He is an ex-husband, a weekend dad, a non-custodial parent. He finds out many things after the fact, and others at the last minute, when it's too late to offer any well-thought-out ideas or opinions. He ends up saying no a lot, more out of a desperate need to have some input, some control, than out of an actual desire to prevent things. He cares deeply about this troubled and brilliant child, and he wants to protect him, especially from things he doesn't understand.

He has said no to psychiatric medication. He had grudgingly agreed to therapy, only because he couldn't think of any dangerous side effects of talking. "You can put him on medication," he announces, "if you can guarantee me that there will be no side effects." And no one can guarantee him this, so he has held his ground. In most states, the no of one parent trumps the yes of everyone else in the world, even the other parent.

Now he stands, helpless and oversized, many inches taller than anyone else in the hospital, except for the seven-foot-two security guard. He is dressed in khaki pants and a button-down shirt, but there are telltale paint stains on his hands and jacket, belying his blue-collar existence. "I'm not a bad guy," he whispers. "I don't want to hurt him, or prevent him from getting help. I just don't want to throw medication at him and worry that I'm causing permanent damage."

He seems to hear the feedback: with the possible exception of his ex-wife, no one here thinks he is a bad guy. His mere presence is appreciated, in a world where 13-year-olds can overdose on Tylenol PM and lie alone in a hospital bed while the parents refuse to spend another long and boring night in the emergency room. It is clear to anyone who can get past his initial gruffness that he is a scared, overwhelmed, underinformed father who can't quite understand how ten years have moved a squalling, helpless, protectable infant into an intelligent, volatile, emotionally dysregulated boy. The hospital staff would rather have a concerned parent saying no than a dilatory, absent parent, any day of the week.

And yet he is deflated, sinking into himself. He has heard his ex-wife's tales of their son's uncontrollable outbursts, his violent acts and his screaming fits, but he hadn't yet seen it in action. He had convinced himself that this was one more instance of the woman playing head games, and the boy was fine, would continue to be fine. He was doing the best he could with what he had, and he had believed it was good enough.

But now, he stands in the emergency department, hovering in the doorway, shocked and frightened to watch the boy devolve from a talkative, polite pre-teen into a kicking, whining toddler at the mere mention of having blood drawn. He goggles at the admission from his ex-wife that this is the sixth attempt in a year to draw blood, and every other time the boy has thrown a large enough tantrum that she has given up and gone home. He agrees that blood work is necessary, given certain alarming symptoms, and can't understand why it hasn't happened before now. He nods as he's told that the boy will be physically restrained for the procedure, and acquiesces to staff requests that both parents remain in the hallway for what is going to be an unpleasant experience for everyone if the boy continues to escalate his protests.

He has learned that the best he could do was not enough, because his child is not okay. This is not how a normal 10-year-old reacts, and it has clearly moved well beyond a power struggle into the horrifying and confusing realm of mental illness. He pulls aside the mental health worker to whisper, "Would medication help this? Would it help keep this from happening again?" He nods at the answer, which, like anything else in mental health, comes with caveats and uncertainties.

He is reminded that the child is lucky to have parents who are so concerned, lucky not to be alone. "As long as I'm alive," he said, "he will never sit alone in a hospital." The father is reminded that there is every reason to be optimistic that serious and long-term changes are possible to make his child's life, his heart, feel better. His nod is barely perceptible.

From behind the closed examination room door, screams and moans erupt that are unlike anything anyone - including the staff - has ever experienced. The noises continue for a long time; more than 20 minutes, though it feels far longer.

And the father stood very straight, back against the wall. And tears flowed, unchecked, down his face.