Selective Mutism, in dreams and in reality

I’m watching K’s private swimming lesson from the viewing area of the local pool, just like I do every Tuesday this term. Part watching, part typing on my laptop, taking advantage of this 30 minutes time slot to catch up on my e-mails and stuff. This time there is another private lesson taking place in the same small pool: a girl of about the same age as K swimming widths accompanied by her teacher, several yards away from K. I vaguely hear both teachers giving instruction to the kids, their voices melting into the general background noise of the pool…  In this melting pot of voices coming from all three pools – the big pool, the small and the baby pool – only one voice makes me jump up every time I hear it, makes me lift my eyes off my notes, looking at the source of the sound in sheer amazement: the voice of the little girl having her lesson short distance from K. Every time she answers her teacher out loud, her voice rings like a bell standing out from the background noises of the pool, and I stare at the scene as if I have just witnessed some kind of magic. Is this normal? Can six year olds do that? Just reply to a grown up, just like this, out loud? I’m so used to K’s silent ways that I forgot what is ‘normal’, and this girl seems to me nothing short of a miracle. Will I ever hear K’s voice like this one day too?

*  *  *

K is lying on the couch, his long hair almost sweeping the floor, he bare feet in his hands, dreamily looking at the ceiling and smiling shyly at something, his thoughts. “Mama, remember how I forgot to give my present to Ded Moroz this year?” (Ded Moroz is the Russian version of Santa who comes towards New Years. Every year Gleb dresses up as one and pretends to arrive towards midnight on the 31st to give out presents. This year K drew a picture for him before his arrival and wanted to give it him but forgot). “Yes, but you’ll have a chance to give it to him next year” I say. K, even more dreamily, half-whispering “Next year I want to try to talk to Ded Moroz out loud…” (he means talking out loud to Gleb who comes disguised as Ded Moroz). “That’s a good idea,” I say, matching his whisper, “We can practice in advance if you like to”. He had never explicitly expressed his hope to be able to speak out loud to someone, not to his friends, not to his teachers, not to the train driver… But he wants to try and speak out loud to Ded Moroz. Maybe he can practice with Gleb pretending to be Ded Moroz, before Gleb actually arrives at New Years dressed up as Ded Moroz to give out presents so K won’t recognise him…

* * *

K had a bad dream, about a scary old lady who laughs and tickles his tummy and maybe wants to eat him. That was after a book we read one night at bed time. Not the “Hansel and Gretel” horror story. We had read a chapter of the Comet in Moominland, and there was an old lady there who was nice and sweet and helpful, but in K’s dream she became evil. So one day he tells me about her. It turns out he met her more than once in his dreams. I ask some questions, and he suddenly starts crying and crying and saying he is scared to go to bed at night now because he will have to see her again. I’m trying hard to think of ways to keep the scary old lady away from K’s dreams. I suggest that he tries to think about nice things before going to bed so that she wouldn’t come, so that he will only dream about nice things. Can he do that? No, he says he can’t think about only good things, that he’ll think about her anyway  (that’s true, who can control their thoughts? nobody). OK, how about we make him prepared then for next time he meets her? I say, “When you see her next time and she scares you, you can try and drive her away. Remember, she is not real, she is only in your dream, but YOU are real. You’re a real boy. Can you tell her that? If you tell her that, she’ll get scared herself and might even run away. Can you do that?” He cries even more: “But you know that I can’t talk to strangers!” I guess that’s true, you’re right, what should we do, what should we do then? I can’t allow SM to terrorise him in his dreams as well as in real life. “Look, K, she IS not real, she lives only in your head, and you DO talk in your head, don’t you?” He does of course. “Well, then, don’t tell her out loud, tell her IN YOUR HEAD, in your dream, tell her to go away and that she’s not real… Can you do that?” He’s not sure, maybe… I tell him to practice now saying it in his head, and then again, before going to bed. “If she comes into year head while you’re awake, tell her “GO AWAY! You’re not real, I’m real!” He falls silent for a few moments, thinking, looking past me for some time… then frowns his eyebrows…. then says sternly and quietly to somebody who is not in the room “GO AWAY! You’re not real! I am real!”  I applaud: “Yes! You did it! And you said it out loud too! What did she say?” He replies hesitantly: “I think she got smaller and then ran away…” “See? It worked! Yay! Do that again, every time she comes during the day, and then at night, if she dares to show up, you’ll be used to driving her away, even if you won’t say it out loud but only in your head.” And then for the rest of the evening I see him regularly lifting his head from whatever he’s doing and yelling bravely into the empty room, “Go away! You’re not real! I’m real! I’m not scared of you!”, preparing for the night….

