Susie Matsuda and Patricia Matsuda
Overview
Susan “Susie” Marie Matsuda and her younger sister Patricia “Pattie” Alison Matsuda loved and protected one another while often struggling to understand their different ways of responding to pressure. Both were autistic; Pattie also had ADHD. Born in August 1977, Susie was five years older than Pattie, who was born in November 1982. Susie was gentle, soft-spoken, careful, and frequently assumed responsibility for family care. Pattie was impulsive, physically fearless, and often disciplined for fighting people who targeted their brother Cody. Susie tended to think and process internally before acting, concealing much of her own difficulty; Pattie’s impulsivity and support needs were more visible.
Susie could exclaim, “Pattie, you can’t just PUNCH people!” Pattie would answer that someone needed to be punched. Susie defended her sister despite that frustration. She sometimes envied Pattie’s openness and courage, while worrying that Pattie’s actions would expose her to physical injury and social punishment. Susie’s desire to protect Pattie did not give her control over Pattie’s choices.
Origins
Pattie was born when Susie was five and Cody was three, the third of the Matsuda children. Susie’s earliest memories of her baby sister included noise, constant movement, and physical fearlessness. Susie had been a quiet baby who preferred gentle stimulation; Pattie sought intense physical input, climbed, and broke things. Their differences were visible before they had words for them.
As Pattie grew, adults increasingly cast Susie as the “good child” who helped and complied, and Pattie as the “problem child” who acted impulsively, challenged rules, and was often injured while taking physical risks. Teachers praised Susie and repeatedly complained about Pattie. Their mother, Ellen, fought for Pattie’s accommodations while attending exhausting disciplinary meetings. Susie began translating Pattie’s intentions and mediating conflicts during childhood.
Susie helped Pattie with homework, tried to explain recurring school trouble, and intervened when she saw a risk of injury. Pattie appreciated the help but resented being treated as a problem Susie had to manage. Their different family roles were reinforced through these repeated interactions.
Dynamics and Communication
Susie’s gentle exasperation met Pattie’s blunt, often loud defense of her actions. Susie tried to reason with her about consequences: “Pattie, you can’t just punch people when you’re mad!” and “I know you’re trying to protect him, but there are other ways.” Pattie could answer at full volume even when she was not angry: “Someone HAD to punch them!” and “What OTHER ways?! They were hurting Cody!”
Susie also explained Pattie’s intentions to parents and teachers: “She’s not being deliberately defiant, she just doesn’t think before acting.” She added, “She doesn’t mean to be disrespectful, she just doesn’t understand the social rules.” Susie intervened when she could to help adults recognize Pattie’s ADHD-related impulsivity rather than see every incident as willful misconduct.
The caretaking coexisted with sisterly affection and admiration. Susie told Pattie, “I love you. Even when you drive me crazy.” Pattie knew that Susie saw her as a whole person rather than a collection of behavior problems. When Pattie was suspended for fighting children who bullied Cody, Susie defended her to outsiders while telling her privately, “but you really can’t keep punching people.”
Cultural Architecture
Susie and Pattie were mixed-race Japanese American and White sisters whose different disability presentations shaped how their family and schools understood them. Both were autistic, and Pattie also had ADHD. Their assigned roles as the responsible daughter and the problem daughter reflected gendered expectations as well as their differing needs.
As the eldest daughter, Susie masked her autistic difficulties while using her pattern recognition, close observation, and preference for structure in a caretaking role. Her competence helped obscure the cost of that work. Pattie’s ADHD-related impulsivity, physical intensity, and emotional dysregulation were highly visible. Adults often treated Susie as the responsible girl who caused no trouble and Pattie as the girl who needed discipline. Their responses also intersected with Susie’s understanding of Japanese American perseverance and the Moore family’s expectations of service; neither cultural inheritance made one sister’s needs less real.
