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Pediatric Skills for Occupational Therapy
Assistants

FIFTH EDITION

Jean Welch Solomon, MHS, OTR/L, FAOTA

Occupational Therapist, Private Practice, Moncks Corner, South Carolina

Jane Clifford O’Brien, PhD, MS, EdL, OTR/L,

FAOTA
Professor, Department of Occupational Therapy, University of New England,
Portland, Maine
Table of Contents

Cover image

Title page
Copyright

Elsevier
3251 Riverport Lane
St. Louis, Missouri 63043
PEDIATRIC SKILLS FOR OCCUPATIONAL THERAPY ASSISTANTS, FIFTH
EDITION ISBN: 978-0-323-59713-5

Copyright © 2021 by Elsevier, Inc. All rights reserved.

No part of this publication may be reproduced or transmi ed in any form or

by any means, electronic or mechanical, including photocopying, recording, or
any information storage and retrieval system, without permission in writing
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about the Publisher’s permissions policies and our arrangements with
organizations such as the Copyright Clearance Center and the Copyright
Licensing Agency, can be found at our website:
www.elsevier.com/permissions.

This book and the individual contributions contained in it are protected under
copyright by the Publisher (other than as may be noted herein).

Notice

Practitioners and researchers must always rely on their own experience and
knowledge in evaluating and using any information, methods, compounds or
experiments described herein. Because of rapid advances in the medical
sciences, in particular, independent verification of diagnoses and drug dosages
should be made. To the fullest extent of the law, no responsibility is assumed
by Elsevier, authors, editors or contributors for any injury and/or damage to
persons or property as a ma er of products liability, negligence or otherwise,
or from any use or operation of any methods, products, instructions, or ideas
contained in the material herein.

Previous editions copyrighted 2016, 2011, 2007, and 2000.

Library of Congress Control Number: 2020931591

Senior Content Strategist: Lauren Willis
Senior Content Development Manager: Lisa Newton
Senior Content Development Specialist: Danielle M. Frazier
Publishing Services Manager: Julie Eddy
Senior Project Manager: Rachel E. McMullen
Design Direction: Margaret Reid

Printed in China

Last digit is the print number: 9 8 7 6 5 4 3 2 1

Dedication

This book is dedicated to my childhood best friend, Elaine.

Jeannie
Contributors

Susan Bazyk, PhD, OTR/L, FAOTA

Professor Emerita
School of Health Sciences
Cleveland State University;
Director
Every Moment Counts, LLC
Cleveland, Ohio

Patricia Bowyer, EdD, MS, OTR, FAOTA, SFHEA, ACUE

Professor/Post Professional Programs Coordinator
School of Occupational Therapy
Texas Woman’s University
Houston, Texas

Susan M. Cahill, PhD, OTR/L, FAOTA

Associate Professor & Program Director
Occupational Therapy Program
Lewis University
Romeoville, Illinois

Theresa Carlson Carroll, OTD, OTR/L

Clinical Assistant Professor
Occupational Therapy
University of Illinois at Chicago
Chicago, Illinois

Ricardo C. Carrasco, PhD, OTR/L, FAOTA

Director & Professor, Entry-Level Doctor of Occupational Therapy Program
Occupational Therapy
Nova Southeastern University, Tampa Bay Regional Campus
Clearwater, Florida

Nancy Carson, PhD, OTR/L, FAOTA

Associate Dean for Academic and Faculty Affairs, College of Health
Professions
Medical University of South Carolina
Charleston, South Carolina
Pa y Coker-Bolt, PhD, OTR/L, FAOTA
Professor
Department of Health Professions
Medical University of South Carolina
Charleston, South Carolina

Hannah Colias, MS, OTR/L

Occupational Therapy
University of New England
Portland, Maine

Elizabeth W. Crampsey, EdD, MS, OTR/L, BCPR

Assistant Clinical Professor
Occupational Therapy
University of New England
Portland, Maine

Brad E. Egan, OTD, PhD, CADC, OTR/L

Associate Professor/Site Coordinator
Occupational Therapy
Lenoir-Rhyne University
Columbia, South Carolina

Nadine K. Hanner, OTD, OTR/L

Academic Fieldwork Coordinator/Instructor
OTA Program
Trident Technical College
North Charleston, South Carolina

Karen S. Howell, BS, MHS, PhD , Retired St. Augustine, Florida

Jessica M. Kramer, PhD, OTR/L

Associate Professor
Department of Occupational Therapy
University of Florida
Gainesville, Florida

Cheryl B. Lucas, EdD, OTR/L

Assistant Professor
Occupational Therapy Department
Quinnipiac University, Hamden
Hamden, Connecticut;
Developmental Specialist
Thom Early Intervention Program
Worcester, Massachuse s

Angela Chinners Marsh, AHS, COTA/L

Department of Exceptional Children
Charleston County School District
Charleston, South Carolina

Margaret Q. Miller, MS, OTR/L, C/NDT, CNT

Pediatric Acute Care Therapy
Providence Sacred Heart Medical Center, Spokane, Washington;
Occupational Therapy Assistant Program
Spokane Falls Community College
Spokane, Washington

Erin Naber, BS, DPT

Senior Physical Therapist
Fairmount Rehabilitation Programs
Kennedy Krieger Institute
Baltimore, Maryland

Randi Carlson Neideffer, AA, AHS(OT), Certificate in Massage Therapy,

MSOT, OTR/L
Lead Therapist—Active Day of the Lowcountry
The Weston Group
Goose Creek, South Carolina;
OTR/L (Retired)
Office of Exceptional Children
Charleston County Schools
Charleston, South Carolina

Jane Clifford O’Brien, PhD, MS, EdL, OTR/L, FAOTA

Professor
Department of Occupational Therapy
University of New England
Portland, Maine

Molly O’Brien
Roger Williams University
Education
Roger Williams University
Bristol, Rhode Island

Mashelle K. Painter, MEd, COTA/L, CLA

OTA Program Director and Faculty
Occupational Therapy Assistant Program
Linn-Benton Community College
Lebanon, Oregon

Mary Elizabeth Patnaude, DHSc, OTR/L

Associate Clinical Professor
Occupational Therapy
University of New England
Portland, Maine

Teressa Garcia Reidy, MS, OTR/L

Senior Occupational Therapist
Fairmount Rehabilitation Programs
Kennedy Krieger Institute
Baltimore, Maryland

Winifred Schul -Krohn, PhD, OTR/L, BCP, SWC, FAOTA

Chair and Professor of Occupational Therapy
Occupational Therapy
San Jose State University
San Jose, California

Deborah A. Schwar , OTD, OTR/L, CHT

Product and Educational Specialist
Physical Rehabilitation
Orfit Industries America
Leonia, New Jersey

Natasha Smet, OTD

Assistant Professor
Occupational Therapy
Baylor University
Waco, Texas

Jean Welch Solomon, MHS, OTR/L, FAOTA

Occupational Therapist
Private Practice
Moncks Corner, South Carolina
Erin Kelly Speeches, MS, OTR/L
Occupational Therapy
University of New England
Portland, Maine

Susan A. Stallings-Sahler, MS, PhD, OTR/L, FAOTA

Professor
Department of Occupational Therapy
Nova Southeastern University
Tampa, Florida

Ashley Stoffel, OTD, OTR/L, FAOTA

Clinical Associate Professor
Occupational Therapy
University of Illinois at Chicago
Chicago, Illinois

Abigail Swidergal, BS, AAS, AA, AS

Adjunct Faculty
Occupational Therapy Assistant Program
McHenry County College
Crystal Lake, Illinois;
Adjunct Faculty
Occupational Therapy Assistant Program
South Suburban College
South Holland, Illinois

Kerryellen G. Vroman, PhD, OTR/L, FAOTA

Vice President for International Programs
University of New Hampshire
Durham, New Hampshire

Pamela J. Winton, BA, MA, PhD

Senior Scientist Emeritas
Frank Porter Graham Child Development Institute;
Research Professor Emeritas
School of Education
University of North Carolina, Chapel Hill
Chapel Hill, North Carolina

Robert E. Winton, MD
Retired
Department of Psychiatry
Duke University
Durham, North Carolina

