Faith in a Seed was the first of Henry David Thoreau's manuscripts to be published since the posthumous appearance of his journals a century ago. In it Thoreau describes the succession of different types of forest trees, using data gleaned from personal observations and records kept over more than a decade in his short life. "Convince me that you have a seed there," Thoreau wrote, "and I am prepared to expect wonders."
Last year, my eldest son gifted us an Aero-Garden. This self-contained unit functions as an indoor hydroponic garden bed. Tiny seeds generate and establish their roots in nutrient-rich fluid while delicate green shoots stretch toward the fluorescent lights overhead. Seeds sprout over a period of days, depending on the type of herb. Italian basil unfolds in 3 to 7 days; mint takes 6 to 10 and parsley 8 to 15 days. Each seed germinates in its own predetermined time.
This past week, I examined 8-year-old Kristen in the office. Her mother brought her in because she was concerned about the recent onset of a cough and congestion. When I glanced at the chart to review my previous notes, I realized that I hadn't seen Kristen in nearly a year.
Kristen is the youngest of three siblings. Unlike her older sister and brother, she was born with a genetic defect—a partial chromosomal deletion and translocation. When Kristen was an infant, she cried constantly. Her parents quickly
discovered that feeding was the easiest way to pacify her.
By the time she was 4 months old, Kristen was macrosomic. Over the ensuring months, it became apparent that this dysmorphic girl was not relating to her parents and siblings well. Eventually, a consultation with a geneticist was arranged.
The parents were shocked when they learned the diagnosis—all the more disturbing, because this particular translocation was unique. This made it difficult to predict Kristen's developmental outcome. As she grew older, it became obvious that Kristen suffered some degree of mental retardation.
With the support of her parents, siblings, and members of the extended family, Kristen continued to take small steps in her development. She was enrolled in a special education program, where she received occupational therapy as part of her school experience. All things considered, to date she has done quite well.
There she was, sitting on the exam table, neatly dressed in a clean blouse and skirt, watching me over the rims of a pair of glasses awkwardly cocked on the tip of her nose. Those innocent eyes were wide-spaced, the twisted ears set low; the lips full and thick, the tongue partially protruding from her mouth.
I proceeded with my examination. Kristen let me peer into her ears, nose, and mouth, and listen to her chest. I recalled former visits when it had taken three adults just to steady her head for an examination.
"She actually looks okay," I reassured her mother. "She has a slight cold—nasal congestion, post-nasal drip—but her ears and lungs are clear, and there's no fever. With plenty of fluids and some warm chicken soup, she'll do just fine."
Kristen's mother smiled. "She loves chicken soup." Kristen nodded her head and beamed.
"Kristen wanted to tell you something else," her mother said. "Actually, I think that might have been the main reason why she wanted to see you today."
"Oh," I said. "What did you want to tell me, Kristen?"
The girl took a deep breath and then spoke haltingly: "Last night I—sat down and—ate all my dinner," she said, struggling through the words.
"Wow, that's great!" I said, watching her break into another smile.
"That is great," her mother said. "That was the very first time that Kristen managed to stay in her seat the whole time and eat her dinner like a big girl with the rest of the family."
"I'm so proud of you," I said. "I'll bet your mommy and daddy are proud of you, too."
"We are," her mother said. "Tell Dr. Brian why you sat down so nicely and ate all your dinner, Kristen."
Again the little girl took a big breath. "Because Dr. Brian—told me that—I needed to," she said.
I looked at the mother with questioning eyes. She met my gaze with a smile of her own.
"Last year at her physical exam, you told Kristen that she had to sit down and stay at the table to eat all of her dinner with the family," she explained. "Last night, for some reason, she decided that it was time to do it. When we commented on her behavior, she said that she did it because you told her to."
Every seed germinates in its own time. Some seeds that
we plant lie dormant for months, perhaps even years. Sometimes we might even forget that we planted them. But then one fine day, suddenly, we see the first tiny shoots unfolding in the light.
Even after three decades of medical practice, like Thoreau, I still have faith in a seed. JAAPA
Brian T. Maurer, PA-C, practices pediatrics at Enfield Pediatric Associates, Enfield, Connecticut. He is the author of Patients Are a Virtue and a member of the JAAPA editorial board. Visit the author at http://briantmaurer.wordpress.com/.