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Still no talking… but things are moving

About a year and a half ago, I had optimistically declared that K had completely outgrown his Selective Mutism and was now able to speak normally in all settings. Well, fast forward 18 months, and what we see is K who is comfortably settled into whispering in all settings outside of home and family.

True, last school year back in Toronto we seemed to have a mini breakthrough that made me optimistic. He was silent for the first little while at school, but then gradually progressed to whispering and then even talking out loud to selected few there. He had started speaking occasionally in some other settings. Although he remained silent in most other settings, including his regular music classes with the Suzuki program, it felt like we started seeing some light at the end of the tunnel.

But then we moved again, and in September he started a new school again. (Seriously, he is so used to changing cities every year, that he’s recently asked me, in an unconcerned and curious tone of voice, “Mom, so what city are we gonna move to next year?” It’s sad. And we’re not even diplomats and not in the military.) He’s gotten comfortable at his new school pretty quickly, and started whispering there only after a few weeks, but then quickly hit a plateau. And that’s how things are now: he comfortably whispers or simply communicates in gestures at school as well as in all other out of home settings, but is showing no signs of further progress. He loses his voice as soon as we get off the bus on our way to school, regains it only after we get off the bus near our house at the end of the school day.

He hasn’t completely gotten over his fear of toilets either. He now agrees to use a toilet outside of home only if it has one stall because he doesn’t want to hear people flushing in other stalls. Wherever we’re out and about, I take with me a pair of ear protectors for him to wear (more of a psychological protection, since I don’t flush until he’s out, and we don’t go into bathrooms with more than one stalls), and a pack of post-it notes, in case we encounter one of those horrible automatic-flushing toilets.

He regularly acquires other anxieties, and establishes new rituals (like the urge to have all doors closed), some of which dissolve on their own after a while, and some stay. He is terrified of dogs, even small and old ones, even if they are far away. At this point, it seems most likely that his tendency towards anxieties is just a part of his personality, whichever way you explain it, rather than a normal developmental stage of an average three year old, as I used to think.

But the thing is that, outside of these anxieties and his SM, he is generally a very happy kid. He has got a couple of good friends at school, who I’ve seen him communicate with in an excited whisper. He can relate important details of his half-term break to his teachers in whisper (like the fact that he got to accompany me at the ultrasound exam and see that he is likely going to have a baby sister). He is even prone to occasional minor mischief at school without beating himself too much about it, which I think is very healthy for him.

The good thing is that the school that he got into this year turned out to be very involved and supportive. Because we were so late in signing up for a school (because we didn’t know where/whether we were gonna move until May last year), we ended up in one of the schools that is not in very high demand in the city. But as with many things in life, it turned out to be a blessing in disguise. Classes are small (his class has got only 16 kids per two teachers!), so he gets tons of individual attention every day. The teachers are wonderful and caring and very involved. I was particularly pleased that they took the initiative in alerting the SENCO (Special needs coordinator) to K’s issues, and the SENCO is also very involved now. They now got him a pair of ear protectors to wear whenever there is loud noise that bothers him or simply background noise that he can’t block out. He was meeting with the SENCO person regularly for a while for some non-invasive art therapy, which he loved.

He’s also got a couple of good friends who are very non-judgemental and even help him with his bathroom issues and the talking. He doesn’t use the boys’ bathroom at school because he’s scared of the automatic flushing in the urinals. He agrees to use the girls’ bathroom but only if a teacher or one of his friends stands by the door so nobody would come in to use another stall because he’s terrified of the flushing sounds. In general, so far, he has been very lucky to mostly have experience with kids who are sweet and understanding. Some friends also speak up for him during circle time when the teacher can’t hear his responses in whisper.

So that’s where we are right now. No talking, lots of other issues like various anxieties and sensitivities, but at least we have started getting some support here.