Rachael J. Wurst, MS, OTR/L

Occupational Therapy
University of New England
Portland, Maine
Preface

This book has been wri en for the occupational therapy assistant (OTA)
student and the certified occupational therapy assistant (COTA) working in
the pediatric practice se ing. The language is consistent with the Occupational
Therapy Practice Framework (3rd edition). a Each chapter emphasizes practical
information that may readily be used by students, COTAs and entry-level
registered occupational therapists (OTR) who work with children and
adolescents. Theories, frames of reference, and practice models are introduced
and integrated into the content so they can be easily applied. When possible,
the text differentiates between the roles of the COTA and the OTR. The term
occupational therapy practitioner refers to OTRs and COTAs and is used during
discussions of procedures that can be performed by either.
All the chapters contain the following elements: outline, key terms,
objectives, summary, review questions, and suggested activities to help
readers understand material and apply concepts in practice. Each chapter
begins with an outline that identifies the main topics included in each chapter.
Key terms are listed in the order they are discussed and are bolded within the
text. The chapter objectives concisely outline the material readers will learn
from studying the chapter. A summary at the end of each chapter
reemphasizes the key points of the chapter. Review questions help readers
synthesize the information presented. Suggested activities are designed to
reinforce information in interesting ways. These activities can be completed
individually or in small groups.
Boxes, case studies, tables, and figures are used throughout the chapters to
reiterate, exemplify, or illustrate specific points. Interspersed throughout each
chapter are “Clinical Pearls”—words of wisdom based on the authors’ clinical
expertise. The Clinical Pearls contain helpful hints or reminders that have been
consistently useful for OT practitioners working with children and youth.
Several chapters include additional appendixes useful in clinical practice.
The first five chapters present an overall framework of occupational therapy
practice with children and adolescents and the se ings in which practitioners
work. Chapter 1, Scope of Practice, provides an overview of occupational
therapy practice with children and youth, including a discussion of
recommended pediatric curriculum content, selected practice models, COTA
supervision, establishment of service competency, and a review of the OT
Code of Ethics. The next four chapters—Family Systems (Chapter 2), Medical
 p y y ( p )
Systems (Chapter 3), Educational Systems (Chapter 4), and Community Systems
(Chapter 5)—delineate the variety of se ings in which practitioners who work
with children and families practice and describe contexts, team members,
intervention approaches, and laws governing occupational therapy services.
The next group of chapters provides readers with an overview of typical
development that serves as a foundation for clinical practice. Principles of
Normal Development (Chapter 6) offers an overview of the periods and
principles of normal development. Using the Occupational Therapy Practice
Framework a as a guide, Development of Performance Skills (Chapter 7) explains
the development of performance skills from infancy to adolescence.
Development of Occupations (Chapter 8) presents information about the typical
sequence of development of areas of occupation (e.g., education, feeding,
dressing, bathing, toileting, play, rest, and sleep). Adolescent Development: Being
an Adolescent, Becoming an Adult (Chapter 9) portrays the uniqueness of
adolescence and the journey into adulthood.
The Occupational Therapy Process (Chapter 10) addresses the manner in which
OT practitioners evaluate, intervene, and measure outcomes of intervention.
The authors provide an overview of documentation, practice models (frames
of reference), and measurements using a variety of case examples. An
explanation of anatomy, physiology, and neuroscience structures, functions,
and terminology for practice with children and adolescents are covered in
Chapter 11 (Anatomy and Physiology for the Pediatric Practitioner) and Chapter
12 (Neuroscience for the Pediatric Practitioner).
A variety of chapters explain the etiology, signs, and symptoms of pediatric
conditions/disorders that an OT practitioner may encounter and include
current intervention models and strategies. Chapter 13 (Pediatric Health
Conditions) describes a variety of medical conditions, and Chapter 14 (Mental
Health Disorders) reviews disorders affecting psychosocial functioning. Chapter
15, Childhood and Adolescent Obesity, explores issues surrounding the health
and wellness of children and includes information on intervention planning
specific to this population. Two common conditions are examined in Chapter
16 (Intellectual Disabilities) and Chapter 17 (Cerebral Palsy). Specific intervention
strategies for children with cerebral palsy are outlined in Chapter
18 (Positioning and Handling: A Neurodevelopmental Approach) using case studies
to illustrate its application to practice.
Chapters 19 to 22 examine areas of intervention of primary importance to
OT practitioners and include specific strategies for intervention related to
occupations, specifically, Activities of Daily Living and Sleep/Rest (Chapter 19),
Instrumental Activities of Daily Living (Chapter 20), Play and Playfulness (Chapter
21), and School: Handwriting (Chapter 22). Each chapter elaborates on
intervention techniques, strategies, and outcomes using case studies to
illustrate key concepts and principles.
OT practitioners often use media to assist children in achieving their
therapeutic goals. Chapter 23 (Therapeutic Media: Activity With Purpose)
provides sample activities, describes grading and adapting activities, and
outlines the process for matching activities to children’s therapeutic goals.
Chapter 24 (Motor Control and Motor Learning) describes principles that
practitioners may use to teach motor skills. The authors provide an overview
of research evidence while outlining strategies that can easily be implemented
in practice with a variety of children and adolescents.
The remaining chapters explore specialized areas of practice. Integration and
Occupation/Sensory Processing (Chapter 25) defines sensory processing and
integration, describes intervention strategies, and discusses the underlying
theory and principles of a sensory integrative approach. Applying the Model of
Human Occupation to Pediatric Practice (Chapter 26) defines the components of
this model and describes how it can be applied to design and conduct effective
intervention for children and youth. Assistive Technology (Chapter 27) explains
the process of selecting assistive technology and gives examples of types of
assistive technology. Orthoses, Orthotic Fabrication, and Elastic Therapeutic Taping
for the Pediatric Population (Chapter 28) reviews types of orthoses, describes
principles and reasoning related to orthotic fabrication, and summarizes
strategies and principles regarding elastic therapeutic taping (e.g., kinesio
taping). The final chapter, Animal-Assisted Therapy (Chapter 29), presents
readers with innovative ideas for incorporating animals in occupational
therapy practice with children and youth. The authors provide examples of
animal-assisted therapy projects.
This book has evolved from many years of teaching pediatric skills to
students and is intended to present readers with theoretical and practical
knowledge required for occupational therapy practice with children and
adolescents. All chapters have been revised and updated to reflect current
professional philosophy, research, and practice. Case studies and examples are
embedded throughout to illustrate concepts more clearly. Each chapter offers
numerous clinical pearls based on the expertise of the author(s). Readers are
urged to examine the tables, boxes, and figures that clarify topics. This fifth
edition includes additional content throughout to assist readers in applying
concepts to occupational therapy intervention for children and youth.
Chapters are wri en in clear and concise language with numerous examples to
help readers understand and use concepts to design and implement
interventions. In addition to the textbook, the Evolve Learning Site has been
updated and revised to be er meet the reader’s needs.
The Evolve Learning Site includes instructional materials (e.g., video clips,
student multiple-choice questions, and Web resources) to help readers
comprehend information and apply it in practice. A variety of video clips are
available to illustrate key concepts from specific chapters. For example, video
clips illustrate the use of therapeutic media, hand skill intervention, play,
dressing, and feeding. Additional video clips display typical and atypical
development, family-centered care, and community and rehabilitation
intervention. To develop increased observational skills, questions are supplied
for readers to consider while viewing video clips. Student multiple-choice
questions (with rationales) assist in focusing student reading and are designed
to cue students toward important content. Students are urged to examine the
questions and review content in the textbook to reinforce learning. The Evolve
Learning Site also includes a compilation of websites that provide resources
useful in practice. For example, websites regarding orthotic material, assistive
technology, therapeutic media ideas, and creative intervention plans are
provided. An expanded glossary and chapter specific appendices for several
chapters have been included on the Evolve Learning Site for this edition.
The fifth edition of Pediatric Skills for Occupational Therapy Assistants
represents the expertise of an impressive group of contributing authors who
have developed up-to-date, practical, and innovative material. The authors
represent expertise in a variety of areas. We are grateful to the authors,
reviewers, and contributors for their wisdom and skill. We hope you will enjoy
reading and using all the learning materials provided in the textbook and
Evolve Learning Site.
Jean Welch Solomon, MHS, OTR/L, FAOTA
Jane Clifford O’Brien, PhD, MS, EdL, OTR/L, FAOTA

a American Occupational Therapy Association. (2014). Occupational therapy

practice framework: domain and process (3rd ed.). Am J Occup Ther, 68(Suppl.
1), S1–S48.
Acknowledgments

On this fifth edition, we had the opportunity to work with many talented and
dedicated professionals who are passionate about the care of children and
youth who have special needs. The authors come from various areas of the
country, represent a wide range of practice areas, and have extensive clinical
experience and knowledge that they share with the readers. It was fun and
exciting reconnecting with colleagues and friends who participated in this
project, and we are thankful for their work. We appreciate the hard work of
the Elsevier editorial team, Danielle Frazier and Lauren Willis, and the
production staff. It has been such a pleasure working with everyone on this
textbook.
1: Scope of Practice
Jean Welch Solomon, and Jane Clifford O’brien

CHAPTER OUTLINE

Subject Areas for Pediatric Occupational Therapy

Vision 2025
Occupational Therapy Practice Framework
The Occupational Therapy Process
Roles of the Occupational Therapist and Occupational Therapy
Assistant
Qualifications, Supervision, and Service Competency
Qualifications
Supervision
Service Competency
Videotaping
Cotreatment
Observation
AOTA Code of Ethics
Scholarship
Summary

CHAPTER OBJECTIVES
After studying this chapter, the reader will be able to accomplish the following:
• Identify subject areas related to pediatric course content for which
entry-level certified occupational therapy assistants need to have
general knowledge.
• Describe the vision of the American Occupational Therapy Association
(AOTA).
• Describe the basics of the Occupational Therapy Practice Framework
(OTPF), and its relationship to clinical practice.
• Describe the four levels at which occupational therapists supervise
occupational therapy assistants.
• Define service competency and give examples of ways it may be
obtained.
• Outline AOTA Code of Ethics and apply the code to pediatric practice.
• Define and give examples of the different types of scholarship in which
practitioners may engage.

KEY TERMS
Vision 2025
Occupational Therapy Practice Framework: Domain and Process
Levels of supervision
Service competency
AOTA Code of Ethics
Scholarship
This chapter provides an overview of occupational therapy (OT) practice
with children and adolescents. The authors begin with a discussion of the
subject areas important in pediatric OT curriculum, followed by a
description of the vision of the American Occupational Therapy
Association (AOTA) with a ention to issues of children and youth. To
understand the OT process, a review of the OTPF is provided. Using case
examples, the authors provide descriptions of levels of supervision and
service competency requirements for occupational therapy assistants
(OTAs). The scope of OT practice with children and adolescents would not
be complete without an understanding of the AOTA Code of Ethics.
Lastly, the authors emphasize lifelong learning and scholarship to enhance
practice.
During the past 20 years, significant changes have occurred in the
provision of pediatric OT services (AOTA, 2014a, 2014c, 2018). Numerous
federal laws that expand the services available to infants, children, and
adolescents who have disabilities have been implemented. Approximately
18% of OTAs work in pediatric se ings (early intervention and schools)
(AOTA, 2015b). OT practitioners also provide pediatric services in medical
se ings such as outpatient clinics and hospitals, as well as in community
se ings such as schools, homes, and daycare centers.
Subject Areas for Pediatric Occupational Therapy
The Accreditation Council for Occupational Therapy Education (ACOTE,
2018) provides standards for educational programs. While educational
programs may organize and structure content in numerous ways, entry-
level OT practitioners must have knowledge in the following areas:

Human development: OT practitioners working with children with

disabilities or atypical development pa erns use knowledge of
normal development and the expected range of performance to
understand children and design effective interventions (see
Chapters 6 to 8, 11).
Importance of families in the OT process: Families are the most
consistent participants on the pediatric team and are central to the
child’s well-being. Understanding the needs of families and
children is essential to the therapeutic process (see Chapter 2).
Specific pediatric diagnoses: Pediatric OT practitioners use
knowledge of specific pediatric diagnoses as a guideline for
determining which assessments, strategies, and methods are the
most appropriate for the child or youth. OT practitioners use
knowledge of the diagnosis to understand factors such as
prognosis, precautions, medical interventions, and guidelines that
are considered in practice decisions (see Chapters 3, 12 to 17).
OT practice models and frames of reference: Understanding models
of practice and frames of reference are necessary for organizing and
developing interventions based on evidence. Knowledge of the
principles, strategies, and techniques allows OT practitioners to
develop and implement interventions for children with a variety of
diagnoses and conditions. Understanding the theory and principles
for intervention allows practitioners to create intervention plans for
children with a variety of conditions interfering with occupational
performance (see Chapters 10, 18, 22 to 29).
Assessments appropriate for a child with a specific disability or
diagnosis: OT practitioners work with children and youth who
have a variety of conditions and diagnoses that interfere with
occupational performance. Therefore OT practitioners use
knowledge of a variety of assessments and therapeutic reasoning to
choose, administer, score, and interpret results so they can develop
and carry out intervention plans. Practitioners also use data from
 assessments to measure outcomes of interventions (interspersed
throughout chapters and a table of assessments is included on the
Evolve website).
Age-appropriate activities: OT practitioners working with children
need to adjust therapy activities to suit the age, developmental
needs, and intervention goals of each child. Knowledge of a range
of age-appropriate activities and the ability to carefully analyze the
client factors required for performance are essential to practice. OT
practitioners use creative activities to address occupational
performance goals. They carefully adjust and change the level of
difficulty (referred to as grading) for activities to meet the child’s
needs (see Chapters 6 to 9, 19 to 22).
Differences among systems (contexts): OT services are provided in a
variety of se ings (e.g., hospitals, schools, daycare centers,
community se ings, and home). OT practitioners work within these
se ings and design OT interventions to meet the needs of children
and youth. For example, children receiving services in a public-
school system require educationally relevant therapy goals and
objectives, whereas children receiving services in a hospital require
medically necessary goals and objectives that allow them to engage
in a variety of occupations (see Chapters 1 to 5).
Assistive technology: OT practitioners who work with infants,
children, and adolescents with disabilities use knowledge of the
range of assistive technologies that promote safe and independent
living and allow children to engage in a variety of occupations (see
Chapter 27).
Vision 2025
Vision 2025 reads: “As an inclusive profession, OT maximizes health, well-
being, and quality of life for all people, populations, and communities
through effective solutions that facilitate participation in everyday living”
(AOTA, 2017). Vision 2025 further defines the work of OT professionals
through five pillars:
Pillars:

• Effective: OT is evidence based, client centered, and cost-effective.

