doing?” he had said.

“Calculating whether the house is positioned properly in the solar system.”

As though Gordon was only a child taking apart a toy to see how it worked, Tobin said, “I see.”

Gordon smiled and patted Tobin’s back. “We will now live healthy, happy lives.”

“Do you have a large, dysfunctional family?” she asked.

Again, her boldness surprised him. He thought about that. Celia was divorced now.

She had suggested they live together after Gordon died. “I don’t think you should be alone,” she had said. It would be Tobin, his sister and a dog. They would live in her house and share common themes. Celia’s husband had left her years ago and her children were all grown, so she was alone in many ways.

Tobin and his sister were a year apart in age, both of them entering their sixties. He couldn’t comprehend living with her at this age, existing with her collection of dolls, or deflecting the onslaught of judgments from the rest of his family. Yet it was more than his brother would ever offer. He didn’t even come to the funeral service. His wife had sent a card and signed his name under “Our Condolences.”

When he didn’t answer she said, “Thought so. It’s a plague.”

The rocking chair pinged again and he looked away. “Do you mind if I look myself?”

So he had gone and snooped through the dead man’s mail and now Samantha Jools was in the room with him again.

“I’m almost done,” he said. He left her and moved into the back hallway. There was a twin bed in the third and master bedroom. The man must have lived alone. Two people could not share a twin bed. Tobin had always insisted on a king because of Gordon’s restlessness at night. When a stray leg occasionally found its way on Tobin’s side of the bed he threatened to tie it to the bedpost.

In the week after he died, Tobin put blankets on the floor in the bedroom and tried to sleep there. He hadn’t slept in the bed yet. Toward the end, Gordon required an adjustable hospital bed and that’s where he’d been until the last day. Tobin slept alone in the king and listened for Gordon’s breath in the dark room. There were nights when Tobin never slept but crossed the room every hour to put his ear on Gordon’s chest to see if he was breathing.

The man’s bed was stripped with blankets balled at the end. A night table on the left held books and a beautiful antique alarm clock with an oversized face. It ticked so loudly he wondered how anyone could sleep with it. He bent down and studied the clock hands. The time was wrong. Tobin almost reached to set the proper time. Then he wondered who had wound the clock and yet not set the correct time.

There was a recliner against one wall in front of a small TV. A large oval stain bled across the headrest, oil from a hair product. The cloth was indented, too, where it had once supported the weight of a head for endless hours. Gordon had once told him that the human head weighs about the same as a cooking chicken. Tobin foolishly held one up in the market one day, testing what he had said, the frigid bird pushing into his hand.

The TV remote rested on the chair arm. An ancient, boxy VCR was below the television, stacked with dusty tapes without jackets. What had he been watching toward the end? Gordon had requested The King and I in those last days, Yul Brynner and Deborah Kerr leaping across those magnificent sets. They’d watched it many times. Tobin had propped Gordon’s head up by innumerable pillows so he could see the television. His mouth was always dry from the medications, so Tobin had to hold the straw under his puckered lips when he was thirsty. They rarely finished the movie before Gordon’s head tilted back and his eyes closed.

“You can turn it off now,” Gordon would say. And Tobin stood there, his body exhausted and sleep-deprived, held up as though only by a wire. He felt his heart beating and felt the sting of blood pulsing through his body.

He felt like he was a million light-years away looking in at this tableau through a window in the universe. Sitting in the room with him for too long became stifling, so he took strolls, sometimes onto the sidewalks along the city. Pigeons pecked furiously around his feet, barely moving as he stepped through them. When he looked behind him, the feathered mass was converging on new bread crumbs tossed by an elderly woman on a bench.

He smelled peanut oil and meat cooking from Chinatown. The smells triggered something in his head, and fuzzy images came unanchored. It was enough to make him stop on the sidewalk, and as he stood there he felt passing people brushing his body, as though they were merely bits of clothing blowing in the wind.

He waited for the images in his head to clear so he could see one, but there was never one but many, a thousand snapshots firing all at once. When he began walking again he occasionally collided with a pedestrian on the sidewalk or aimlessly dodged someone’s attempt to avoid hitting him. He would move to the right of the person, then to the left, the stranger mimicking his movement as though he were looking into a mirror. It was a ridiculous thing, yet it somehow made him feel in sync with the living.