Susie’s frustration with Pattie’s impulsivity could make it hard for her to offer the validation Pattie needed. While Susie hid her own distress to keep caring for others, she sometimes expected Pattie to try harder to control herself. That expectation echoed Pattie’s demands of Cody and the mistaken belief that effort alone determined capacity. Pattie acted physically when impulse, anger, loyalty, and circumstance converged. Susie’s apparent competence could reinforce Pattie’s fear that being “good” was a choice she was too broken to make.
During childhood, neither sister had language for their different autistic presentations, Pattie’s co-occurring ADHD, or the effects of birth order and gendered expectations. The roles of “good daughter” and “problem daughter” could obscure their shared disability and the distinct person beneath each role.
Shared History and Milestones
Childhood, 1982–1995
During childhood, Susie watched Pattie get into trouble for climbing out of school windows, jumping off roofs, punching bullies, and other actions that led to repeated suspensions. Susie tutored Pattie in subjects she found difficult, particularly reading; talked through consequences with her; and mediated between her and frustrated teachers. That loving work also added to Susie’s substantial responsibility for Cody and Joey.
Susie sometimes envied Pattie’s fearlessness, bluntness, and apparent freedom from the social performance that exhausted her. She also knew those qualities brought punishment and rejection. Her more persistent concern was that Pattie would be injured while climbing or jumping, or hurt by social consequences she had not anticipated.
Cody’s suicide attempt, April 1995
When Cody attempted suicide, seventeen-year-old Susie held seven-year-old Joey, tried to support their parents, and kept much of her own fear private. Twelve-year-old Pattie punched a hole in the living-room wall and ran upstairs, unable to face what she had said or process what had happened.
Susie understood that Pattie’s reaction came amid overwhelming emotion. Pattie’s ADHD-related emotional dysregulation was one factor, alongside her age, terror, guilt, and the shock of Cody’s attempt; no single factor determined her response. Susie was exhausted by attending to others while suppressing her own fear. When Ellen went upstairs to comfort Pattie, Susie stayed downstairs with Joey because she felt someone had to remain steady for him.
In the following weeks, Pattie fought children at school who said cruel things and confronted adults who whispered about the family. Her violence was partly an attempt to defend Cody. Susie understood that motive while wishing Pattie would protect him without fighting. Both loved Cody fiercely and expressed that love differently.
Susie leaves for Stanford, fall 1995
When Susie left for Stanford after turning eighteen, Pattie lost daily access to the sister who had explained her intentions to teachers and tutored her when reading was difficult. Pattie tried to appear unaffected but hugged Susie tightly when she left. Susie worried about Pattie navigating school and family life without her help. She trusted Ellen and Greg while knowing that Cody’s recovery already demanded much of their attention.
Contact during Susie’s Stanford years
During Susie’s first three years at Stanford, her calls home became frequent, eventually daily, although direct conversations with Pattie were less regular. Pattie was not inclined to write letters or talk by phone. Ellen updated Susie about suspensions and other school difficulties. Susie worried from a distance and felt guilty that she could no longer provide daily help, even as she trusted Ellen and Greg to care for Pattie.
Pattie’s pregnancy, spring and summer 1998
Pattie became pregnant at fifteen in spring 1998. Susie, then twenty, came home for the summer between her junior and senior years at Stanford. Her support differed from Ellen’s maternal care: as Pattie’s sister, she could listen without taking a parental role and offer guidance informed by her own experience.
Susie sat with Pattie during periods of severe nausea and vomiting described as borderline hyperemesis gravidarum, held back her hair, brought water and crackers, and acknowledged how difficult the illness felt. When Pattie’s clinicians stopped her ADHD medication during pregnancy, daily planning and emotional regulation became substantially harder. Susie listened to Pattie’s frustrations with Ellen without the “I’m your mother” dynamic of a parent-child conversation.
They discussed Pattie’s fear of motherhood and her doubts about her ability to care for a child. Susie told her, “You’re already doing it. You go to appointments. You take care of yourself. That’s strength.” When Pattie said she did not know how to be a mother, Susie answered, “No one knows how to be a mom. You figure it out as you go.”