• Leaders: OT is influential in changing policies, environments, and
complex systems.
• Collaborative: OT excels in working with clients and within
systems to produce effective outcomes.
• Accessible: OT provides culturally responsive and customized
services.
• Equity, inclusion, and diversity: We are intentionally inclusive
and equitable and embrace diversity in all its forms (AOTA, 2017).

OT practitioners working with infants, children, and youth embrace

Vision 2025 to be er health, well-being, and quality of life of those with
whom they intervene. OT practitioners work with children and families
using a client-centered approach that encourages children and families to
engage in meaningful activities. They add to the evidence of the profession
by measuring the outcomes of intervention with children and youth;
presenting findings at local, regional, and national meetings; and engaging
in ongoing education and scholarship. As leaders, practitioners working
with children and youth advocate for policies and procedures to support
children and their families. They may influence local, regional, or national
policies and environments. For example, OT practitioners may write
le ers to congress, serve on policy commi ees (such as school board, state
or national), or advocate for services or equipment to funding agencies. As
members of teams (such as teams in school systems, hospital, community),
OT practitioners collaborate with others to promote engagement in daily
activities. They may serve on work groups to be er services for children
and youth; create new and innovative programming with others; or seek
resources by collaborating with community members. The OT practitioner
working with children and families provides intervention in a variety of
cultures and tailors services to meet the child’s and family’s needs.
Importantly, OT practitioners working in pediatrics promote involving
persons with all abilities in daily activities. They may support accessible
playgrounds and school programs and provide resources so that children
and their families may participate fully in the community. OT
practitioners working with children and families embrace the diversity of
families and provide equitable services to all. They are a uned to obstacles
which may prevent children and their families from participating in
meaningful occupations. For example, the OT practitioner may discover
that a school event is not accessible to those in wheelchairs and bring this
to the a ention of those in charge so that all children and family members
may a end. These are some of the ways in which OT practitioners can
contribute to Vision 2025 to benefit the health, well-being, and quality of
life of children and families.
Occupational Therapy Practice Framework
The Occupational Therapy Practice Framework (the Framework) defines
both the process and domain of OT (AOTA, 2014b). (Subsequent chapters
in this text discuss the Framework in detail and apply the concepts to
practice.) It is designed for use by occupational therapists, certified
occupational therapists, consumers, and health care providers. The
domains of OT are: occupations, client factors, performance skills,
performance pa erns, contexts and environments, and activity demands
(AOTA, 2014b). Occupations include activities of daily living (ADLs) (e.g.,
bathing, toileting, dressing, feeding, eating, functional mobility),
instrumental activities of daily living (IADLs) (e.g., care of others, care of
pets, driving, and community mobility), rest and sleep, education, work,
play, leisure, and social participation (AOTA, 2014b). OT practitioners
examine client factors to determine how they are influencing occupations.
Client factors include specific capacities and characteristics of beliefs that
reside within the person and influence how they perform (AOTA, 2014b).
Client factors include values, beliefs and spirituality, body functions, and
body structures (AOTA, 2014b). For example, a child may have cerebral
palsy, resulting in muscle tone that interferes with his ability to use his
hand effectively (e.g., body function), influencing his ability to feed
himself (occupation). His body functions (e.g., range of motion, muscle
tone) influence his occupations. See Fig. 1.1, which shows an OT
practitioner facilitating upright si ing posture for play. Practitioners also
examine performance skills (sensory, motor, process, social, cognitive, and
emotional skills) and pa erns (habits, routines, roles, and rituals)
associated with occupations. OT practitioners may design interventions to
address all domains. Equally important is an examination of the contexts
and environments in which an occupation occurs.
FIG. 1.1 The occupational therapy practitioner facilitates sitting
so the child can play with toys.
Table 1.1

Definitions of Contexts and Environments

Adapted from the American Occupational Therapy Association. (2014). Occupational

therapy practice framework: domain and process. American Journal of Occupational
Therapy, 68(Suppl. 1), S1–S48.

According to the Framework, these contexts and environments are

cultural, personal, physical, social, temporal, and virtual (Table 1.1
provides examples). Contexts influence how an occupation is viewed,
performed, and evaluated. For example, when considering the temporal
context, practitioners expect differences in social behavior between a 2-
year-old toddler and 6-year-old child. The practitioner evaluates the
activity demands (objects, properties, social, space, actions, and body
functions needed) as part of the OT process. Fig. 1.2 shows children during
free play in an unstructured activity. The children aged 2 and 4 are both
able to succeed in this play because the activity demands are flexible.
 FIG. 1.2 Children enjoy free play with others. This activity
requires minimal motor skills (activity demands) for each child to
be successful.
 FIG. 1.3 The occupational therapy assistant engages the child in
a conversation to collaborate with the child during the
occupational therapy session.

OT is a dynamic ongoing process that includes evaluation, intervention,

and outcomes (AOTA, 2014b). Evaluation provides an understanding of the
clients’ challenges, occupational history, pa erns, and assets (AOTA,
2014b). Intervention includes the plan (based on selected theories, models
of practice, frames of reference, and evidence), implementation, and
review. Outcome refers to how well the goals are achieved. The practitioner
and client collaborate throughout the OT process. Fig. 1.3 shows the OTA
engaging the child in a conversation to find out her likes and dislikes. The
practitioner first completes an occupational profile that helps the OT
practitioner to understand the client’s story, goals, and routines. The
occupational profile informs the intervention plan, along with any
assessment and observational information. The practitioner implements
and reviews the plan to determine the outcomes of the intervention. A
practitioner may revise the occupational profile during intervention as
new information emerges. The practitioner also measures outcomes
throughout the intervention. The context and environment influence all
stages of the process.
FIG. 1.4 Occupational therapy practitioners help children to
engage in occupations such as play.
 The Framework emphasizes that practitioners focus on occupations
rather than its components. The goal of OT services is to enable children
and adolescents to engage in daily occupations within their own
environments (Fig. 1.4). For example, a practitioner may identify that poor
hand skill is interfering with a child’s ability to write in the classroom. The
practitioner may target the occupation of success in the academic se ing
by providing the child with an alternative method (such as iPad access) to
communicate in class and work on the components of writing outside of
class time. The goal is to enable the child’s success in the occupation of
education (i.e., school, home, community).
The Occupational Therapy Process
The OT practitioner uses a model of practice to organize his or her
thinking and chooses a frame of reference to design interventions based on
the child’s and family’s needs (see Chapter 10 for specifics on model of
practices and frames of reference). The frame of reference provides the
guidelines, strategies, and techniques for what to do during therapy
sessions. Frames of reference provide information on what function and
dysfunction look like and how to intervene. The OT process begins when a
parent, physician, teacher, or other concerned professional requests a
referral for OT. The occupational therapist decides whether the referred
client should be screened to determine whether the client will benefit from
OT services (AOTA, 2005, 2014a, 2014c). If the screening shows that the
child is likely to benefit from OT services, an evaluation is performed. The
occupational therapist determines the areas to be evaluated and may
assign portions of the evaluation to an OTA. The evaluation process helps
the occupational therapist to identify the child’s strengths and weaknesses.
After interpreting assessment findings, the occupational therapist creates
long-term goals and short-term objectives to meet the child’s needs. In
collaboration with the OTA, the occupational therapist develops an
intervention plan based on these goals and objectives (AOTA, 2018) (Fig.
1.5). The plan is implemented and modified as needed based on the child’s
progress. The intervention is designed to address the goals and objectives
based on a selected frame of reference.
 FIG. 1.5 The occupational therapist and occupational therapy
assistant collaborate on goals and an intervention plan.

When deciding on a frame of reference, OT practitioners consider the

child’s diagnosis, age, and stage in life (e.g., toddler, adolescent, adult) and
goals. They also consider the se ing in which services will be provided,
their own clinical expertise, and current research. OT practitioners use
current research to develop effective interventions for the children they
serve. The client is discharged when all the goals and objectives have been
met or if the occupational therapist decides that services should be
discontinued. (For a more detailed discussion of the OT process, see
Chapter 10.)
Roles of the Occupational Therapist and
Occupational Therapy Assistant
The occupational therapist is responsible for all aspects of the OT process
and supervises the OTA. The extent to which the occupational therapist
supervises the OTA depends on the OTA’s knowledge, skill, and
experience. Occupational therapists and OTAs are both considered OT
practitioners, and therefore they share the responsibility of communicating
with each other about their clients (AOTA, 2005, 2014a). Fig. 1.6 shows an
OTA engaging a child in a fine motor intervention activity.

FIG. 1.6 The occupational therapy assistant engages the child in

a creating a book to work on visual perceptual and fine motor
skills needed for handwriting in school.
Qualifications, Supervision, and Service
Competency
Entry-level OTAs must meet basic qualifications to practice in the field of
OT. As they gain experience by working with occupational therapists,
OTAs require less supervision and gradually become more competent at
providing OT services (AOTA, 2014a).

Qualifications
Entry-level OTAs must meet specific qualifications, which include
successful completion of course work in an accredited OTA program and
passing the certification examination administered by the National Board
for Certification in Occupational Therapy (AOTA, 2014a). In addition,
OTAs must meet specific requirements established by OT regulatory
boards in their respective states and obtain a license to practice if required
by state law. State regulatory boards work with the AOTA to advocate for
the profession and lobby for legislation to define, update, and revise the
scope of practice (Parsons, 2018; Vogeley, 2018).

