“Don’t be sorry,” the man replied, enunciating as deliberately as he was able. “Lots of people ask me to repeat myself. Others should, but don’t. The truth is, most people can’t be bothered. Sorting out what I’m saying is simply too much work for them. Long sentences can be tiring for me, too. Sometimes leave out words that aren’t important. Sometimes use screen and joystick.”

His speech was articulated with effort, and some words were distorted by involuntary grimacing and grunting. But in general, his physical limitations were more prominent than those affecting talking. The man was probably around forty, and his disability was impressive—spastic quadriplegia, one of the most disabling manifestations of CP. His facial muscles and limbs were in nearly constant motion, and his lips were often distorted. Straps on his wrists helped keep his limbs in proper alignment.

Lou had the impression he had never walked, and at the very least, had help dressing and undressing himself each day. But despite his condition, he was able to manipulate a very complex wheelchair console, and to make his speech legible by shortening his sentences if his listener was willing to make the effort to concentrate. Perhaps his most appealing feature, though by no means his only one, were his dark brown eyes—wide and intelligent, even behind the thick lenses of his tortoiseshell glasses.

Lou’s experiences with CP were largely limited to a girl in his high school and to patients in the ER. But over the last decade, he felt connected to those people on a very special level—one that unfortunately not all physicians shared. Based solely on outward appearances—poor motor control and thick, difficult speech—too many doctors assumed that CP was a global neurologic disorder affecting not only movement and speech, but intellect as well. In truth, with exceptions, a CP person’s intelligence was fully engaged.

Lou was sensitive to any form of generalization or stereotyping—especially medical stereotyping. As a doctor who had past troubles with drugs and alcohol, he had encountered too many colleagues who judged his condition to be a moral deficiency, or who lumped him in with others afflicted with his disease.

The wiry man in the wheelchair appeared simply to be hanging around the ER, and nobody working there seemed to care. It was Lou’s nature to listen to people—especially those with information that might be useful to him. He pulled over a chair so they could be at the same level.

“You said Dr. Lichter is not the right doctor for Cap?”

“That’s what I said,” the man replied.

“How’d you hear our conversation anyway? You were at least fifteen feet away from us and we weren’t speaking that loudly.”

The man pointed to a tiny microphone affixed to his wheelchair and then to the small plastic hearing aid in his right ear.