Yesterday we had to take Courtney for medical testing. She needed an MRI and an EEG. This was attempt number two.

Attempt number one for the EEG—the “normal” way—was a bust. That’s probably not a big surprise to anyone who knows Courtney. So this time everything was scheduled under sedation.

I was hopeful. We had gone through a sedated procedure back in November. Was it easy? No. But it wasn’t impossible. It was hard, but manageable. So when we walked into the hospital yesterday, I expected something similar.

Boy, was I wrong.

Here’s the thing about Courtney—and so many others like her. You can prepare them. You can explain the process. You can use social stories, visual schedules, rewards, fidgets, favorite toys, and every strategy you’ve learned over years of parenting and therapy. But once they hit that fight-or-flight mode, logic is gone. The ability to reason through what is happening disappears. The fear takes over.

And when that happens, size suddenly matters.

Courtney is 12 years old and weighs over 140 pounds. But when that 140 pounds goes into fight-or-flight mode, I honestly think she could give Hulk Hogan a run for his money.

Yesterday she proved it.

To move her from the floor to the hospital bed took four strong adults. Three of those adults were security guards. Once she was on the bed, four more adults helped hold her still while another administered the sedative. They all stayed there, holding her safely until the medication finally took effect.

As parents, Joe and I sat there in tears.

Not because anyone did anything wrong.

Not because the staff wasn’t amazing.

Not because we hadn’t prepared.

We had done everything we could think of.

We had a visual schedule.

We had incentives.

We had fidgets.

Child Life was there helping.

The staff was patient, kind, and understanding.

Yet none of it mattered in that moment because Courtney was terrified.

She was not going to willingly sit on that bed and get that shot.

And honestly, I understood why they needed her on the bed. During a previous procedure, she had been sitting in her stroller. When it was time to transition her to the hospital bed, the medication kicked in and she completely collapsed in my arms—all 140 pounds of her. The bed was the safest place for her to receive the sedative.

I understood the why.

That didn’t make it any easier to watch.

What most people don’t see is that this is what severe autism can look like.

People see the cute smiles.

They see the funny videos.

They see the moments of joy.

What they don’t see are the moments where your child is so overwhelmed, so frightened, and so unable to understand what is happening that it takes multiple adults to safely complete a routine medical procedure.

They don’t see parents standing in a hospital room fighting back tears while strangers hold their child down.

They don’t see the guilt. The heartbreak. The exhaustion.

And they don’t see the impossible choices parents make every day between what needs to be done medically and the trauma it may cause in the process.

Yesterday was one of those days.

And while the MRI and EEG were important, I left thinking about something else.

I thought about how much courage Courtney shows every day navigating a world she doesn’t fully understand.

I thought about how hard she fights when she’s scared.

And I thought about how severe autism is often invisible to people until moments like these force it into the open.

Those are the moments that stay with you long after the hospital bracelet comes off.