Supervision
AOTA has delineated four levels of supervision: close, routine, general,
and minimal. Close supervision is direct, daily contact between the OTA
and the occupational therapist at the work site. Routine supervision is
direct contact between the OTA and the occupational therapist at the work
site at least every 2 weeks and interim contact through other means, such
as telephone conversations or e-mail messages. General supervision is
minimum direct contact of 1 day per month and interim supervision as
needed. Minimum supervision is that provided on an “as-needed” basis. It
is important to note that state OT regulatory agencies may require stricter
guidelines than those established by AOTA. Stricter state guidelines
supersede those of AOTA (AOTA, 2005, 2018).
Table 1.2

Supervision of Occupational Therapy Assistants

Level Of
Type Of Supervision
Supervision
Close Direct and daily contact; on-site supervision.
Routine Direct and regularly scheduled contact; on-site supervision.
General Indirect supervision as needed and direct contact once a month or as
mandated by state regulatory board.
Minimum Direct and indirect supervision as needed or as mandated by state regulatory
board.

The level of supervision that OTAs require varies with their level of
expertise. AOTA defines three levels of expertise: entry, intermediate, and
advanced (AOTA, 2014a). OTAs progress from one level to another based
on acquisition of skills, knowledge, and proficiency and not on their years
of experience. OTAs at the entry-level are typically new graduates or those
entering a new practice se ing who have general knowledge of the
population or se ing but limited clinical experience. Intermediate-level
OTAs have acquired a higher level of skill through clinical experience,
continuing education, and involvement in professional activities.
Advanced-level OTAs have specialized skills and may be recognized as
experts in areas of practice. Although the extent to which an OTA is
supervised varies according to the individual, the level of supervision
generally falls into one defined by AOTA based on the OTA’s expertise.
An entry-level OTA requires close supervision, an intermediate-level OTA
requires routine or general supervision, and an advanced-level OTA
requires minimum supervision (Table 1.2) (AOTA, 2014a).

Service Competency
AOTA defines service competency as “the determination, made by
various methods, that two people performing the same or equivalent
procedures will obtain the same or equivalent results” (AOTA, 2005,
2014a, 2014c, 2018). Service competency is a means of ensuring that two
individual OT practitioners will have the same results when administering
a specific assessment, observing a specific performance area or component,
or providing intervention. Communication between the OTA and the
occupational therapist is an essential part of the entire OT process but is
especially important when establishing service competency. Occupational
therapists must make sure that they and the OTAs perform assessments
and intervention procedures in the same way. Once an occupational
therapist has determined that an OTA has established service competency
in a certain area, the OTA may perform an assessment or intervention
procedure (within the parameters of that area) without close supervision
by the occupational therapist. Ensuring service competency is an ongoing
mutual learning experience (AOTA, 2014a).
AOTA has specific guidelines for establishing service competency. For
standardized assessments and intervention procedures that require no
specific training to administer, the occupational therapist and OTA both
perform the procedure. If they obtain equivalent results, the OTA may be
allowed to administer subsequent procedures independently. For
assessments and intervention procedures requiring subjective
interpretations, direct observation and videotaping are valuable tools that
can be used to establish service competency. These tools allow
practitioners to observe a client performing a task and compare their
individual interpretations of the performance. Likewise, an occupational
therapist can videotape a session with a client, have an OTA watch the
tape, and compare the observations that have been made. If the
occupational therapist and the OTA consistently have similar
interpretations, the OTA has established competency in observing and
interpreting the area of performance (AOTA, 2005, 2014a, 2014c, 2018).
Specific examples of establishing service competency are provided here.

Videotaping
Teresa, an OTA, used the biomechanical approach to intervention when
providing care for Abigail, a 10 month old who experienced a brachial
plexus injury at birth. Before working with Abigail, Teresa reviewed a
videotape of her supervising occupational therapist treating another child
with the same injury. Teresa’s discussion of the videotaped session with
the occupational therapist revealed that she understood the intervention
procedures used. Abigail’s next therapy session, which was led by Teresa,
was videotaped. The occupational therapist watched the videotape and
observed that Teresa carefully positioned the child and successfully
carried out the intervention plan. The occupational therapist determined
that Teresa established the service competency needed to treat Abigail.
The occupational therapist and Teresa agreed that as part of the ongoing
learning process, each month they would videotape a session and
subsequently discuss one of Abigail’s intervention sessions.

Cotreatment
Raja, a 4-year-old boy diagnosed with cerebral palsy, recently received a
nerve block to decrease flexor tone in his right arm. Since then, Alejandro,
the occupational therapist, was treating him. Alejandro asked Richard, an
OTA, to assist him in treating Raja. Richard prepared for the cotreatment
by reading about nerve blocks and carefully observing Alejandro’s one-on-
one intervention session with Raja. Richard asked pertinent questions and
expressed a keen interest in working with Raja. After several successful
cotreatment sessions during which Alejandro and Richard obtained
equivalent outcomes from the procedures used, Alejandro assigned Raja’s
case to Richard. Richard then received only general supervision from
Alejandro because he demonstrated service competency when working
with Raja.