Now Tobin sat on the man’s bed. He wanted to reach down and eject the tape and check his presumption, that all men requested The King and I as a final wish, but he felt foolish. He reached for the clock. It was heavy in his hands. The large brass bells were pitted and they needed polishing. He wished he could tend to that, that he could get some polish and clean the pitted metal.

“What time do you think it is?” Sam was in the doorway, her pale face and wiry frame leaning into the wood frame.

Tobin looked at his watch. “It’s one o’clock.”

“No, the alarm clock. Is it 10:30 in the evening or 10:30 in the morning? It’s maddening.”

a little west of silence

the detour said

take the road into the hills

and never look back

don’t mind the endless holes

of buried nonsense

or the cavern where your heart lies

seek where seeking blinds most

a precipice fit for the noble

an outlook that’s outlived others

and wait for a feast that starves

my neighbor absconded

and i never said goodbye

wave to her as she rolled away

or blink as the brake lights faded

every day now

i see the vacant porch

suspended in darkness by eight

under velvet shadows by dawn

and i wonder where she went

and if she knows herself

she left an extension cord

bleeding from the doorframe

where she once hung lights

that no one saw

because they were too busy seeing

and remnants of plants

once a jungle for my escape

reduced to a crispy gecko

left between windowpanes

yet i saw her

i saw her before goodbye

and never hello

This article is an addendum to my book, Invisible Parents: Hidden Secrets of Special Needs Parents: A Book of Hope.

In 2022, doctors diagnosed one in every 100 children with Autism Spectrum Disorder (ASD) (Zeidan J. et al., 2022). This year, the CDC reported that one in 36 children is now diagnosed with autism (Maenner M., et al., 2023).

When your child is first diagnosed with autism, it can be an isolating time for parents and a time of confusion and even denial. One of the most powerful things special needs parents can do is stay current with the latest autism research. Doing so not only keeps you in the know about medical and alternative treatments, but it makes you part of a large autism community.

The most current research for 2026 includes some ground-breaking discoveries involving ASD. In this article, I’ve compiled four of the most remarkable studies to keep special needs parents well-informed on their autism journey.

1. New Insights on the Autistic Brain

Citation: Trinity College Dublin. “Autism brain states hold the key to unlocking childhood memories, findings show.” ScienceDaily. ScienceDaily, 9 November 2023. www.sciencedaily.com/releases/2023/11/231108164117.htm

Neuroscientists at Trinity College Dublin uncovered a remarkable connection between early life memories, retention, and brain development associated with autism.

The scientists explored connections to infantile amnesia forms of autism. Infantile amnesia is a term used to describe the inability to recall memories from before the age of two (most of us we don’t recall autobiographical memories formed in early life).

Maternal Infections

Maternal infections during pregnancy contribute to the cause of autism in both humans and mice. Researchers discovered that this altered brain state stops memory loss during infancy. In addition, researchers found that triggering specific neural pathways with light can permanently restore memories that were previously “erased” if the proper memory cells activate.

Restored Memories

This revolutionary study showed that early memories remain stored in the adult brain but normally remain dormant through recall memory. The connection between the retention of early childhood memories and the maternal immune responses associated with autism is a milestone in developmental memory research.

2. Unlocking the Gut-Brain Connection: New Hope for Autism

Citation: Coley-O’Rourke, Elena J., and Elaine Y. Hsiao. “Microbiome Alterations in Autism Spectrum Disorder.” Nature News, Nature Publishing Group, 17 Aug. 2023, www.nature.com/articles/s41564-023-01455-2#citeas

In a life-changing study, scientists discovered an important association between gut (microbiome) bacteria and autism spectrum disorder.

For decades, scientists grappled with understanding the link between the gut and autism spectrum disorder. Now, recent technological advancements in microbiome research offer a glimmer of hope. In a landmark study outlined in the Nature Neuroscience Journal, researchers claim to have discovered a crucial connection between alterations in the gut microbiome and observable traits in individuals with ASD. Several previous studies found an association between GI disturbances and the behavioral traits of ASD.

