Suddenly, he stood up in the chair and lurched forward. I was inserting needles at the vertex of his head and took a step back before I realized what was happening. I grabbed his left arm and his mother his right, but it didn't matter. He had a focused momentum that propelled him forward to jump off the two-foot high porch. He fell into a brusk walk through the yard, his mother running after him, and quickly exited the gate to the street. As he did this, I looked at Milan who shrugged and then made eye contact with Ritesh, who was working at the reception table. The two of us let out a giggle.

"What the hell?" I raised an eyebrow in confusion.

"I need to pee! I need to pee!" Milan shouted as he laughed and washed his face under the water bucket.

Twenty-four year old Anil was my last patient before lunch. Three translators were hanging out and waiting for me to finish up with him so we could go eat. Since he'd just run down the street with acupuncture needles in, I figured it would be a while until we would get to go home and have some dal bhat.

The morning had been busy and I was feeling pretty tired. I started taking my supplies back into the clinic, where Anil had been too fearful to be treated. He suffers from autism and is pretty high on the spectrum. He can't speak and his hands are almost permanently formed into fists. When he gets scared, he bites his hands. While I worked with him, massaging his arms and relaxing his fingers, I exposed a number of large wounds there.

His mother rarely takes him on the bus because he gets far too scared and can get very violent. I saw from his file that he had lashed out at some of his previous treatments, breaking some items and biting himself at the clinic. Even so, his parents kept bringing him because after he started acupuncture last September, he started trying to speak for the first time in his twenty-four years on Earth. In December, the traveling got to be too hard and they said they would discontinue treatment. Today was the first time that Anil has been to the clinic to see this set of doctors that I'm with.

As I touched Anil, I kept contact with his eyes, whether or not he would make eye contact with me. Emotions moved across his face like erratic weather patterns and I tried to stay with him. I was checking in to see if it would be safe enough to use needles with him.

"Anil, I'm so proud of you for riding the bus today."

Smile. Laugh and head bounce. Attention out to the street. Fear. Big eyes, something scary out there.

"Anil, here's a tickle," as I pressed into his medial elbow and palm and slowly stretched his arm.

Eyes back to me. Smile. Recognition of safety.

I looked at his mother. She was smiling at him and trying to help me keep his attention. My translator entertained him while I put eight needles into his scalp and after the last one was inserted, he ran off.

After I had packed my things, I wandered out to the street and started walking the way that they'd gone. I saw Anil and his mother walking back and I went to meet him. I saw his right hand in a fist again and I picked it up, softly opened his fingers and touched his palm to mine. His mother held his other hand and we walked him back to the clinic. No other patients were inside and I sat him down and removed everything from his scalp.

Anil's mother thanked us and walked to the bus with her son. She was courageous enough to try it again for the trip home. The translators and I headed home, where we ate and were surprised to share a birthday cake for "Andrew Sir." The chocolate and whipped cream had been motorbiked in from Hetauda by the amazing Tsering Sherpa. I am constantly in awe of all he does for our team and as the director of Good Health Nepal - the NGO that we are partnered with here.

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