Observation
Missy, an OTA, used the rehabilitative approach to treat Dewayne, a 6-
year-old who obtained an amputation below the elbow. Before becoming
an OTA, Missy volunteered regularly at Shriner’s Hospital (on the unit
that specialized in trauma and burn cases) and she observed many clients
being fi ed with prostheses; she frequently assisted the therapists. After
graduating as an OTA, she was hired to work in the OT Department at
Shriner’s Hospital. As an OTA, she worked closely with an occupational
therapist, who developed intervention plans for clients with injuries like
Dewayne’s. Missy also observed and assisted in administering the
department’s prosthetic checklist, which was designed to assess the care,
application, and use of prostheses. Missy began working with Dewayne
when he was fi ed for his first prosthesis at the age of 3. The occupational
therapist observed Missy administering the procedures on the prosthetic
checklist; their findings were equivalent. When Dewayne was fi ed with a
new prosthesis, the occupational therapist was confident that Missy could
independently and accurately complete the checklist procedures. Missy
demonstrated service competency in administering the assessment.
Exploring the Variety of Random
Documents with Different Content
 § 18
It contributed to the thoroughness of Peter’s thinking that it was
some time before he could be put into a position to read comfortably.
And it has to be recorded in the teeth of the dictates of sentiments
and the most sacred traditions of romance that the rôle played by
both Joan and Hetty in these meditations was secondary and
incidental. It was an attenuated and abstract Peter who lay in the
French hospital, his chief link of sense with life was a growing
hunger; he thought very much about fate, pain, the nature of things,
and God, and very little about persons and personal incidents—and
so strong an effect had his dream that God remained fixed steadfastly
in his mind as that same intellectual non-interventionist whom he
had visited in the fly-blown office. But about God’s rankling repartee,
“Why don’t you exert yourself?” there was accumulating a new
conception, the conception of Man taking hold of the world,
unassisted by God but with the acquiescence of God, and in
fulfilment of some remote, incomprehensible planning on the part of
God. Probably Peter in thinking this was following one of the most
ancient and well-beaten of speculative paths, but it seemed to him
that it was a new way of thinking. And he was Man. It was he who
had to establish justice in the earth, achieve unity, and rule first the
world and then the stars.
He lay staring at the ceiling, and quite happy now that healing and
habituation had freed him from positive pain, thinking out how he
was to release and co-operate with his India, which had invariably
the face of Mir Jelalludin, how he was to reunite himself with his
brothers in America, and how the walls and divisions of mankind,
which look so high and invincible upon the ground and so trivial
from twelve thousand feet above, were to be subdued to such greater
ends.
It was only as the blood corpuscles multiplied inside him that
Peter ceased to be constantly Man contemplating his Destiny and
Races and Empires, and for more and more hours in the day shrank
to the dimensions and natural warmth of Mr. Peter Stubland
contemplating convalescence in Blighty. He became eager first for
the dear old indulgent and welcoming house at Pelham Ford, and
then for prowls and walks and gossip with Joan and Oswald, and
then, then for London and a little “fun.” Life was ebbing back into
what is understood to be the lower nature, and was certainly the
most intimate and distinctive substance of Mr. Peter Stubland. His
correspondence became of very great interest to him. Certain letters
from Joan, faint but pursuing, had reached him, those letters over
which Joan had sat like a sonneteer. He read them and warmed to
them. He thought what luck it was that he had a Joan to be the best
of sisters to him, to be even more than a sister. She was the best
friend he had, and it was jolly to read so plainly that he was her best
friend. He would like to do work with Joan better than with any man
he knew. Driving a car wasn’t half good enough for her. Some day
he’d be able to show her how to fly, and he would. It would be great
fun going up with Joan on a double control and letting her take over.
There must be girls in the world who would fly as well as any man, or
better.
He scribbled these ideas in his first letter to Joan, and they pleased
her mightily. To fly with Peter would be surely to fly straight into
heaven.
And mixed up with Joan’s letters were others that he presently
sorted out from hers and put apart, as though even letters might hold
inconvenient communion. For the most part they came from Hetty
Reinhart, and displayed the emotions of a consciously delicious
female enamoured and enslaved by one of the heroes of the air. She
had dreamt of him coming in through the skylight of her studio, Lord
Cupid visiting his poor little Psyche—“but it was only the moonlight,”
and she thought of him now always with great overshadowing wings.
Sometimes they were great white wings that beat above her, and
sometimes they were thrillingly soft and exquisite wings, like the
wings of the people in Peter Wilkins. She sent him a copy of Peter
Wilkins, book beloved by Poe and all readers of the fantastic. Then
came the news of his smash. She had been clever enough to link it
with the death of von Papen, the Hun Matador. “Was that your fight,
dear Peterkins? Did you begin on Goliath?” As the cordials of
recovery raced through Peter’s veins there were phases when the
thought of visiting the yielding fair, Jovelike and triumphant in
winged glory, became not simply attractive but insistent. But he
wrote to Hetty modestly, “They’ve clipped one wing for ever.”
And so in a quite artless and inevitable way Peter found his first
leave, when the British hospital had done with him, mortgaged up to
hilt almost equally to dear friend Joan and to Cleopatra Hetty.
The young man only realized the duplicity of his nature and the
complications of his position as the hospital boat beat its homeward
way across the Channel. The night was smooth and fine, with a high
full moon which somehow suggested Hetty, and with a cloud scheme
of great beauty and distinction that had about it a flavour of Joan.
And as he meditated upon these complications that had been
happening in his more personal life while his attention had been still
largely occupied with divinity and politics, he was hailed by an
unfamiliar voice and addressed as “Simon Peter.” “Excuse me,” said
the stout young officer tucked up warmly upon the next deck chair
between a pair of crutches, “but aren’t you Simon Peter?”
Peter had heard that name somewhere before. “My name’s
Stubland,” he said.
“Ah! Stubland! I forgot your surname. Of High Cross School?”
Peter peered and saw a round fair face that slowly recalled
memories. “Wait a moment!” said Peter.... “Ames!”
“Guessed it in one. Probyn and I were chums.”
“What have you got?” said Peter.
“Leg below the knee off, damn it!” said Ames. “One month at the
front. Not much of a career. But they say they do you a leg now better
than reality. But I’d have liked to have batted the pants of the
unspeakable Hun a bit more before I retired. What have you got?”
“Wrist chiefly and shoulder-blade. Air fight. After six weeks.”
“Does you out?”
“For flying, I’m afraid. But there’s lots of ground jobs. And anyhow
—home’s pleasant.”
“Yes,” said Ames. “Home’s pleasant. But I’d like to have got a scalp
of some sort. Doubt if I killed a single Hun. D’you remember Probyn
at school?—a dark chap.”
Peter found he still hated Probyn. “I remember him,” he said.
 “He’s killed. He got the M.M. and the V.C. He wouldn’t take a
commission. He was sergeant-major in my battalion. I just saw him,
but I’ve heard about him since. His men worshipped him. Queer how
men come out in a new light in this war.”
“How was he killed?” asked Peter.
“In a raid. He was with a bombing party, and three men straggled
up a sap and got cornered. He’d taken two machine-guns and they’d
used most of the bombs, and his officer was knocked out, so he sent
the rest of his party back with the stuff and went to fetch his other
men. One had been hit and the other two were thinking of
surrendering when he came back to them. He stood right up on the
parados, they say, and slung bombs at the Germans, a whole crowd
of them, until they went back. His two chaps got the wounded man
out and carried him back, and left him still slinging bombs. He’d do
that. He’d stand right up and bung bombs at them until they seemed
to lose their heads. Then he seems to have spotted that this
particular bunch of Germans had gone back into a sort of blind alley.
He was very quick at spotting a situation, and he followed them up,
and the sheer blank recklessness of it seems to have put their wind
up absolutely. They’d got bombs and there was an officer with them.
But they held up their hands—nine of them. Panic. He got them right
across to our trenches before the searchlights found him, and the
Germans got him and two of their own chaps with a machine-gun.
That was just the last thing he did. He’d been going about for months
doing stunts like that—sort of charmed life business. The way he
slung bombs, they say, amounted to genius.
“They say he’d let his hair grow long—perfect golliwog. When I saw
him it certainly was long, but he’d got it plastered down. And there’s
a story that he used to put white on his face like a clown with a great
red mouth reaching from ear to ear—— Yes, painted on. It’s put the
Huns’ wind up something frightful. Coming suddenly on a chap like
that in the glare of a searchlight or a flare.”
“Queer end,” said Peter.
“Queer chap altogether,” said Ames....
He thought for a time, and then went on to philosophize about
Probyn.
 “Clever chap he was,” said Ames, “but an absolute failure. Of
course old High Cross wasn’t anything very much in the way of a
school, but whatever there was to be learnt there he learnt. He was
the only one of us who ever got hold of speaking French. I heard him
over there—regular fluent. And he’d got a memory like an
encyclopædia. I always said he’d do wonders....”
Ames paused. “Sex was his downfall,” said Ames.
“I saw a lot of him altogether, off and on, right up to the time of the
war,” said Ames. “My people are furniture people, you know, in
Tottenham Court Road, and his were in the public-house fitting line
—in Highbury. We went about together. I saw him make three or
four good starts, but there was always some trouble. I suppose most
of us were a bit—well, keen on sex; most of us young men. But he was
ravenous. Even at school. Always on it. Always thinking about it. I
could tell you stories of him.... Rum place that old school was, come
to think of it. They left us about too much. I don’t know how far you
——.... Of course you were about the most innocent thing that ever
came to High Cross School,” said Ames.
“Yes,” said Peter. “I suppose I was.”
“Curious how it gnaws at you once it’s set going,” said Ames....
Peter made a noise that might have been assent.
Ames remained thinking for a time, watching the swish and surge
of the black Channel waters. Peter pursued their common topic in
silence.
“What’s the sense of it?” said Ames, plunging towards philosophy.
“It’s the system on which life goes—on this planet,” Peter
contributed, but Ames had not had a biological training, and was
unprepared to take that up.
“Too much of it,” said Ames.
“Over-sexed,” said Peter.
“Whether one ought to hold oneself in or let oneself go,” said
Ames. “But perhaps these things don’t bother you?”
Peter wasn’t disposed towards confidences with Ames. “I’m
moderate in all things,” he said.
“Lucky chap! I’ve worried about this business no end. One doesn’t
want to use up all one’s life like a blessed monkey. There’s other
things in life—if only this everlasting want-a-girl want-a-woman
would let one get at them.”
His voice at Peter’s shoulder ceased for a while, and then resumed.
“It’s the best chaps, seems to me, who get it worst. Chaps with
imaginations, I mean, men of vitality. Take old Probyn. He could
have done anything—anything. And he was eaten up. Like a fever....”
Ames went down into a black silence for a couple of minutes or
more, and came up again with an astonishing resolution. “I shall
marry,” he said.
“Got the lady?” asked Peter.
“Near enough,” said Ames darkly.
“St. Paul’s method,” said Peter.
“I was talking to a fellow the other day,” said Ames. “He’d got a
curious idea. Something in it perhaps. He said that every one was
clean-minded and romantic, that’s how he put it, about sixteen or
seventeen. Even if you’ve been a bit dirty as a schoolboy you sort of
clean up then. Adolescence, in fact. And he said you ought to fall in
love and pair off then. Kind of Romeo and Juliet business. First love
and all that.”
“Juliet wasn’t exactly Romeo’s first love,” said Peter.
“Young beggar!” said Ames. “But, anyhow, that was only by way of
illustration. His idea was that we’d sort of put off marriage and all
that sort of thing later and later. Twenty-eight. Thirty. Thirty-five
even. And that put us wrong. We kind of curdled and fermented.
Spoilt with keeping. Larked about with girls we didn’t care for. Demi-
vierge stunts and all that. Got promiscuous. Let anything do. His
idea was you’d got to pair off with a girl and look after her, and she
look after you. And keep faith. And stop all stray mucking about.
’Settle down to a healthy sexual peace,’ he said.”
Ames paused. “Something in it?”
“Ever read the Life of Lord Herbert of Cherbury?” asked Peter.
“Never.”
“He worked out that theory quite successfully. Married before he
went up to Oxford. There’s a lot in it. Sex. Delayed. Fretting.
Overflowing. Getting experimental and nasty.... But that doesn’t
exhaust the question. The Old Experimenter sits there——”
 “What experimenter?”
“The chap who started it all. There’s no way yet of fitting it up
perfectly. We’ve got to make it fit.”
Peter was so interested that he forgot his aversion from confiding
in Ames. The subject carried him on.
“Any healthy young man,” Peter generalized, “could be happy and
contented with any pretty girl, so far as love-making goes. It doesn’t