The potential link between autism and the microbiome appeared in the 1990s when parents noticed changes in their autistic children’s behavior after taking antibiotics — medication that affects gut bacteria.

The gut microbiome refers to the community of microorganisms, including ‘good’ and ‘bad’ bacteria, living in our digestive tract. Maintaining a healthy balance of these bacteria is essential for digestion, metabolism, immune function, and overall well-being.

Key Findings: A Definitive Association

Scientists used an innovative algorithm to examine years of research, establishing a clear link between temporal changes in the gut microbiome and the characteristics of ASD. Several studies, for example, demonstrated that the gut microbiota affects the development of the nervous system. Since the brain connects to the nervous system, altering gut microbiome might embolden future treatment.

The study not only sheds light on the intricate relationship between the gut and ASD, but also offers hope for therapies and treatments. Understanding these connections could create more effective interventions and improve the quality of life for individuals on the autism spectrum.

3. Uncovering Autism’s Origins

Citation: Jourdon, Alexandre, et al. “Modeling Idiopathic Autism in Forebrain Organoids Reveals an Imbalance of Excitatory Cortical Neuron Subtypes during Early Neurogenesis.” Nature News, Nature Publishing Group, 10 Aug. 2023, www.nature.com/articles/s41593-023-01399-0#citeas

A recent Yale-led study uncovered key insights into the early stages of autism spectrum disorder (ASD). By examining brain organoids (miniature 3D replicas of developing brains) created from stem cells of boys diagnosed with autism, researchers found two distinct abnormalities in neurodevelopment.

Early Clues to Autism

The study revealed that these neurodevelopmental abnormalities emerge just weeks after the start of brain development. More surprisingly, the specific abnormalities appear to be linked to the size of the child’s brain.

Researchers discovered that autistic children with the same symptoms may exhibit two forms of altered neural networks not seen in other brains. Brain size also helps determine the behavior abnormalities.

Brain Size Matters

The size of the child’s brain plays a crucial role in determining these specific abnormalities. Scientists took stem cells from 13 boys diagnosed with autism, including those with an enlarged head condition known as macrocephaly, and “grew” brain organoids in the lab. They then compared the brain development of the children to that of their fathers.

We know approximately 20% of autism cases involve macrocephaly, where a child’s head is larger than the 90th percentile at birth. In this study, autistic children with macrocephaly displayed excelled growth of excitatory neurons compared to their fathers, while other autistic children showed a deficit in the identical neurons. Understanding this might one day aid doctors in diagnosing and creating specific treatments for autism in the future.

The Future of Diagnosis and Treatment

The implications of this fascinating study are myriad. Tracking the growth of specific neurons is a quantum leap for diagnosing autism. Because symptoms commonly surface between 18 to 24 months after birth, early identification is prudent.

The study also predicts strategic treatments, possibly with existing drugs. Treating excessive excitatory neuron activity disorders could potentially help certain autism cases.

4. Decoding Brain Inflammation

Citation: University of Maryland School of Medicine. “How brain inflammation in children may cause neurological disorders.” ScienceDaily. ScienceDaily, 12 October 2023. www.sciencedaily.com/releases/2023/10/231012161729.htm

For the first time, researchers at the University of Maryland School of Medicine (UMSOM) revealed how inflammation in the brain during childhood might lead to neurological disorders like autism and schizophrenia.

Inflammation’s Influence on Brain Cells

In this study, scientists discovered that inflammation alters the growth of delicate brain cells, creating potential links to neurodevelopmental disorders such as autism. It’s common knowledge that severe inflammation in early childhood is a risk factor in developing autism and schizophrenia.

RNA Sequencing Sheds Light on Brain Changes

Led by scientists from UMSOM’s Institute for Genome Sciences, Department of Pharmacology, the study used innovative single nucleus RNA sequencing technology. By examining gene expression changes at the cellular level, researchers delved into the brains (specifically the cerebellum) of children who died from inflammatory conditions such as asthma, bacterial, or viral infections. The inflammation in these cases prevented specific neurons in the cerebellum from maturing fully.