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Big boy meets Belly

There was time when Koopa was fascinated with babies. At first he wanted to have a baby sister. Then, after someone helpfully pointed out to him that boys usually want a baby brother, he adjusted his desires to make them more gender appropriate. He was never particularly impatient about getting a sibling (perhaps because, being an introvert, he never felt the need to have a constant playmate?), but he was always certain that getting one was just a matter of time. Every statement he made regarding the matter started not with “if” but with “when” (“When I’m a big brother, I’ll….), and I didn’t correct him, myself hoping for the “when”. Then, in the last few months, the months ridden with anxieties due to our recent move to a new country, his interest in babies seemed to have waned. Now, when asked about the preferred gender of a potential sibling, he would honestly reply that he would prefer a labrador, reasonably explaining that “he won’t mess up the toys in [his] room”. But I knew that the interest was still there. I mean, somebody must have downloaded the ugly graphics game called “Newborn Baby Care” onto my phone (where you’re supposed to care for pregnant ladies and then deliver and care for their babies), and I promise it wasn’t me.

I waited well past the first twelve weeks to tell him. Partially because I wanted to be 150% sure there was somebody in there. But also because I wanted to savour the moment of seeing him learn the news for the first time. We were sitting at the kitchen table and he was performing an ultrasound on some pregnant lady who came to see him in his “Newborn Baby Care” game. I pulled out the pictures from my first ultrasound and asked him if he knew what it was. He didn’t. I said it’s an ultrasound picture of a baby in my belly, just like the ones in your game. A baby? It’s ME? No, it’s not you, it’s another baby in my belly. A very long pause. “There is a baby in your belly?” “Yes”. “Right now?” he said, suddenly turning into his public self and glancing at my abdomen the way he would look at a stranger in the room: with suppressed interest and suspicion. “Yes, right now.” Another long pause. His voice turned into gentle almost-whisper, as if not to wake the baby: “I want to kiss your belly”, climbing off his chair. Lifted my t-shirt and gave my belly a long and most gentle kiss. Lingered a little, then rose and started to back out of the room, his eyes still pinned to my abdomen. “What’s wrong? Why are you leaving?” I asked. “I’m… I’m worried that I will kick your tummy and hurt the baby”. “No, no, you won’t hurt it, come back…” It took quite some effort to convince him to come back and sit on my lap. He sat on the very edge, all the while anxiously looking back on my belly and asking if the baby was still ok.

He’s become my pregnancy police, strict and vigilant. “Mama, promise me that you won’t drink any beer of wine. PROMISE.”  “Mama, eat your vegetables, the baby needs all the vitamins!” “Mama, are you sure you’re allowed to run? The baby won’t fall out of your belly? Because I really REALLY want to become a big brother.” I feel like he’s already well on his way to becoming a big brother. They say that a woman becomes a mother as soon as she gets pregnant. Well, it feels like Koopa became a big brother as soon as he learned I’m pregnant.

He’s always been very sweet and gentle, but has become tenderness itself since learning the news.  He now talks to the baby and gently kisses my belly several times a day. He kisses my belly goodbye through my coat when I drop him off at school. He kisses it whenever he wants to let someone know that he’s on his way to becoming a big brother and is unable to use his words (because he still doesn’t talk to people outside close family and friends).

But also, predictably, a new wave of anxieties followed. Nowadays, when I’m angry at him for some mischief, he cries “Mama, I’m worried that the baby will think I’m a bad person!” Or, recently, at bedtime: “Mama, I’m worried that you’ll love the baby more than you love me, will you?” “Well. You are my favorite big boy in the entire world. And the baby will be my favorite baby in the entire world.” That seemed to settle it.

“Mama, when I grow up, I’ll build a special shield made of metal that mommies could wear to protect the babies in their bellies. So that bad people wouldn’t hit their bellies. And… and on the shield it will say ‘there is no baby in here’ so that bad people will think there is no baby in there and will not do anything to hurt it.”

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7 Habits of Highly Perfectionist Children

1. Always make sure your bingo cards are perfectly aligned with each other AND with the hardwood pattern on the floor, or whatever surface they are lying on.

2. Every time upon leaving the house, inquire how much time you have left to be outside before you get a sun stroke. Repeat the same question at approximately 2.5 minute intervals. Keep asking until you realize that your mother’s anger is a more imminent danger than any possible damage from the sun.