strike you—as a particularly recondite art, eh? But you’ve got to be in
love with each other generally. That’s more difficult. You’ve got to
talk together and go about together. In a complicated artificial world.
The sort of woman it’s easy and pleasant to make love to, may not be
the sort of woman you really think splendid. It’s easier to make love
to a woman you don’t particularly respect, who’s good fun, and all
that. Which is just the reason why you wouldn’t be tied up with her
for ever. No.”
“So we worship the angels and marry the flappers,” said Ames.... “I
shan’t do that, anyhow. The fact is, one needs a kind of motherliness
in a woman.”
“By making love too serious, we’ve made it not serious enough,”
said Peter with oracular profundity, and then in reaction, “Oh! I
don’t know.”
“I don’t know,” said Ames.
“Which doesn’t in the least absolve us from the necessity of going
on living right away.”
“I shall marry,” said Ames, in a tone of unalterable resolve.
They lapsed into self-centred meditations....
“Why! there’s the coast,” said Ames suddenly. “Quite close, too.
Dark. Do you remember, before the war, how the lights of
Folkestone used to run along the top there like a necklace of fire?”
 § 19
The powers that were set over Peter’s life played fast and loose
with him in the matter of leave. They treated him at first as though
he was a rare and precious hero—who had to be saved from his
friends. They put him to mend at Broadstairs, and while he was at
Broadstairs he had three visits from Hetty, whose days were free, and
only one hasty Sunday glimpse of Joan, who was much in demand at
the Ministry of Munitions. And Oswald could not come to see him
because Oswald himself was a casualty mending slowly at Pelham
Ford. Hetty and Joan and returning health fired the mind of Peter
with great expectations of the leave that was to come. These
expectations were, so to speak, painted in panels. Forgetful of the
plain fact that a Joan who was not available at Broadstairs would
also not be available at Pelham Ford, the panels devoted to the latter
place invariably included Joan as a principal figure, they represented
leave as a glorious escape from war to the space, the sunshine, the
endlessness of such a summer vacation as only schoolboys know. He
would be climbing trees with Joan, “mucking about” in the boats
with Joan, lying on the lawn just on the edge of the cedar’s shadow
with Joan, nibbling stems of grass. The London scenes were
narrower and more intense. He wanted the glitter and fun of
lunching in the Carlton grill-room or dining at the Criterion, in the
company of a tremendous hat and transparent lace, and there were
scenes in Hetty’s studio, quite a lot of fantastic and elemental scenes
in Hetty’s studio.
But the Germans have wiped those days of limitless leisure out of
the life of mankind. Even our schoolboys stay up in their holidays
now to make munitions. Peter had scarcely clambered past the
approval of a medical board before active service snatched him
again. He was wanted urgently. Peter was no good as a pilot any
more, it was true; his right wrist was doomed to be stiff and weak
henceforth, and there were queer little limitations upon the swing of
his arm, but the powers had suddenly discovered other uses for him.
There was more of Peter still left than they had assumed at first. For
one particular job, indeed, he was just the man they needed. They
docked him a wing—it seemed in mockery of the state of his arm—
and replaced the two wings that had adorned him by one attached to
the letter O, and they marked him down to join “balloons” at the
earliest possible moment, for just then they were developing kite
balloons very fast for artillery observation, and were eager for any
available men. Peter was slung out into freedom for one-and-twenty
days, and then told to report himself for special instruction in the
new work at Richmond Park.
One-and-twenty days! He had never been so inordinately greedy
for life, free to live and go as you please, in all his days before.
Something must happen, he was resolved, something bright and
intense, on every one of those days. He snatched at both sides of life.
He went down to Pelham Ford, but he had a little list of engagements
in town in his pocket. Joan was not down there, and never before had
he realized how tremendously absent Joan could be. And then at the
week-end she couldn’t come. There were French and British G.H.Q.
bigwigs to take down to some experiments in Sussex, but she
couldn’t even explain that, she had to send a telegram at the eleventh
hour: “Week-end impossible.” To Peter that seemed the most
brutally offhand evasion in the world. Peter was disappointed in
Pelham Ford. It was altogether different from those hospital dreams;
even the weather, to begin with, was chilly and unsettled. Oswald
had had a set-back with his knee, and had to keep his leg up on a
deck chair; he could only limp about on crutches. He seemed older
and more distant from Peter than he had ever been before; Peter was
obsessed by the idea that he ought to be treated with solicitude, and a
further gap was opened between them by Peter’s subaltern habit of
saying “Sir” instead of the old familiar “Nobby.” Peter sat beside the
deck chair through long and friendly, but very impatient hours; and
he talked all the flying shop he could, and Oswald talked of his
Africans, and they went over the war and newspapers again and
again, and they reverted to Africa and flying shop, and presently they
sat through several silences, and at the end of one of them Oswald
inquired: “Have you ever played chess, Peter—or piquet?”
Now chess and piquet are very good pastimes in their way, but not
good enough for the precious afternoons of a very animated and
greedy young man keenly aware that they are probably his last
holiday afternoons on earth.
 Sentiment requires that Peter should have gone to London and
devoted himself to adorning the marginal freedom of Joan’s days. He
did do this once. He took her out to dinner to Jules’, in Jermyn
Street; he did her well there; but she was a very tired Joan that day;
she had driven a good hundred and fifty miles, and, truth to tell, in
those days Peter did not like Joan and she did not like herself in
London, and more especially in smart London restaurants. They sat
a little aloof from one another, and about them all the young couples
warmed to another and smiled. She jarred with this atmosphere of
meretricious ease and indulgence. She had had no time to get back to
Hampstead and change; she was at a disadvantage in her uniform. It
became a hair shirt, a Nessus shirt as the evening proceeded. It
emphasized the barrier of seriousness between them cruelly. She was
a policeman, a prig, the harshest thing in life; all those pretty little
cocottes and flirts, with their little soft brightnesses and adornments,
must be glancing at her coarse, unrevealing garments and noting her
for the fool she was. She felt ugly and ungainly; she was far too much
tormented by love to handle herself well. She could get no swing and
forgetfulness into the talk. And about Peter, too, was a reproach for
her. He talked of work and the war—as if in irony. And his eyes
wandered. Naturally, his eyes wandered.
“Good-night, old Peter,” she said when they parted.
She lay awake for two hours, exasperated, miserable beyond tears,
because she had not said: “Good night, old Peter dear.” She had
intended to say it. It was one of her prepared effects. But she was a
weary and a frozen young woman. Duty had robbed her of the energy
for love. Why had she let things come to this pass? Peter was her
business, and Peter alone. She damned the Woman’s Legion,
Woman’s Part in the War, and all the rest of it, with fluency and
sincerity.
And while Joan wasted the hours of sleep in this fashion Peter was
also awake thinking over certain schemes he had discussed with
Hetty that afternoon. They involved some careful and deliberate
lying. The idea was that for the purposes of Pelham Ford he should
terminate his leave on the fourteenth instead of the twenty-first, and
so get a clear week free—for life in the vein of Hetty.
He lay fretting, and the hot greed of youth persuaded him, and the
clean honour of youth reproached him. And though he knew the way
the decision would go, he tossed about and damned as heartily as
Joan.
He could not remember if at Pelham Ford he had set a positive
date to his leave, but, anyhow, it would not be difficult to make out
that there had been some sort of urgent call.... It could be done....
The alternative was Piquet.
Peter returned to Pelham Ford and put his little fabric of lies upon
Oswald without much difficulty. Then at the week-end came Joan,
rejoicing. She came into the house tumultuously; she had caught a
train earlier than the one they had expected her to come by. “I’ve got
all next week. Seven days, Petah! Never mind how, but I’ve got it. I’ve
got it!”
There was a suggestion as of some desperate battle away there in
London from which Joan had snatched these fruits of victory. She
was so radiantly glad to have them that Peter recoiled from an
immediate reply.
“I didn’t seem to see you in London somehow,” said Joan. “I don’t
think you were really there. Let’s have a look at you, old Petah.
Tenshun!... Lift the arm.... Rotate the arm.... It isn’t so bad, Petah,
after all. Is tennis possible?”
“I’d like to try.”
“Boats certainly. No reason why we shouldn’t have two or three
long walks. A week’s a long time nowadays.”
“But I have to go back on Monday,” said Peter.
Joan stood stock still.
“Pity, isn’t it?” said Peter weakly.
“But why?” she asked at last in a little flat voice.
“I have to go back.”
“But your leave——?”
“Ends on Monday,” lied Peter.
For some moments it looked as though Joan meant to make that
last week-end a black one. “That doesn’t give us much time together,”
said Joan, and her voice which had soared now crawled the earth....
“I’m sorry.”
 Just for a moment she hung, a dark and wounded Joan, downcast
and thoughtful; and then turned and put her arms akimbo, and
looked at him and smiled awry. “Well, old Peter, then we’ve got to
make the best use of our time. It’s your Birf Day, sort of; it’s your
Bank Holiday, dear; it’s every blessed thing for you—such time as we
have together. Before they take you off again. I think they’re greedy,
but it can’t be helped. Can it, Peter?”
“It can’t be helped,” said Peter. “No.”
They paused.
“What shall we do?” said Joan. “The program’s got to be cut down.
Shall we still try tennis?”
“I want to. I don’t see why this wrist——” He held it out and
rotated it.
“Good old arm!” said Joan, and ran a hand along it.
“I’ll go and change these breeches and things,” said Joan. “And get
myself female. Gods, Peter! the craving to get into clothes that are
really flexible and translucent!”
She went to the staircase and then turned on Peter.
“Peter,” she said.
“Yes.”
“Go out and stand on the lawn and tighten up the net. Now.”
“Why?”
“Then I can see you from my window while I’m changing. I don’t
want to waste a bit of you.”
She went up four steps and stopped and looked at him over her
shoulder.
“I want as much as I can get of you, Petah,” she said.
“I wish I’d known about that week,” said Peter stupidly.
“Exactly!” said Joan to herself, and flitted up the staircase.
 § 20
Joan, Mrs. Moxton perceived that afternoon, had a swift and angry
fight with her summer wardrobe. Both the pink gingham and the
white drill had been tried on and flung aside, and she had decided at
last upon a rather jolly warm blue figured voile with a belt of cherry-
coloured ribbon that suited her brown skin and black hair better
than those weaker supports. She had evidently opened every drawer
in her room in a hasty search for white silk stockings.
When she came out into the sunshine of the garden Peter’s eyes
told her she had guessed the right costume.
Oswald was standing up on his crutches and smiling, and Peter
was throwing up a racquet and catching it again with one hand.
“Thank God for a left-handed childhood!” said Peter. “I’m going to
smash you, Joan.”
“I forgot about that,” said Joan. “But you aren’t going to smash me,
old Petah.”
When tea-time came they were still fighting the seventh vantage
game, and Joan was up.
They came and sat at the tea-table, and Joan as she poured the tea
reflected that a young man in white flannels, flushed and a little out
of breath, with his white silk shirt wide open at the neck, was a more
beautiful thing than the most beautiful woman alive. And her dark
eyes looked at the careless and exhausted Peter, that urgent and
insoluble problem, while she counted, “Twenty-four, thirty-six, forty-
one—about forty-one hours. How the devil shall I do it?”
It wasn’t to be done at tennis anyhow, and she lost the next three
games running without apparent effort, and took Peter by the arm
and walked him about the garden, discoursing on flying. “I must
teach you to fly,” said Peter. “Often when I’ve been up alone I’ve
thought, ’Some day I’ll teach old Joan.’”
“That’s a promise, Petah.”
“Sure,” said Peter, who had not suffered next to two Americans for
nothing.
 “I’ve got it in writing,” said Joan.
“I’d rather learn from you than any one,” said she.
Peter discoursed of stunts....
They spent a long golden time revisiting odd corners in which they
had played together. They went down the village and up to the
church and round the edge of the wood, and there they came upon
and devoured a lot of blackberries, and then they went down to the
mill pond and sat for a time in Baker’s boat. Then they got at cross
purposes about dressing for dinner. Joan wanted to dress very much.
She wanted to remind Peter that there were prettier arms in the
world than Hetty Reinhart’s, and a better modelled neck and
shoulders. She had a new dress of ivory silk with a broad belt of
velvet that echoed the bright softness of her eyes and hair. But Peter
would not let her dress. He did not want to dress himself. “And you
couldn’t look prettier, Joan, than you do in that blue thing. It’s so like
you.”
And as Joan couldn’t explain that the frock kept her a jolly girl he
knew while the dress would have shown him the beautiful woman he
had to discover, she lost that point in the game. And tomorrow was
Sunday, when Pelham Ford after the good custom of England never
dressed for dinner.
Afterwards she thought how easily she might have overruled him.
