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What Causes Autism: A fictional short story by Michael Fine

By Michael Fine

© 2026 by Michael Fine

When Dave drove by City Hall and saw those people with the purple hair, with their signs and outrage, he leaned on his horn, but those stupid people just raised their fists because they thought he was honking to support them.

“Get out of the road, you stupid f—s,” he yelled.  He stopped his truck and rolled down the window to keep yelling, but the cop on the corner waved him forward and then approached the truck when he didn’t move.

“Come on, come on.  Get a move on.  Don’t make this worse than it is,” the cop said.

“You know they are dumb f—s.  All they do is make noise,” Dave said.

“Don’t I know it, brother,” the cop said.  “But they got a right, at least at the moment.  And you don’t need to get pulled into this. Their time will come.”

Dave shook his head and rolled up his window.  These people don’t understand what rights are and what they are for, he thought, as he turned the corner.  Give them an inch and they take a goddamned foot.  They think they know everything, and know what’s good for the rest of us.  But look at them.  Pink and purple hair.  All those down jackets.  They look exactly alike.  They got no respect and they got no discipline.  They think they get to decide what is legal and what isn’t.  Who gets into this country and who gets to stay.  Like all their lives and all their ideas are so perfect.

Dave drove up Washington Street, hung a right on one of those little cross streets, hung another right on Fountain, and took a left toward the mall and got ready to take another left to get himself on the 6/10 Connecter, to get the hell out of there.

There were six police cruisers parked on the corner across from the mall, the one next to Fidelity and the Capitol Grill.  And two more parked on the median strip.  What are they expecting, a civil war? Dave thought.  We might need one.

But better safe than sorry, he thought.  There’s bad stuff happening all over. Look at Minneapolis. Things sometimes get out of hand, he told himself. Let me get out of Dodge before the bottles, cans, and rocks start flying.  Before the whistles start blowing.  Before the tear gas gets fired off.  Glad we have overwhelming force, he thought.  These people need boundaries.  They need to remember who’s boss.  Forewarned is forearmed.  Don’t you tread on me. And a little Semper Fi, just for good measure.

.

Brian Jones didn’t love his tent in the winter, but he’d found a good place for it – just off Promenade Street as you go down to the river.  The riverbank provided shelter from the wind.  There were trees on the bank so nobody could see his tent from Promenade Street, Dean Street, or even from Providence Place —  and he didn’t think people in the Journal’s production plant, which was right there, could see him either, because there was a blind wall facing him.  Out of sight, out of mind.  Other people sleeping raw clustered together —  in city parks or next to the highway, which was really dumb because that got John Q. Citizen all riled up.  Then the cops would come and roust them out.  Huge waste of time.  It’s dumb to tell people with no place else to go to move on.  And dumb to put yourself where you can be seen, because that makes the inevitable happen.  There is shock, shock, that human beings are sleeping in tents in the winter.  John Q. Citizen doesn’t think much about how to get people housed.  Only about how not to have to look at tents where people sleep raw.  Offends their sensibilities.  Their sense of smell, or something, even when they aren’t close enough to smell squat.  Those dumb people sleep in orange tents where they can be seen.  They are asking for trouble.

All Brian wanted was to be left alone.

Brian had a dark green tent that you couldn’t see even when you were twenty yards away.  There was no better location.  The mall was just a couple of blocks away.  Eagle Square was just a couple of blocks in the other direction.  It had good dumpsters.  The 903 Residences, the place Buddy Cianci once promoted, was just across the river.  IHOP was across the street, and open all night long.  The Blood Center, right there for easy cash.  Even Dunkin Donuts was there. Farm Fresh just a couple of blocks away – a good place to hang out on weekends, after the farmer’s market closed. The central library was pretty close as was the great little library in Olneyville. The dumpsters of Little Italy and Pastiche were just over the highway and up the hill, whenever he got the urge for something sweet or pizza, though that was not a good walk when a cold winter wind was blowing down the highway.  The trains come through but you stop hearing them after a while.