The summer deepened their bond. Susie saw Pattie’s fear beneath her tough exterior, alongside the exhaustion of pregnancy and managing without medication. Pattie came to value Susie’s gentleness as a form of strength alongside her own more forceful ways of defending people.
Susie’s return to Stanford, August 28, 1998
When Susie left at 8:47 AM on August 28, 1998, to begin her senior year at Stanford, Pattie was roughly twenty-two to twenty-three weeks pregnant. She clung to Susie and sobbed, “I can’t do this without you.” She added, “I don’t know how to be a mom.” Susie reassured her, promised to call often, and reminded her that Ellen, Evan, and the rest of the family would remain with her. The separation was painful for both, and Susie felt that leaving might be an abandonment.
Pattie lost the daily support of a sister who understood her fears without occupying a parental role. Susie did not see her again until Thanksgiving. By then, Lila had been born prematurely and admitted to the neonatal intensive care unit. Pattie navigated the final trimester, delivery, and the early weeks of Lila’s life without Susie’s in-person support.
Susie felt guilt similar to what she had experienced when she left Joey in 1995. She also knew that Pattie had strengths of her own, that Ellen and Evan would help, and that she could not indefinitely give up her education to remain Pattie’s primary support. Greg had encouraged her to recognize in 1995 that loving her family and pursuing her own path were compatible.
Their relationship after Lila’s birth
After Lila was born in October 1998, Susie visited when she could and saw Pattie’s fierce devotion to her daughter expressed through daily care. The sisters found more common ground as autistic women navigating expectations about competence. Pattie also lived with ADHD, while Susie eventually experienced burnout from sustained masking.
Public vs. Private Life
To teachers and some people in the family network, Susie appeared academically successful, socially adept, and responsible, while Pattie’s repeated suspensions and physical confrontations drew attention. The contrast reinforced judgments about who was “trying hard enough” and who was “choosing” difficult behavior, without accounting for either sister’s support needs.
After both sisters’ autism was recognized in adulthood, they had clearer language for their different autistic presentations and for the effects of Pattie’s ADHD. Susie’s masked presentation had required exhausting work; Pattie’s visible impulsivity and dysregulation had often brought punishment.
In private, Susie defended Pattie while also expressing frustration directly to her. Pattie relied on Susie’s support but could resent being managed. Their affection endured through those disagreements and their different ways of responding to distress.
Emotional Landscape
Susie loved Pattie and worried about her. She admired Pattie’s fearlessness, loyalty, and willingness to show emotion openly. Exhausted by her own social performance, Susie sometimes envied that openness while recognizing that Pattie paid for it through punishment and rejection.
Susie feared that climbing and fighting would physically injure Pattie, and that school discipline and social rejection would hurt her emotionally. She also resented the tendency to see Pattie as a problem without recognizing her disabilities or protective motives. Feeling responsible for Pattie’s wellbeing added to Susie’s wider burden of family care.
Supporting Pattie through pregnancy in summer 1998 changed Susie’s understanding of her sister. She saw Pattie’s fear beneath her tough exterior and her love for the unborn baby despite her doubts about motherhood. Returning to Stanford in August brought back Susie’s guilt about pursuing her education while family members needed help.
Pattie trusted Susie to see her as a whole person rather than a collection of behavior problems. Susie defended her to teachers and relatives, explaining motives that adults sometimes read only as defiance, even as she helped Pattie face the consequences of impulsive actions.
Pattie came to value Susie’s quiet strength during the summer of 1998. Susie sat with her through vomiting and heard her fears about motherhood without judging her. Pattie’s distress when Susie left in August made clear how much that support had meant.