The cerebellum negates motor control and cognitive operations, and it plays a vital role in social skills, language, and emotional control. The study found that two specific, yet rare types of cerebellar neurons were most susceptible to brain inflammation — the Golgi and Purkinje neurons. From a single-cell level, these two kinds of neurons showed early interruption of growth.

Since genetics, the environment, and inflammation are likely to increase the risk of developing autism and other brain disorders, it’s crucial to understand the roles of specific cells and how they interact with genes to change brain function.

The Future of Neurodevelopmental Disorders

The study is one of the first to explain gene expression alterations during brain inflammation that possibly sets later cellular dysfunction in motion. Understanding these specific mechanisms at a cellular level during brain development may one day improve treatments for neurodevelopmental disorders like autism.

As research on ASD constantly emerges, these four unique developments give hope to the autism community. One of the most powerful things special needs parents can do is stay updated on autism research. For a comprehensive book on autism and tips on how to navigate the service system, see my book here. All proceeds go to autism research.

This article is an addendum to my book, Invisible Parents: Hidden Secrets of Special Needs Parents: A Book of Hope, and my intention is to keep special needs parents updated on the most current research. This article appeared in Health and Science.

As any special needs parent knows, raising a child with autism is a journey unlike any other. It’s an experience filled with unique challenges, but also incredible rewards. To help you on this journey, we’ll explore some lesser-known services and therapies that improve the lives of autistic children. Peer-reviewed research and expert advice back these strategies, providing traditional and holistic approaches to support your child’s development at every stage.

A Spectrum of Possibilities

Before discussing the myriad of resources available to special needs parents, it’s vital that we put autism in the proper perspective. Autism Spectrum Disorder (ASD) is not a single category but a spectrum, and every autistic child is remarkable in their own way. To get the most out of therapies and services for your child, keep these points in mind:

• Embrace Individuality: Recognize your child’s strengths, needs, and challenges, and celebrate their individuality (Yamamoto, M., & Asano, M., (2018).

• Early Intervention Helps: Research shows that early intervention is key. Schedule a professional evaluation if you believe your child may be on the spectrum. Early diagnosis puts a treatment plan in place and reassures parents (Randolph, MA., 2015.).

• Building Connection with Effective Communication: Establishing a powerful connection with your child is imperative. If your child is hearing impaired, the entire family — especially the child — should learn sign language so communication is clear. Using concise and simple language, along with patience and calmness, is prudent (Hudry et al., 2017).

• Visual Aids: Colorful, clear picture schedules and sensory-focused teaching aids help reduce anxiety by building better secure communication.

• Established Routines: Autistic children often thrive in organized environments. Planning their days with consistent routines helps reduce anxiety and gives them a sense of security (Schreibman, et al., 2015).

• Create Sensory-Friendly Spaces: Many autistic children experience sensory overstimulation. Creating a sensory-friendly home by mitigating sensory triggers and offering sensory toys will help your child stay calm (Park M., Lee K., (2014–2016).

Traditional Therapies and Supports for Autistic Children

While the autism community learns of new and innovative medical treatments and therapies every year, many traditional and holistic-based therapies remain unknown. These unique therapies help assist autistic children and ensure they develop important life skills.

The following list summarizes therapies and supports for autistic children, including behavioral, family-based, therapy-based, and alternative. Some therapies and supports work with other types and some contain common themes.

In each category, peer-reviewed research highlights key points of each protocol. Remember that these therapies and supports are always more effective with a family’s input. After all, as a parent, you know your child best.

Behavioral Therapies and Supports

Behavioral therapies and supports for autistic children include structured techniques to help children understand new behaviors or skills. Behavior therapy protocols classify as Applied Behavior Analysis (ABA).

1. Discrete Trial Training (DTT)

DTT and other similar therapies are based on Applied Behavior Analysis theory used in various teaching therapies for autistic children (Arim RG., Miller AR., 2017). Condensed skills, simplified to their most basic units, teach children step by step. While children aged 2–6 years remain the focus, people of any age may benefit.

ABA is not without controversy. Many older autistic people who experienced ABA-type therapies when they were children believe ABA supports “masking” autism with the idea that autistic children should behave like normal children (Jessel J., Hanley GP., 2016)). A belief that ABA doesn’t include neurodiversity in its philosophy because it doesn’t accept the differences in how brains function in the real world permeates neurodiverse society.