3. Demand bottled water when brushing your teeth.

4. At a breakfast buffet, don’t forget to inquire which dish has the largest protein content (in strict adherence with your plan to grow 5 cm in two months so you can easily stand on your feet at the shallow end of a grown up pool.)

5. Arrange the toiletries in the bathroom by colour, size, and designated user. Patiently rearrange it every time any of the irresponsible designated users dares to disrupt the established pattern.

6. When signing your name, make sure that all the letters are the same height, width and angle (but don’t worry about the direction they are written in). Scratch and start all over again, as many times as needed, ignoring comments by puzzled non-perfectionists whose untrained eye cannot discern the crucial difference in size between 6 and 6.1 millimetres.

7. When going to a zoo, take with you a carefully prepared and pre-approved plan of the trip, listing the animals in the order they have to be seen. Refuse to deviate from this plan under any circumstances, even if that means that the viewing of a lion at one end of the zoo must be followed by visiting the bear in the other end, skipping tens of of unplanned animals on the way. “Mama, DON’T LOOK AT THAT CHIMPANZEE! We have a bear next on the list!”

P.S. Sadly, it is not always as amusing as it sounds. But that’s what we’ve got. Koopa :)

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Talking about death and…. koalas

Not exactly sure how to talk to kids about difficult stuff like death. My grandfather, who lived overseas, died some time ago. I was not sure how to present this news to Koopa without making him too distressed. So one day, after picking him up from school, I waited for a moment when I had his undivided attention, and just shared the news with him. He studied my serious and sad face, looking a little nervous, as if measuring up my emotions and trying to adjust his own, didn’t say anything. We had talked about death before, in quite simple terms, he knows that all living things die, people grow old and die, but he never encountered it, and so there was no reason to discuss it in much detail. So I don’t know what was going on through his mind when I told him the news. He was silent for a little while, then inquired if my grandma was ok. I said yes, she is. Will she live alone now? Yes, she will live alone now. And that seemed to be it. After that he seemed satisfied with the conversation and ready to go about his five-year-old business.

But as it often happens with five-year-olds, after he digested the information, he was ready for more. Several hours later, unprompted, he suddenly asked “Where will I go when I die?” “You mean you want to know where my grandpa is now?” – I rephrased his question, probably for my sake, because it was easier to handle it this way. I paused because I realized just how poorly prepared I was for this question. I wished I had rehearsed or something, beforehand, or read some stuff about how to answer such questions. I wished I was religious or at least held some deep beliefs about this stuff, that would give me something coherent to say, and that would help him feel safe. But I didn’t have anything like this. So I said honestly and probably quite unhelpfully “I don’t know. Nobody knows for sure what happens to people when they die.” From the look on his face I wasn’t sure if my answer was too terrifyingly uncertain for his five-year-old mind, or if the uncertainty of it just made it meaningless. I decided that maybe offering some concrete ideas would make it more easily digestible, so I added: “Some people believe that when people die, they don’t disappear completely, but they turn into something, like a tree or an animal.” He was quiet. Then I asked “What do you think?” hoping it won’t be too burdensome of a question for him. It wasn’t. He immediately frowned his eyebrows and held his index finger to his forehead as if trying to solve a math problem of intermediate complexity, and a moment later announced, very seriously, “I think he turned into a koala!” “A koala?” I barely managed to suppress a chuckle. Certainly didn’t expect to hear that. “Why?” “Well because its one of my four favorite animals (he started counting on his fingers): panda, mouse, rabbit and koala!” he explained quite reasonably.

Well, it’s all clear then, I guess. I’m so glad this all went so smoothly. And I’m proud of myself I managed to explain death to my five-year-old. I’m just hoping he won’t go around telling people that, according to his mom, his great-grand-dad turned into a koala.

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Do toilets die?

I have to admit I wasn’t really looking forward to August 2013, the month when Koopa was already out of his daycare in Montreal but wasn’t yet in school in Toronto. That is, I wasn’t looking forward to having to unpack and arrange all the stuff you have to arrange in new city without any child care support. We ended up working in shifts, me and Gleb, each of us alternating parenting and unpacking/working shifts. And I don’t know about Gleb’s shifts (I think the two of them were mostly busy exploring the Toronto transit system, judging from the fact that Koopa has memorized the whole subway map by now), but my time with Koopa was largely filled with these philosophical conversations about the essence of the universe. It’s like all this time spent together set off some kind of inquiry mode in him, and he was finally able to ask all these important questions that must have bothered him for a long time. Basically, he wants to know how the world works. And I am there to offer my (very limited) expertise about these issues. So even though August was not an easy month, it was also a lot of fun to spend more time with this new inquisitive Koopa. And now he goes to school but only till 3pm, so we still have a lot more time to talk every day than we used to.