Intersection with Health and Access
Both sisters were autistic, though neither sister’s autism was recognized during childhood or adolescence. Susie’s heavily masked presentation was read as high-achieving, socially appropriate, “just sensitive,” or “just introverted.” Pattie’s ADHD was diagnosed during childhood, but her visible, punishable behaviors were still labeled as defiance rather than recognized as disability manifestations requiring consistent support.
The contrast affected the support each sister received. Susie had access to extended time and alternative assessments when those accommodations supported academic achievement, but her autism remained unrecognized. Pattie faced suspensions for fighting and detention for climbing out windows even after her ADHD diagnosis. Ellen advocated for accommodations, but school discipline continued to treat many of Pattie’s needs as misconduct. Neither sister’s autism was recognized until adulthood.
Susie gave Pattie informal support through tutoring, discussing consequences, and mediating conflicts. That help addressed needs the schools did not consistently meet. When Susie left for Stanford, Pattie lost daily access to it, while Ellen continued coordinating Pattie’s school advocacy and Cody’s recovery.
During Pattie’s pregnancy, Susie saw how much harder planning, emotional regulation, and daily routines became when clinicians stopped Pattie’s ADHD medication. The experience contributed to Susie’s later understanding, as a physician, that medication could be a necessary accommodation rather than a moral failing.
Turning Points
Cody’s crisis and its aftermath
Both sisters were devastated by Cody’s suicide attempt. Susie held Joey and tried to support their parents while concealing much of her own fear. Pattie punched a wall and fought others in the weeks that followed. Their responses reflected differences in age, neurology, family role, and circumstance; Pattie’s violence also caused harm. Susie wished Pattie could respond less explosively, while Pattie may have wished Susie would let herself show distress instead of always appearing strong.
Distance after Susie left for Stanford
Susie’s move to Stanford removed a daily source of tutoring and mediation. Their relationship continued through less frequent direct calls and news shared by Ellen. Pattie’s school difficulties and suspensions continued, increasing family stress. Susie worried from Stanford and felt guilty that she could not resolve those problems from a distance.
Pregnancy support in summer 1998
During Pattie’s pregnancy, the sisters moved beyond the childhood pattern in which Susie managed Pattie’s difficulties. Susie recognized Pattie’s vulnerability and strength together; Pattie recognized that Susie’s gentleness required strength. They supported each other as disabled women who had both been underestimated, although neither yet had an autism diagnosis.
Susie’s return to Stanford
Susie returned to Stanford when Pattie was roughly twenty-two to twenty-three weeks pregnant. Pattie lost her sister’s daily support and relied more heavily on Ellen, Evan, and her own developing ability to manage appointments and routines. Susie struggled with guilt but had to trust that Pattie could continue without her constant presence. Their separation changed how each understood support, boundaries, and Pattie’s autonomy.
Legacy and Lasting Impact
As both sisters received autism diagnoses in adulthood, they gained language for experiences that the childhood “responsible one/problem child” pattern had obscured. Susie understood more clearly that Pattie’s impulsivity reflected disability rather than a character flaw and that her protective love did not make harmful actions harmless. Pattie recognized the effort behind Susie’s quiet care and the affection that motivated it, even when she had felt managed.
Susie saw in Pattie qualities she had suppressed through masking: intensity, open emotion, and willingness to be seen. Pattie’s visibility brought punishment, but it also helped Susie question the belief that being “too much” was a moral failing. As Susie learned to unmask and accommodate her own autism, Pattie’s refusal to treat visibility as shame became a model rather than a warning.
For Pattie, Susie’s quiet support showed that care could be as forceful in its effects as physical defense. During her pregnancy, Pattie learned to value consistent presence, acknowledge fear, and accept help without treating it as weakness. As she raised Lila, Susie’s eventual willingness to seek accommodations offered another example she could use without having to imitate her sister.
Their relationship reflected how different disability presentations could be assigned unequal legitimacy even within one family. Susie’s responsible caregiving and Pattie’s protective fighting both expressed love, while each sister also needed support and room to make choices beyond those childhood roles.