Other forms of ABA therapies include Early Intensive Behavioral Intervention (EIBI), Incidental Teaching, Pivotal Response Treatment (PRT), and Positive Behavior Support (PBS). They all share similar philosophies, such as simplifying skills and teaching step by step.

Family-Based Therapies and Supports

Perhaps one of the most important therapies and supports is the family-based concept. As a special needs parent, you are the authority of your child, perhaps more than any professional therapist, doctor, or teacher (Heidary A, Shahidi LH., Mohammadpuor A., 2015). Because it involves the support of family members, family-based therapy supports your child’s developmental needs through family bonding.

While there are many family-based therapy programs, a good example is More Than Words. This family-oriented program, and others like it, focuses on group-based training with families. At its core, parents learn new communication skills so they learn to communicate better with their autistic child. The program also strengthens a child’s interactions so they are better equipped to handle real-life social situations.

Therapy-Based Supports

Therapy-based supports focus on specific areas or skills. Like other therapies, they often use combined approaches for behavioral and developmental protocols. The physical or mental therapies enhance a child’s interaction skills, dexterity, problem-solving, and group participation (Tanaka M., Szabó, 2022). Examples of therapy-based supports include:

• Occupational therapy to build brain and muscle-eye skills for daily living tasks

• Physical therapy for improved strength, balance, and coordination

• Speech therapy to improve language and intersocial skills

• Sign language therapy for the hearing impaired (this is a vital therapy to begin as early as possible for improved communication)

Alternative Therapies

Besides traditional therapies, alternative therapies place perspective on the emotional and sensory components of living with autism. Light and sound sensitivity, emotional triggers, and touch deficits improve with these simple yet effective programs (Singer A., Ravi R, et al., 2014). Here are just a handful of possibilities:

1. Music Therapy

Music therapy is often unknown to parents, but it’s a remarkable tool for calming autistic children and adults. Sessions use the eloquence of music to promote better communication, improve social skills, and balance emotional expression. Structured music sessions encourage children to express themselves and connect with peers in a non-verbal yet exciting way. Research shows that music therapy helps improve communication and emotional control for children on the spectrum (LaGasse et al., 2019).

2. Animal-Assisted Therapy

Evolving studies support the inclusion of animals in therapy. Animal faces provide more social and emotional reward when compared to human interaction (Stevenson K., et al., (2015). The reward sections of the brain — the amygdala and putamen, respectively — show remarkable activity when autistic children interact with animals (Whyte, S., et al., 2015).

Supervised animal-assisted therapy involves dogs or other animals. Children interact with the animals, either by holding or playing with them. The trusting, gentle presence of the animals has a profound effect on autistic children, and the animals help reduce anxiety and encourage social interaction. Other positive outcomes include stress reduction, emotional well-being, and fewer outbursts.

3. Yoga and Mindfulness

Teaching your child guided yoga and mindfulness practices helps autistic children develop self-control and emotional intelligence. This therapy creates a rich, family-based activity with family members involved. While research is ongoing, preliminary studies show yoga and mindfulness help stress reduction, impulse regulation, and improvement of social skills (Chan et al., 2016).

Other alternative therapies include Equine-Assisted Therapy, Sensory Integration Therapy, Art Therapy, and Wilderness Therapy. Special autism camps exist throughout the United States offer monthly or weekend “stay and play” programs that include many autism therapies and more. Funded programs by grants or autism organizations continue to thrive globally and offered at low or no cost.

It Takes a Village

Raising an autistic child is a challenging journey filled with unique adventures and opportunities. By exploring traditional and lesser-known services and therapies, you create a specific approach that best supports your child’s needs and personality. Remember, every child is unique, so it’s essential to work closely with professionals to determine which therapies are the best fit for your child’s specific requirements. These programs empower you to shape the life of your autistic child while improving your parenting skills.

One of the most powerful things special needs parents can do is stay updated on autism research. For a comprehensive book on autism and tips on how to navigate the service system, see my book here. All proceeds go to autism research.

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boolean: A data type containing two values: true or false.