Probably ninety per cent of his questions have one of the following formats: a)”Who made X?”    b)”Do Y die?”    c) “Can Z move/operate by itself?  d) “Can I drown in ___?”

For instance:

“Why is thunder so loud?”

“Can I drown in the ocean?”

“Who made lakes and rivers?”

“Why is it dark at night?”

“Do cars die?”

“Who makes toilets?”

“Can I drown if I get into your cup of coffee?”  (I’m not joking, he seriously asked it the other day)

“Can a bus move on its own?”

“Why do people need a nose?”

“Do toilets die?”

And, finally, my personal favourite:

KOOPA: Who made ME?
ME: me and daddy
KOOPA: But how? How did you make me? [Me: oh shit, do we have to get into this already? i don’t have energy for this right now… but thankfully a helpful clarification follows] Did you make my arms or my legs first?
ME [thank God, he must think we made him out of play dough]: Well, they just kind of formed at the same time I think, your arms and legs.
KOOPA: Did you make my head too?
ME: Yeah, I suppose.

I didn’t realize what a serious impact this conversation had until the following exchange took place two days later. I noticed Koopa sitting on the floor and shaking a not-very-stable shelf with a heavy cast iron pot on it. I rushed towards him, exclaiming “Koopa, please don’t do it! It can fall on you and break your head!” To which he calmly replied: “Well then you and daddy will make me a new one!”

So as of this writing, we’re not completely unpacked, not quite settled down, and not really feeling like we’re home or anywhere in particular (that won’t happened any time soon, but whatever, that’s a different story). But who cares? I don’t. When your (only) head is occupied with such important matters as the life and death of a toilet, the last thing that will bother you is a couple of unpacked boxes and stranded household items scattered around the under-furnished living room.

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Koopa the Conqueror

Koopa has come a really long way with his fear of unfamiliar toilets. He is far from being completely at ease with them, and is still quite picky about his pubic bathroom choices, but he can handle them now most times. A trip to the bathroom when we’re out and about is still never a mundane event for us, but almost always involves at least a slight surge in anxiety, and a lot of negotiations and sometimes tears. But the toilet is not an invincible monster anymore, like it used to be for almost two years for him.

For two years Koopa was terrified of toilets. Or maybe even longer. Or maybe he was always somewhat scared of them, and this fear just developed and evolved as Koopa developed other sensitivities? At some point during the past year I realized just how bad his fear was and that it didn’t seem like something that would easily pass on its own.

My first attempt to actively do something about it was in April 2012, when Koopa was 3.5 years old, when I started freaking out about how on earth we were going to survive our upcoming 12 hour long trans-atlantic flight. At the time, I spent a lot of time and energy trying to convince Koopa to use a public bathroom in a “positive” way, telling stories about how the toilet was really his friend and trying to bribe him with stickers. Looking back now, it was the most ridiculous thing I’ve ever done, and quite insensitive, too. I mean, to a child who is convinced that toilets have teeth this would have been the most confusing and terrifying offer imaginable, especially coming from his mother. After all, from his perspective I was suggesting that he trade his safety and his butt for a sticker, and who in his right mind would agree to that? Thankfully, Koopa has always been a pretty reasonable person, so he did not agree. No, seriously, retrospectively, I am quite happy he chose to trust his instincts and not to do what in his world was INSANE. I’m happy because it is always best to trust one’s instincts, even if they seem unreasonable to another person (even if that person is your mom), and I hope he will always do that.