Brian went to bed early in winter.  He had a propane heater but he didn’t like to burn extra gas.  You get good at this. He had two down sleeping bags, a down parka and he slept in a hat.  Winter wasn’t his favorite season, especially in mid-December when the days are so short.  But his way of living was better than sleeping in a shelter, where they woke you at 6 AM so they could put you out on the street at 7, where life was worse than high school or jail: one rule after the next, where they move you from place to place like you are a cow in a herd of cattle they are fattening for slaughter.  His way of living was better than being in some single-room-only apartment, where they keep the heat up too high, and way better going to work every day, living in some condo development and sucking up to some boss.

Talk about prison.  No one told Brian when to get up in the morning or what to do every day.  He didn’t have to spend his life in front of a computer, going to Zoom meetings.  He didn’t have to go to meetings at all, not anymore, which meant he didn’t have to listen to people who don’t know anything talking on and on, as if anyone cared one little bit about what they had to say.  He was a free man.  Free as a bird.  His own man.  Free at last.  Free to be.   Nothin don’t mean nothin if it ain’t free.

.

The train was pulling out of the station when the left-turn arrow on Francis Street turned green.  Dave turned left onto Memorial Boulevard.  He stayed left under Route 95 and then started to move right once the right lane ended.  He joined the traffic coming from the mall and the traffic exiting from 95 South.  Dave had to bide his time, to ease between the cars entering from his right, most of which wouldn’t make room for his truck, despite his signaling.  Bastards, Dave thought.  Everyone is in so much of a hurry.  Nobody polite anymore.  Nobody yields. These hot-dogs must all be from Olneyville.  The Spanish, the Guatemalans and the Salvadorans.  The Dominicans.  They come here and they think they own the place.

Dave barely noticed the train pull in front of him on the tracks that ran between the 6/10 connector and Harris Avenue —  a sleek bright blue and silver Acela, which was moving faster than he was moving.   He just wanted to get home.  Back to his house and the trees.  With his dog.  Out and away from the city and it’s crazies.  And craziness.  Back to where a man is a man and a woman is a woman and everybody works for a living, more or less.

He saw the sparking out of the corner of his eye as he turned his head to look for those cars merging from the right.  The ones that wouldn’t give him a break.

.

There were sparks coming from under the train.  Really bright yellow and orange sparks. Like from a sparkler on the Fourth of July.  Only bigger and brighter.

“What the.…”  Dave said.  That’s not from overhead wires, he said to himself.  That’s no short.

There was a loud screeching sound, the sound of metal being dragged over metal. He turned to look at the cars and road in front of him, and out of the corner of his eye saw the train wheels nearest him rise from the track, as the train started to tip to one side.

.

Brian got out of his tent to pee.  He hadn’t been down an hour, but it was what is was.  He wasn’t a fan of keeping a pee bottle in the tent.  He had one, of course, but he used it only in the middle of the night, when it was really cold out and he just couldn’t get himself to go outside and into the trees.  The pee bottles stink if you use them too early in the night.  And they are too damn easy to kick over.

He heard the screeching about the same time as he saw the sparking.  It was across that little river, the Woonasquatucket, and on the other side of the Journal plant’s parking lot.  But it was what, only a few yards away.  It was like he was right next to it.

He saw it and heard it and felt the ground shake under his feet, all at the same time.

A huge shower of bright yellow and orange sparks. White, even.  White hot. That awful, miserable screech, a cat being tortured in front of a microphone, played through huge speakers; or an airplane that had crash-landed on an aircraft carrier without landing gear and was speeding across the deck on its belly.  He felt the rumble of the speeding train as it struck the earth, as the cars crumbled and rolled and rose into the air, collapsing like an accordion, with the ends of two or three of those cars jutting into the air and coming to rest stacked on one another.

.

“Holy shit,” Brian said.

And then he started to run. He ran onto Dean Street.  Over the river.  Across the roadway.  Into the Journal parking lot, climbing over fences as he ran, with strength and agility he had no idea he had in him.

He ran towards the train.

He didn’t stop to think, not for one second. Run toward trouble.  You see danger, you see people in trouble, you run towards them.  Not away.  Never away.  That’s what was in his brain.  Always had been there and always would be.  Don’t ever let them get you down. Don’t you tread on me.

.

They got there first, Brian and Dave, at the same time,  two men alone in the night, the fires from the train burning white hot.