When I went to see Margaret at the hospital, seen her lying there wrapped in bandages, one arm bent helplessly over the side of the hospital bed, the other clamped to the traction brace as though it were strangling her, I knew what I had to do.

Margie was my big sister, but her role in my life was vast. When our mother died, I was just a kid. Margie became my mother and raised me, and she is the reason I am on this earth.

She had wires in her jaw, but she could talk.

“Marge,” I said, placing my hand over hers. “Tell me.”

The last time she had tripped in the middle of the night, cracked her cheek on a table. Before that, a softball caused the purple blossom over her eye. It happened during their weekly game, simple as that.

Her eyes flooded, and she tried to blink it away. “I’m a spaz. Would you believe I tripped on the litter box? I hate those stairs.” She winced in pain.

“Don’t talk,” I said, “And no, I don’t believe you.”

stack: linear data structures composed of a collection of items of the same type.

When I left my work cubical for the last time, I watered my plants and took the stairs to the garage.

In code, everything begins with numbers and characters to create complex things. Phone apps, websites, viruses that could wipe an entire city’s electrical grid. What it won’t do is uncreate your reality. In code, there are only two values. True and false.

It was the constants now, the things outside the stack, the wind blowing off the lake, whispering past my ears as my body moved toward my car, the soreness at my lower back from the blackjack club I had worn for days tucked up against my spine so that I knew it was there, the street ending somewhere I couldn’t see.

I know what I’m doing. I have a code. I’ve written a code for it in my head. Like any binary code, it will not work in reality unless all the data is correct. I made sure I always completed the entire stack in my head. That was important. I visualized the entire stack and saw it over and over.

I knew I had to control my anger and avoid carelessness. In the event things went sideways, I used the Dark Web to find tools so they couldn’t track me. I would go to Maldives, where they could not extradite me. Maybe they wouldn’t discover what was on my phone for days, but it didn’t matter. The phone would have the answers, a closure.

function: A routine with zero or more arguments that might return a valid outcome.

I wait. The act of waiting is a grievous thing. Stillness is an enemy to waiting. The body at rest holds its own melodies. Blood rushing through the body. A pulsing symphony in the ears, like a river. It can drive you insane, this reluctant hesitation.

I think of all the reasons I’m here, and it makes me burn, as though my skin were on fire, my very pores cauldrons of red coals. I go through the stack again in my mind, from the beginning.

Riley’s car roars up and stops. He steps out, shuts the door, cocks his head left and right during his paranoid gait, and slowly climbs the steps to his apartment.

In my mind I hear his work boots climb the weathered stairs — I’ve been up them myself many times, measuring the distance to his door (thirty-two feet) — and as his boot touches the last step, I hear it moan under his weight, know the right beveled panel is missing a nail precisely twenty-six inches from where the door meets the wood.

Second floor, apartment 2B, rotted railings on the left side where the super hadn’t replaced them and never would, not in this neighborhood, a doormat that says Go Away frayed at the edges. He had rented the place when Margie insisted they separate, but still, he stalked her like an animal.

I see him reach for the corroded doorknob and push the fractured door open, split from the bottom where he had probably kicked it when he misplaced his keys.

He shuts the door. I wait two minutes, then reach for the blackjack —

exception: An interruption in normal processing, especially as caused by an error condition.

It didn’t happen like that. I snap forward in the front seat of my car. Someone is tapping on the roof. When I look to my left, his face fills my open window. He’s bent down to it, hands on his knees.

“What you doing out here, cowboy?” he says.

I’m stunned that he got by me. I didn’t see him arrive and it angers me, that it goes against the stack.

“Hey, how’s Margie doing? Meant to come see her today,” he says, pointing to his phone hooked on his belt. “So goddamn busy with these fucking storms blowin’ roofs up.”

I glare up at him. “I wanted to talk.”

“Yeah, goddamn shame, her falling and all.” He shifts his weight to the other hip as he leans into the window, invading my personal space, something he was good at. “Your sister can be such a dizzy bee.”

My temples pulse with acid blood. I study the tattoo on his forearm, two hissing snakes curled into a circle, then look at the back of his enormous hand. I imagine it crossing her face, snapping her head back. I hope she spat blood in his face.