Joan’s plans for the evening were dashed by this costume failure.
She had relied altogether on the change of personality into
something rich and strange, that the ivory dress was to have
wrought. She could do nothing to develop the situation. Everything
seemed to be helping to intensify her sisterliness. Oswald was rather
seedy, and the three of them played Auction Bridge with a dummy.
She had meant to sit up with Peter, but it didn’t work out like that.
“Good night, Petah dear,” she said outside her bedroom door with
the candlelight shining red between the fingers of her hand.
“Good night, old Joan,” he said from his door-mat, with an infinite
friendliness in his voice.
You cannot kiss a man good night suddenly when he is fifteen
yards away....
She closed the door behind her softly, put down her candle, and
began to walk about her room and swear in an entirely unladylike
fashion. Then she went over to the open window, wringing her
hands. “How am I to do it?” she said. “How am I to do it? The
situation’s preposterous. He’s mine. And I might be his sister!”
“Shall I make a declaration?”
“I suppose Hetty did.”
But all the cunning of Joan was unavailing against the invisible
barriers to passion between herself and Peter. They spent a long
Sunday of comradeship, and courage and opportunity alike failed.
The dawn on Monday morning found a white and haggard Joan
pacing her floor, half minded to attempt a desperate explanation
forthwith in Peter’s bedroom with a suddenly awakened Peter. Only
her fear of shocking him and failing restrained her. She raved. She
indulged in absurd soliloquies and still absurder prayers. “Oh, God,
give me my Peter,” she prayed. “G i v e m e m y P e t e r !”
 § 21
Monday broke clear and fine, with a September freshness in the
sunshine. Breakfast was an awkward meal; Peter was constrained,
Oswald was worried by a sense of advice and counsels not given;
Joan felt the situation slipping from her helpless grasp. It was with a
sense of relief that at last she put on her khaki overcoat to drive Peter
to the station. “This is the end,” sang in Joan’s mind. “This is the
end.” She glanced at the mirror in the hall and saw that the fur collar
was not unfriendly to her white neck and throat. She was in despair,
but she did not mean to let it become an unbecoming despair—at
least until Peter had departed. The end was still incomplete. She had
something stern and unpleasant to say to Peter before they parted,
but she did not mean to look stern or unpleasant while she said it.
Peter, she noted with a gleam of satisfaction, was in low spirits. He
was sorry to go. He was ashamed of himself, but also he was sorry.
That was something, at any rate, to have achieved. But he was going
—nevertheless.
She brought round the little Singer to the door. She started the
engine with a competent swing and got in. The maids came with
Peter’s portmanteau and belongings. “This is the end,” said Joan to
herself, touching her accelerator and with her hand ready to release
the brake. “All aboard?” said Joan aloud.
Peter shook hands with Oswald over the side of the car, and
glanced from him to the house and back at him. “I wish I could stay
longer, sir,” said Peter.
“There’s many days to come yet,” said Oswald. For we never
mention death before death in war time; we never let ourselves think
of it before it comes or after it has come.
“So long, Nobby!”
“Good luck, Peter!”
Joan put the car into gear, and steered out into the road.
“The water-splash is lower than ever I’ve seen it,” said Peter.
 They ran down the road to the station almost in silence. “These
poplars have got a touch of autumn in them already,” said Peter.
“It’s an early year,” said Joan.
“The end, the end!” sang the song in Joan’s brain. “But I’ll tell him
all the same.”...
But she did not tell him until they could hear the sound of the
approaching train that was to cut the thread of everything for Joan.
They walked together up the little platform to the end.
“I’m sorry you’re going,” said Joan.
“I’m infernally sorry. If I’d known you’d get this week——”
“Would that have altered it?” she said sharply.
“No. I suppose it wouldn’t,” he fenced, just in time to save himself.
The rattle of the approaching train grew suddenly loud. It was
round the bend.
Joan spoke in a perfectly even voice. “I know you have been lying,
Peter. I have known it all this week-end. I know your leave lasts until
the twenty-first.”
He stared at her in astonishment.
“There was a time.... It’s to think of all this dirt upon you that hurts
most. The lies, the dodges, the shuffling meanness of it. From you....
Whom I love.”
A gap of silence came. To the old porter twelve yards off they
seemed entirely well-behaved and well-disciplined young people,
saying nothing in particular. The train came in with a sort of wink
under the bridge, and the engine and foremost carriages ran past
them up the platform.
“I wish I could explain. I didn’t know—— The fact is I got
entangled in a sort of promise....”
“Hetty!” Joan jerked out, and “There’s an empty first for you.”
The train stopped.
Peter put his hand on the handle of the carriage door.
“You go to London—like a puppy that rolls in dirt. You go to
beastliness and vulgarity.... You’d better get in, Peter.”
“But look here, Joan!”
 “Get in!” she scolded to his hesitation, and stamped her foot.
He got in mechanically, and she closed the door on him and turned
the handle and stood holding it.
Then still speaking evenly and quietly, she said: “You’re a blind
fool, Peter. What sort of love can that—that—that miscellany give
you, that I couldn’t give? Have I no life? Have I no beauty? Are you
afraid of me? Don’t you see—don’t you see? You go off to that! You
trail yourself in the dirt and you trail my love in the dirt. Before a
female hack!...
“Look at me!” she cried, holding her hands apart. “Think of me
tonight.... Yours! Yours for the taking!”
The train was moving.
She walked along the platform to keep pace with him, and her eyes
held his. “Peter,” she said; and then with amazing quiet intensity:
“You damned fool!”
She hesitated on the verge of saying something more. She came
towards the carriage. It wasn’t anything pleasant that she had in
mind, to judge by her expression.
“Stand away please, miss!” said the old porter, hurrying up to
intervene. She abandoned that last remark with an impatient
gesture.
Peter sat still. The end of the station ran by like a scene in a
panorama. Her Medusa face had slid away to the edge of the picture
that the window framed, and vanished.
For some seconds he was too amazed to move.
Then he got up heavily and stuck his head out of the window to
stare at Joan.
Joan was standing quite still with her hands in the side pockets of
her khaki overcoat; she was standing straight as a rod, with her heels
together, looking at the receding train. She never moved....
Neither of these two young people made a sign to each other,
which was the first odd thing the old porter noted about them. They
just stared. By all the rules they should have waved handkerchiefs.
The next odd thing was that Joan stared at the bend for half a minute
perhaps after the train had altogether gone, and then tried to walk
out to her car by the little white gate at the end of the platform which
had been disused and nailed up for three years....
 § 22
After Oswald had seen the car whisk through the gates into the
road, and after he had rested on his crutches staring at the gates for a
time, he had hobbled back to his study. He wanted to work, but he
found it difficult to fix his attention. He was thinking of Joan and
Peter, and for the first time in his life he was wondering why they
had never fallen in love with each other. They seemed such good
company for each other....
He was still engaged upon these speculations half an hour or so
later, when he heard the car return and presently saw Joan go past
his window. She was flushed, and she was staring in front of her at
nothing in particular. He had never seen Joan looking so unhappy.
In fact, so strong was his impression that she was unhappy that he
doubted it, and he went to the window and craned out after her.
She was going straight up towards the arbour. With a slight hurry
in her steps. She had her fur collar half turned up on one side, her
hands were deep in her pockets, and something about her dogged
walk reminded him of some long-forgotten moment, years ago it
must have been, when Joan, in hot water for some small offence, had
been sent indoors at The Ingle-Nook.
He limped back to his chair and sat thinking her over.
“I wonder,” he said at last, and turned to his work again....
There was no getting on with it. Half an hour later he accepted
defeat. “Peter has knocked us all crooked,” he said. “There’s no work
for today.”
He would go out and prowl round the place and look at the roses.
Perhaps Joan would come and talk. But at the gates he was amazed
to encounter Peter.
It was Peter, hot and dusty from a walk of three miles, and
carrying his valise with an aching left arm. There was a look of
defiance in the eyes that stared fiercely out from under the
perspiration-matted hair upon his forehead. He seemed to find
Oswald’s appearance the complete confirmation of the most
disagreeable anticipations. Thoughts of panic and desertion flashed
upon Oswald’s mind.
“Good God, Peter!” he cried. “What brings you back?”
“I’ve come back for another week,” said Peter.
“But your leave’s up!”
“I told a lie, sir. I’ve got another week.”
Oswald stared at his ward.
“I’m sorry, sir,” said Peter. “I’ve been making a fool of myself. I
thought better of it. I got out of the train at Standon and walked back
here.”
“What does it mean, Peter?” said Oswald.
Peter’s eyes were the most distressed eyes he had ever seen. “If
you’d just not ask, sir, now——”
It is a good thing to deal with one’s own blood in a crisis. Oswald,
resting thoughtfully on his crutches, leapt to a kind of
understanding.
“I’m going to hop down towards the village, Peter,” said Oswald,
becoming casual in his manner. “I want some exercise.... If you’ll tell
every one you’re back.”
He indicated the house behind him by a movement of his head.
Peter was badly blown with haste and emotion. “Thank you, sir,”
he said shortly.
Oswald stepped past him and stared down the road.
“Mrs. Moxton’s in the house,” he said without looking at Peter
again. “Joan’s up the garden. See you when I get back, Peter.... Glad
you’ve got another week, anyhow.... So long....”
He left Peter standing in the gateway.
Fear came upon Peter. He stood quite still for some moments,
looking at the house and the cedars. He dropped his valise at the
front door and mopped his face. Then he walked slowly across the
lawn towards the terraces. He wanted to shout, and found himself
hoarse. Then on the first terrace he got out: “Jo-un!” in a flat croak.
He had to cry again: “Jo-un!” before it sounded at all like the old
style.
 Joan became visible. She had come out of the arbour at the top of
the garden, and she was standing motionless, regarding him down
the vista of the central path. She was white and rather dishevelled,
and she stood quite still.
Peter walked up the steps towards her.
“I’ve come back, Joan,” he said, as he drew near. “I want to talk to
you.... Come into the arbour.”
He took her arm clumsily and led her back into the arbour out of
sight of the house. Then he dropped her arm.
“Joan,” he said, “I’ve been the damndest of fools ... as you said.... I
don’t know why.”...
He stood before her awkwardly. He was trembling violently. He
thought he was going to weep.
He could not touch her again. He did not dare to touch her.
Then Joan spread out her arms straight and stood like a crucifix.
Her face, which had been a dark stare, softened swiftly, became
radiant, dissolved into a dusky glow of tears and triumph. “Oh! Petah
my darling,” she sobbed, and seized him and kissed him with tear-
salt lips and hugged him to herself.
The magic barrier was smashed at last. Peter held her close to him
and kissed her....
It was the second time they had kissed since those black days at
High Cross school....
 § 23
Those were years of swift marryings, and Peter was a young
married man when presently he was added to the number of that
select company attached to sausage-shaped observation balloons
who were sent up in the mornings and pulled down at nights along
the British front. He had had only momentary snatches of
matrimony before the front had called him back to its own
destructive interests, but his experiences had banished any lingering
vestiges of his theory that there is one sort of woman you respect and
another sort you make love to. There was only one sort of woman to
love or respect, and that was Joan. He was altogether in love with
Joan, he was sure he had never been in love before, and he was now
also extravagantly in love with life. He wanted to go on with it, with a
passionate intensity. It seemed to him that it was not only beginning
for him, but for every one. Hitherto Man had been living down there,
down on those flats—for all the world is flat from the air. Now, at
last, men were beginning to feel how they might soar over all ancient
limitations.
Occasionally he thought of such things up in his basket, sitting like
a spectator in a box at a theatre, with the slow vast drama of the
western front spread out like a map beneath his eyes, with half
Belgium and a great circle of France in sight, the brown, ruined
country on either side of No Man’s Land, apparently lifeless, with its
insane tangle of trenches and communicating ways below, with the
crumbling heaps of ruined towns and villages scattered among canals
and lakes of flood water, and passing insensibly into a green and
normal-looking landscape to the west and east, where churches still
had towers and houses roofs, and woods were lumps and blocks of
dark green, fields manifestly cultivated patches, and roads white
ribbons barred by the purple poplar shadows. But these spectacular
and speculative phases were rare. They came only when a thin veil of
haze made the whole spacious prospect faint, so that beyond his
more immediate circle Peter could see only the broad outlines of the
land. Given worse conditions of the weather and he would be too
uncomfortable for philosophy; given better and he would be too
busy.
He sat on a canvas seat inside the square basket with his