They stood for a moment amidst thick black smoke, in the darkness, with the crackling of the fire and the cries and moans of the survivors who were all still inside.  They were at the rear end of the train, where there was a second locomotive.  That locomotive lay, on fire, perpendicular across the track, burning brightly.  Its front end was still hitched to a passenger car that was on its side.

“Follow me,” Brian shouted.

They ran to the rear door of the passenger car but were pushed back by waves of intense heat, fire, and smoke.  Neither man thought about the people in the other cars.  They heard the people in this car, who were moaning, screaming, and yelling for help.

Brian ran to the front of the passenger car.

“With you, brother,” Dave said.

But there was no way in.

“Come on,” Dave shouted.

The next car was tilted to one side but hadn’t flipped.

There were three steps up to the rear door of that car.  That door was open.

A man whose head was covered in blood stumbled out of that door, trying to get his balance.

“I’m here,” Brian said, and he bounded up those stairs like a billy goat, put his arm around the bleeding man, helped him down the step and led him away from the train as Dave climbed the steps and plunged into the darkness of the ruined car, feeling his way.

.

There were sirens and flashing lights.  People driving on the highway stopped their cars and came off the highway, some to help, most to look.  Before long the night was filled with flashing lights, with cops and firefighters in full battle array, with hazmat teams and soon with helicopters circling overhead, some shining spotlights on the scene, while others dropped water on the burning train.

The night got cold.  The moon rose, but you couldn’t see it.  The air stank. It smelled and tasted like burned rubber, burning plastic and charcoal, like someone’s barbecue had set their house on fire – but a hundred times worse.  Everyone was coughing from the smoke and the stink.  Everyone’s eyes teared.

The onlookers and the gawkers went away because of the stink, even before the cops chased them.

Everyone would remember that stink for the rest of their lives.  It penetrated their eyeballs and lived forever in the pores of their skin.

.

 

Three weeks later, long after the smoke cleared, Dave was driving to the East Side to finish wiring a new kitchen for a doctor who lived off Elmgrove, on Westford Road, where the houses look like castles for English royalty, which this doctor was definitely not.

Wire a heated floor and new lights.  Under cabinet illumination.  The place was going to look like a museum.  Which it wasn’t.  What do people need this stuff for?  Isn’t a simple light fixture good enough?

Dave pulled off the highway and stopped at the traffic light on Branch Avenue.

A panhandler had parked himself in the median strip. He was wearing a puffy green down jacket and had on a blue Patriots hat, which he wore low on his head, almost to his eyebrows, and he had on aviator sunglasses.  This dude had even brought a chair.

Good God, Dave thought, these people think the world owes them a living.  Can this really be legal?  Them hanging out and begging like this?  This is America, or used to be.  Do we really not have any rules at all anymore?  Any structure?  Doesn’t anyone know their place?

The panhandler stood up.  He walked down the row of four cars next to the median strip.  Then he came over and walked the row of cars waiting to make a right turn.

The driver of the car in front of Dave’s rolled down his window and gave the man a dollar or two.  Dave got ready to look past the man and to drive by him as soon as the light changed.

The panhandler took off his sunglasses, wiped his brow and pushed his hat up higher on his head.

Then he came to Dave’s truck.

.

Maybe it was the way the sun hit Brian’s face.  Maybe it was the memory of that train still stuck in Dave’s unconscious mind.  Maybe it was the stink that Dave could still smell and taste.  Whatever it was, against all odds, Dave recognized Brian, whose face he had only seen in the dark, lit by the fire burning through that locomotive, for a moment, and then by Dave’s flashlight, as Brian climbed into the passenger car.

Dave rolled down his window.

“Yo, brother,” he said.

“Yo,” Brian said, and looked lost for a second, until the sound of Dave’s voice percolated into his memory.

“What the hell?  It’s you, ain’t it?” Brian said. “That was a day that will live in infamy.  You were great though.  Bounding up into that car like a cougar climbing rocks on a mountain.”

“You were the rock-star, man” Dave said.  “You led us right to the place we needed to be.  And neither of us got killed, right?  That was a miracle in itself.”

“Indeed it was,” Brian said.  “We’re goddamn lucky that engine didn’t explode on us while we were running past it.  Damn. There was plenty of death and dying though, that night.  Too much.  I’ll never forget it.”

The car behind Dave’s truck began to honk at them.  Then Brian waved that car and the three behind them around Dave’s truck.