He stares at me strangely. “Talk, huh?” He holds his eyes on me, and grins. “Come up for a minute, have a beer.” He punches my shoulder like we’re two old friends. “Let’s talk.”

When he turns away from the window, I slip the slapjack into my belt and pat my phone tucked into my breast pocket.

decompose: condense an issue into minute pieces.

He closes the door to the apartment, opens the refrigerator, and hands me a beer. Then he walks back to the door and locks the deadbolt. This disturbs me. It was not part of the stack. I thought I had imagined every scenario.

He plops onto his peeling, fake leather couch and wipes his hand across his face. “Take a load off, man,” he says. He works in construction and wears a dirty T-shirt and cargo pants. He throws me a look and twitches his eyes at my button-down shirt that I’d purposely worn.

“Shit, cowboy. Kind of warm for that shirt, ain’t it? You cubical boys.”

He swigs his beer and gives me the twisted, smart-ass smile I’ve always despised. He’s watching me carefully. “Leo, you’re a funny little guy.”

I don’t sit because I want to look down at him. “I wanted to talk,” I say again.

He smiles at me. “You okay, Leo? Goddamn, you’re a funny little guy. Talk. Let’s talk. Sit down.”

“I don’t want to sit down,” I say firmly. My pores swell. I push myself against the wall and force a swallow of air. He had appeared out of nowhere.

“She didn’t fall down the stairs,” I say. It’s like I didn’t say it, that another Leo said it, a Leo that has a method, that has visualized the stack carefully.

Then he stands. He sucks his chin into his spine and widens his eyes in disbelief. He whistles and shakes his head.

“This about her? She trying to blame me?” He steps toward me. “Little bro Leo’s gonna protect her? That it?”

“You broke her jaw.”

He tilts his head to one shoulder like a dog does when it hears its name and steps closer. I didn’t see him reach into his cargo pants for the knife, but he must have. I see the metal flash as he holds it at his side, the shaft of white whalebone handle nesting in his calm fingers.

As I stand there against the wall, watching him wave the blade around, I run through what I had omitted, trying to make it all work out.

The blackjack is in my hands, both hands gripping it, my elbows extended and locked in front of me. His face hovers at the end of it.

“Little Leo’s got him a club,” he says. “Ya know, you oughta relax your arms. Lockin’ ‘em’ up like that makes you weak.” He grins. “Are you weak, Leo?”

Sweat pours from my face. I feel warm urine and squeeze to stop it.

He tosses the knife from hand to hand, singing my name each time. “Leo. Leo. Leo. You oughta put that bad club down. You’re scaring me,” he says.

“She didn’t fall down the stairs,” I say again. “She has wires in her jaw!”

This seems to stun him, like I’ve pumped shotgun pellets into his chest. He tilts his head again and fills his lungs with air, then exhales through puckered lips. His fingers are so relaxed the whalebone handle seems to melt from each hand.

“Okay,” he says calmly. “She didn’t fall down the stairs. I pushed her.”

A red flash behind my eyes. Fire as though my head were about to burst. Then I realized he said it. It’s all there. A bellow comes out of me, loud and penetrating, ferocious.

I’m surprised that I connect, and catch him at the side of the neck, lower than where I had aimed. I miss the skull, but the blow stuns him, and causes his torso to twist to the right.

The blade is in and out of my chest before I can take a breath, and when I do, I hear a hissing sound and feel my chest rattle.

It didn’t hurt, just a cold prick. I drop the club, his face suspended in the air. I study it, and it becomes a pale mask. The eyes on the mask don’t blink, the expression doesn’t change. The eyes lose all their color and fade to a vapid gaze. It’s a gaze of incredulity. Suddenly I feel like we’re even. It didn’t work out for him, either.

Then I don’t see it anymore. The mask has disappeared. I see the ceiling, study its pitted exterior and dust webs. I’m on my back but I’m not on my back. I’m floating, listening to my chest wheeze with my labored breath. I’m suffocating, but it doesn’t matter.

Then I feel his hand at the side of my rib cage, his palm over the hole he made. He holds it there. I can breathe and I fear he’ll take his hand away. I hear him at my side.

“I told you to put it down,” he says. “I told you.”

I smile. The constants again. My heart beating.