instruments about him, or leant over the side scrutinizing the details
of the eastward landscape. Upon his head, over his ears, he wore a
telephone receiver, and about his body was a rope harness that
linked him by a rope to the silk parachute that was packed neatly in a
little swinging bucket over the side of his basket. Under his hand was
his map board, repeating the shapes of wood and water and road
below. The telephone wire that ran down his mooring rope abolished
any effect of isolation; it linked him directly to his winch on a lorry
below, to a number of battery commanders, to an ascending series of
headquarters; he could always start a conversation if he had anything
practical to say. He was, in fact, an eye at the end of a tentacle thread,
by means of which the British army watched its enemies. Sometimes
he had an illusion that he was also a kind of brain. When distant
visibility was good he would find himself hovering over the war as a
player hangs over a chessboard, directing fire upon road movements
or train movements, suspecting and watching for undisclosed enemy
batteries, or directing counter-battery fire. Above him, green and
voluminous, hung the great translucent lobes of his gas bag, and the
loose ropes by which it was towed and held upon the ground swayed
and trailed about his basket.
It was on one of his more slack afternoons that Peter fell thinking
of how acutely he now desired to live. The wide world was full of
sunshine, but a ground haze made even the country immediately
below him indistinct. The enemy gunners were inactive, there came
no elfin voices through the telephone, only far away to the south
guns butted and shivered the tranquil air. There was a faint drift in
the air rather than a breeze, and the gas bag had fallen into a long,
lazy rhythmic movement, so that sometimes he faced due south and
sometimes south by east and so back. A great patch of flooded
country to the north-east, a bright mirror with a kind of bloom upon
it, seemed trying with an aimless persistency to work its way towards
the centre of his field of vision and never succeeding.
For a time Peter had been preoccupied with a distant ridge far
away to the east, from which a long-range gun had recently taken to
shelling the kite balloons towards evening as they became clear
against the bright western sky. Four times lately this new gun had
got on to him, and this clear and tranquil afternoon promised just
the luminous and tranquil sunset that favoured these unpleasant
activities. It was five hours to sunset yet, but Peter could not keep his
mind off that gun. It was a big gun; perhaps a 42 centimetre; it was
beyond any counter-battery possibility, and it had got a new kind of
shell that the Germans seemed to have invented for the particular
discomfort of Peter and his kind. It had a distinctive report, a loud
crack, and then the “whuff” of high explosive, and at every explosion
it got nearer and nearer to its target, with a quite uncanny certainty.
It seemed to learn more than any gun should learn from each shot. It
was this steadfast approach to a hit that Peter disliked. That and the
long pause after the shell had started. Far away he would see the
flash of the gun amidst the ridges in the darkling east. Then would
come a long, blank pause of expectation. For all he could tell this
might get him. Then the whine of the shell would become audible,
growing louder and louder and lower and lower in note; Phee-whoo!
Crack! WHOOF! Then Peter would get quite voluble to the men at
the winch below. He could let himself up, or go down a few hundred
feet, or they could shift his lorry along the road. Until it was dark he
could not come down, for a kite balloon is a terribly visible and
helpless thing on the ground until it has been very carefully put to
bed. To come down in the daylight meant too good a chance for the
nearer German guns. So Peter, by instructing his winch to lower him
or let him up or shift, had to dodge about in a most undignified way,
up and down and backwards and sideways, while the big gun marked
him and guessed at his next position. Flash! “Oh, damn!” said Peter.
“Another already!”
Silence. Anticipations. Then: Phee—eee—eee—whoo. Crack!
WHOOF! A rush of air would set the gas bag swinging. That was a
near one!
“Where am I?” said Peter.
But that wasn’t going to happen for hours yet. Why meet trouble
half way? Why be tormented by this feeling of apprehension and
danger in the still air? Why trouble because the world was quiet and
seemed to be waiting? Why not think of something else? Banish this
war from the mind.... Was he more afraid nowadays than he used to
be? Peter was inclined to think that now he was more systematically
afraid. Formerly he had funked in streaks and patches, but now he
had a steady, continuous dislike to all these risks and dangers. He
was getting more and more clearly an idea of the sort of life he
wanted to lead and of the things he wanted to do. He was ceasing to
think of existence as a rather aimless series of adventures, and
coming to regard it as one large consecutive undertaking on the part
of himself and Joan. This being hung up in the sky for Germans to
shoot at seemed to him to be a very tiresome irrelevance indeed. He
and Joan and everybody with brains—including the misguided
people who had made and were now firing this big gun at him—
ought to be setting to work to get this preposterous muddle of a
world in order. “This sort of thing,” said Peter, addressing the
western front, his gas bag, and so much of the sky as it permitted him
to see, and the universe generally, “is ridiculous. There is no sense in
it at all. None whatever.”
His dream of God, as a detached and aloof personage, had taken a
very strong hold upon his imagination. Or, perhaps, it would be truer
to say that his fevered mind in the hospital had given a caricature
personality to ideas that had grown up in his mind as a natural
consequence of his training. He had gone on with that argument; he
went on with it now, with a feeling that really he was just as much
sitting and talking in that queer, untidy, out-of-the-way office as
swaying in a kite balloon, six thousand feet above Flanders, waiting
to be shot at.
“It is all very well to say ’exert yourself,’” said Peter. “But there is
that chap over there exerting himself. And what he is doing with all
his brains is just trying to wipe my brains out of existence. Just that.
He hasn’t an idea else of what he is doing. He has no notion of what
he is up to or what I am up to. And he hasn’t the sense or ability to
come over here and talk about it to me. He’s there—at that—and he
can’t help himself. And I’m here—and I can’t help myself. But if I
could only catch him within counter battery range——!
“There’s no sense in it at all,” summarized Peter, after some
moments of grim reflection. “Sense hasn’t got into it.”
“Is sense ever going to get into it?
“The curious thing about you,” said Peter, addressing himself quite
directly to his Deity at the desk, “is that somehow, without ever
positively promising it or saying anything plain and definite about it,
you yet manage to convey in an almost irresistible manner, that there
is going to be sense in it. You seem to suggest that my poor brain up
here and the brains of those chaps over there, are, in spite of all
appearance to the contrary, up to something jointly that is going to
come together and make good some day. You hint it. And yet I don’t
get a scrap of sound, trustworthy reasoning to help me to accept that;
not a scrap. Why should it be so? I ask, and you just keep on not
saying anything. I suppose it’s a necessary thing, biologically, that
one should have a kind of optimism to keep one alive, so I’m not
even justified in my half conviction that I’m not being absolutely
fooled by life....
“I admit that taking for example Joan, there is something about
Joan that almost persuades me there must be something absolutely
right about things—for Joan to happen at all. Yet isn’t that again just
another biologically necessary delusion?... There you sit silent. You
seem to say nothing, and yet you soak me with a kind of answer, a
sort of shapeless courage....”
Peter’s mind rested on that for a time, and then began again at
another point.
“I wonder,” said Peter, “if that chap gets me tonight, what I shall
think—in the moment—after he has got me....”
 § 24
But the German gunner never got Peter, because something else
got him first.
He thought he saw a Hun aeroplane coming over very high indeed
to the south of him, fifteen thousand feet up or more, a mere speck in
the blue blaze, and then the gas bag hid it and he dismissed it from
his mind. He was thinking that the air was growing clearer, and that
if this went on guns would wake up presently and little voices begin
to talk to him, when he became aware of the presence and vibration
of an aeroplane quite close to him. He pulled off his telephone
receivers and heard the roar of an engine close at hand. It was
overhead, and the gas bag still hid it. At the same moment the British
anti-aircraft gunners began a belated fire. “Damn!” said Peter in a
brisk perspiration, and hastened to make sure that his parachute
rope was clear.
“Perhaps he’s British,” said Peter, with no real hope.
“Pap, pap, pap!” very loud overhead.
The gas bag swayed and billowed, and a wing with a black cross
swept across the sky. “Pap, pap, pap.”
The gas bag wrinkled and crumpled more and more, and a little
streak of smoke appeared beyond its edge. The German aeroplane
was now visible, a hundred yards away, and banking to come round.
He had fired the balloon with tracer bullets.
The thing that Peter had to do and what he did was this. He had to
step up on to a little wood step inside his basket. Then he had to put
first one foot and then the other on to another little step outside his
basket. This little step was about four inches wide by nine long.
Below it was six thousand feet of emptiness, above the little trees and
houses below. As he swayed on the step Peter had to make sure that
the rope attached to his body was clear of all entanglements. Then he
had to step off that little shelf, which was now swinging and slanting
with the lurching basket to which it was attached, into the void, six
thousand feet above the earth.
 He had not to throw himself or dive headlong, because that might
lead to entanglement with the rope. He had just to step off into
pellucid nothingness, holding his rope clear of himself with one
hand. This rope looped back to the little swinging bucket in which his
fine silk parachute was closely packed. He had seen it packed a week
ago, and he wished now, as he stood on his step holding to his basket
with one hand, that he had watched the process more meticulously.
He became aware that the Hun, having disposed of the balloon, was
now shooting at him. He did not so much step off the little shelf as
slip off as it heeled over with the swing of the basket. The first
instants of a leap or fall make no impression on the mind. For some
seconds he was falling swiftly, feet foremost, through the air. He
scarcely noted the faint snatch when the twine, which held his
parachute in its basket, broke. Then his consciousness began to
register again. He kept his feet tightly pressed together. The air
whistled by him, but he thought that dreams and talk had much
exaggerated the sensations of falling. He was too high as yet to feel
the rush of the ground towards him.
He seemed to fall for an interminable time before anything more
happened. He was assailed by doubts—whether the twine that kept
the parachute in its bucket would break, whether it would open. His
rope trailed out above him.
Still falling. Why didn’t the parachute open? In another ten
seconds it would be too late.
The parachute was not opening. It was certainly not opening.
Wrong packing? He tugged and jerked his rope, and tried to shake
and swing the long silken folds that were following his fall. Why?
Why the devil——?
The rope seemed to tighten abruptly. The harness tightened upon
his body. Peter gasped, sprawled and had the sensation of being
hauled up back again into the sky....
It was all right, so far. He was now swaying down earthward with a
diminishing velocity beneath an open parachute. He was floating
over the landscape instead of falling straight into it.
But the German had not done with Peter yet. He became visible
beneath the edge of Peter’s parachute, circling downward regardless
of anti-aircraft and machine-guns. “Pap, pap, pap, pap.” The bullets
burst and banged about Peter.
Something kicked Peter’s knee; something hit his neck; something
rapped the knuckles of his wounded hand; the parachute winced and
went sideways, slashed and pierced. Peter drifted down faster,
helpless, his angry eyes upon his assailant, who vanished again,
going out of sight as he rose up above the edge of the parachute.
A storm of pain and rage broke from Peter.
“Done in!” shouted Peter. “Oh! my leg! my leg!
“I’m shot to bits. I’m shot to bloody bits!”
The tree tops were near at hand. The parachute had acquired a
rhythmic swing and was falling more rapidly.
“And I’ve still got to land,” wailed Peter, beginning to cry like a
child.
He wanted to stop just a moment, just for one little moment,
before the ground rushed up to meet him. He wanted time to think.
He didn’t know what to do with this dangling leg. It became a
monstrous, painful obstacle to landing. How was he to get a spring?
He was bleeding. He was dying. It was cruel. Cruel.
Came the crash. Hot irons, it seemed, assailed his leg and his
shoulder and neck. He crumpled up on the ground in an agony, and
the parachute, with slow and elegant gestures, folded down on the
top of his floundering figure....
The gunners who ran to help him found him, enveloped in silk,
bawling and weeping like a child of four in a passion of rage and fear,
and trying repeatedly to stand up upon a blood-streaked leg that
gave way as repeatedly. “Damn!” cursed Peter in a stifled voice,
plunging about like a kitten in a sack. “Damn you all! I tell you I will
use my leg. I will have my leg. If I bleed to death. Oh! Oh!... You fool
—you lying old humbug! You!”
And then he gave a leap upward and forward, and fainted and fell,
and lay still, with his head and body muffled in the silk folds of his
parachute.
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