They fell silent.

“What the hell are you doing out here like this, man?” Dave said. “You deserve better than this.”

“This is my life, brother,” Brian said. “My choice.  Live free or die.  I’m a free man.  With nothing left to lose.”

“I can get you to a shelter,” Dave said.  “They might be able to find you a place.”

“No harm, no foul,” Brian said. “This is my life, man.  No shelter for me. “

“I got a place,” Dave said, and regretted it as soon as he said it.  There was no way his wife would ever put up with a guy like Brian, and God only knows what kind of trouble a guy like Brian brings with him, what kind of chaos.

But in that moment, Dave knew he had to do something.

“Not my gig, brother,” Brian said.  “Thanks for the offer.  But I’m a live free or die kind of human, from now until eternity.”

By now there were more cars lined up behind Dave’s truck.

The light changed again.

The cars started honking.

“Got to go, brother,” Brian said.

Dave reached for his wallet.

“Let me give you…”

“Not a chance, brother.  I got this.  You and me, we’re connected.  In a different way.  I’m okay.  I got it covered.”

Then Brian turned, went back to the median strip and sat down in his chair.  He sat down to think.

The cars behind Dave honked again.

Dave rolled up his window.  Then he made that right turn. And drove away.

.

We are lost, as a people, if we think any of us has a better way.  If we don’t stop, look, and listen. And be one people, instead of competing with one another for attention, ownership and control.

___

Many thanks to Carol Levitt for proofreading, and to Lauren Hall for all-around help and support.

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Read more short stories by Michael Fine, go here: https://2×8.ea2.myftpupload.com/dr-michael-fine/

Michael Fine, MD is currently Health Policy Advisor in Central Falls, Rhode Island and Senior Population Health and Clinical Services Officer at Blackstone Valley Health Care, Inc. He is facilitating a partnership between the City and Blackstone to create the Central Falls Neighborhood Health Station, the US first attempt to build a population based primary care and public health collaboration that serves the entire population of a place.He has also recently been named Health Liaison to the City of Pawtucket. Dr. Fine served in the Cabinet of Governor Lincoln Chafee as Director of the Rhode Island Department of Health from February of 2011 until March of 2015, overseeing a broad range of public health programs and services, overseeing 450 public health professionals and managing a budget of $110 million a year.

Dr. Fine’s career as both a family physician and manager in the field of healthcare has been devoted to healthcare reform and the care of under-served populations. Before his confirmation as Director of Health, Dr. Fine was the Medical Program Director at the Rhode Island Department of Corrections, overseeing a healthcare unit servicing nearly 20,000 people a year, with a staff of over 85 physicians, psychiatrists, mental health workers, nurses, and other health professionals.He was a founder and Managing Director of HealthAccessRI, the nation’s first statewide organization making prepaid, reduced fee-for-service primary care available to people without employer-provided health insurance. Dr. Fine practiced for 16 years in urban Pawtucket, Rhode Island and rural Scituate, Rhode Island. He is the former Physician Operating Officer of Hillside Avenue Family and Community Medicine, the largest family practice in Rhode Island, and the former Physician-in-Chief of the Rhode Island and Miriam Hospitals’ Departments of Family and Community Medicine. He was co-chair of the Allied Advocacy Group for Integrated Primary Care.

He convened and facilitated the Primary Care Leadership Council, a statewide organization that represented 75 percent of Rhode Island’s primary care physicians and practices. He currently serves on the Boards of Crossroads Rhode Island, the state’s largest service organization for the homeless, the Lown Institute, the George Wiley Center, and RICARES. Dr. Fine founded the Scituate Health Alliance, a community-based, population-focused non-profit organization, which made Scituate the first community in the United States to provide primary medical and dental care to all town residents.Dr. Fine is a past President of the Rhode Island Academy of Family Physicians and was an Open Society Institute/George Soros Fellow in Medicine as a Profession from 2000 to2002. He has served on a number of legislative committees for the Rhode Island General Assembly, has chaired the Primary Care Advisory Committee for the Rhode Island Department of Health, and sat on both the Urban Family Medicine Task Force of the American Academy of Family Physicians and the National Advisory Council to the National Health Services Corps.

 All of Michael Fine’s stories and books are available on MichaelFineMD.com or by clicking here

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