My biggest mistake at that time was that I didn’t try to understand him, I tried to “fix” him. I was too busy with my own agenda. I perceived his fear of toilets as MY problem, as in “Oh my god what am I gonna do with this 3.5 year old child who won’t go to the bathroom outside of home even to change his diaper, and what if he poops his pants on the plane!” It took some time to get out of that mindset and realize that this fear was much more of a problem for him than it was for me: that if he would consciously decline a play date offer or another fun event just in order to avoid an encounter with an unfamiliar toilet there, then things were really bad. That’s when I finally realized that he was suffering and simply needed my help and understanding. And I had to let go and to consciously tell myself “OK, one day there might be a huge public tantrum and/or a child who pooped his pants and that will be unpleasant and I would have deal with it somehow, but HE shouldn’t have to deal with my anxiety in anticipation of that, because he already has a lot on his plate: he has his own anxiety that is much bigger than mine.”

So I had to let go of the idea of “fixing” him and “fixing” the whole situation, and we started simply exploring his fear of toilets, just a little bit at a time, as much as he was comfortable with. We played and pretended that toy bins were toilets and we’re scared and running away from them. We told toilet stories and drew toilet pictures, composed toilet poems, and played toilet games. We drew pink toilet teeth, and watched toilet videos without sound. And none of it was very deliberate, and almost all of it was initiated by Koopa. On my side, it involved just “letting go”, and actively deciding to simply be there with him, wherever he was in his fear, and letting him know that I was there to help and to follow HIS agenda, not mine.

And then one day I decided that we could try the “gradual exposure” thing that cognitive-behavioural therapy talks about. I proposed him that we approach one of the monsters. I didn’t try to convince him that they were friendly or anything. I didn’t ask him to change his mind about them. At that time, unlike a year prior to that, it seemed appropriate to offer a reward for his efforts. The difference was that this time it wasn’t just my agenda, it was his. By this time he was expressing a new kind of interest in the monsters: whenever we were in a new place he would ask where the bathroom was, not in order to avoid it, like before, but in order to look at the closed bathroom door, with awe and interest, from a safe distance. So he clearly was ready to explore his relationship with toilets a little more, and needed a little incentive.Since then every time time he approached a bathroom, we drew a toilet on a white board at home, and every five toilets earned him a reward of some kind. He defined what “approach” meant every time. In some cases, it involved approaching the bathroom door, and in others – simply looking at it from several feet away. Ideally, it would have to involve a little discomfort from time to time (approaching the bathroom closer and closer) but we didn’t manage it often. So we went on like this for a few weeks, but got stuck pretty quickly, and Koopa seemed to be less and less motivated by the rewards.

And then I had another idea that really seemed to make a difference at the end. I designed a bathroom comfort-ladder. I adopted the idea from that book about selective mutism where they talk about a talking comfort ladder to gradually make the child comfortable talking in various situations. You make a list of people, situations, times and conditions that influence your child’s talking anxiety, in the order from least triggering to most triggering, and construct a comfort ladder out of it. Then the idea is to move up the ladder very gradually, moving to more uncomfortable situations one step at a time and becoming more and more comfortable in them. Koopa didn’t really need it for his talking anxiety because his SM seem to resolve on its own. But the idea can be adapted anywhere. So I made a list of bathroom situations from the least to most scary (e.g. at school > friend’s house > my office > at the mall…) and bathroom-related activities (approach the door > touch the door > open the door >… > pee) and so on), and then combined the two lists to make a bathroom comfort ladder.

In the book they suggest that the child shouldn’t be aware of what’s going on, which makes sense in the case of SM, because the child would then feel an increased pressure to talk and that wouldn’t be good. But in our case, Koopa obviously had to participate and be aware of what was going on. Not just that, I decided to make him really aware of the idea of a ladder. I literally made a ladder out of construction paper, and put it on the fridge. Like this:

And every time he conquers his fear a little more, the little paper boy on the fridge moves one step up the ladder. And on every step we write what the situation was that he conquered. And this tangible representation of his progress seems to be the best reward for his efforts, better than any toys or stickers (I still give him stickers and other rewards sometimes). Some evenings he asks to sit down with me on the floor in front of the fridge and count the steps that the boy has passed. And I can tell you that the expression on his face in such moments is priceless. His eyes sparkle with pride, he widens his eyes and lengthens his face in pretend-amazement and surprise, and every time he asks the paper boy “Hey, boy, you’re not scared? You’re so high up! You’re not scared to fall down?” (“Мальчик, ты даже не боишься? Ты не упадёшь?”). And every time the boy replies that he is confident he won’t fall down. And I know that I can trust him in this, because it was his decision and his agenda to go up there in the first place, and I know that he is good at following his instincts.

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