Ask Me Why I Hurt Read online

“Yes.” My voice stuttered. I smoothed it out. “I’m Dr. Christensen.”

  She had blond hair held back with a dirty pale blue rubber band. She was short and barely came to my chest. The infected sore on her cheek looked bad. Her sneakers were busted out, the laces coated in grime. Jan had opened the door again and, standing on the gravel, was trying to pull down the steps. She was yanking with all her strength. At first the steps didn’t work either. Nothing was going as planned. Once Jan finally got them down, the kids crowded up into the van.

  “Excuse me,” I told the girl. I went to wash hydraulic fluid off my hands in the tiny sink. Jan was handing out intake forms to the kids crowding around. My phone was ringing in my pocket with a call from the mechanic, and I didn’t have time to answer it. I led the girl to an examination room. “Wait here,” I said, signaling at the exam table, and went back up front to get an intake form. Jan was raising her voice, trying to organize the kids into some sort of queue. The floor was slanted. I couldn’t find a pen, and the kids around Jan were getting loud with frustration.

  “Jan, where are the clipboards?”

  “I don’t know. I didn’t think to order any. Did you?”

  I returned to the room and handed the girl a form. I took my pen out of my pocket, reminding myself to make sure I got it back.

  “I don’t get this,” she said, looking down at the form she was supposed to fill out.

  “What’s the problem?” I asked, raising my voice to be heard. The noise out front was getting loud.

  Someone knocked on the door. “Is Johnny in there?” the person shouted. “Hey, Johnny!”

  My cheeks colored with frustration and embarrassment. This was not a professional environment.

  The girl was pointing to the form, to where it asked for her immunization history. “I don’t know about shots,” she said. “I don’t think I ever got any.”

  Of course, I thought. A homeless kid won’t be carrying around an immunization record. I tried to say something, but the loud knocking came again. “Johnny!”

  I looked down to see hydraulic fluid embedded in the pores of my forearms. I opened the door, flinching at all the noise outside. “Johnny’s not here,” I said more brusquely than I wanted.

  The boy outside smiled sheepishly. “OK, dude. Chill out,” he said, and wandered back up front.

  I closed the door, feeling more and more frantic by the moment. I examined the infected sore on the girl’s cheek. “How did you get this?” I asked.

  “I think it was a spider,” she said. “We’ve been sleeping in this abandoned house.”

  She lifted the bottom of her filthy shirt and showed me another infected bite on her belly. I looked at the angry sore. The edges were raised and swollen. I didn’t think they were black widow bites; those caused stomach pains but didn’t leave the kind of marks she had. I wasn’t sure what these bites were. I realized I had a lot to learn about different kinds of insect and animal bites. The one on her belly concerned me. It was close to the lymph nodes in the groin. Her general health seemed pretty run-down too. Her immune system was not fighting back.

  “These bites are pretty infected, and the infection is spreading,” I told her. “You’re going to need some oral antibiotics. I need to examine you. Then I’ll see you in a week, see how you are doing.”

  “You mean you’re coming back?” She looked disbelieving.

  “We’ll be coming to this location once a week—”

  More pounding on the door distracted me. “Let me find some cream,” I said. I rushed through a wall of kids in the hall, all asking if it was their turn, to ask Jan where the antibiotic cream was kept. The front of the van was cacophony. Kids were talking and shouting and asking questions. Paper forms began drifting to the floor. I stuck my head down the steps and saw a group of kids outside, running around the van. Some were playing hacky sack in the gravel. Others looked as if they were giving up and started to leave.

  “Hey, don’t leave,” I called.

  I raced back with the cream. The girl was standing up, ready to go. “Don’t leave yet,” I said. I hadn’t given her a full exam yet. I hadn’t asked her why she was homeless. I hadn’t even suggested a place for her to stay. I didn’t even know if there was a shelter in Tempe for homeless kids. Maybe there weren’t any. After a year of preparation, I thought, I am completely unprepared. The day was taking on the nightmarish hue of doom. We didn’t have the right medicine for this or the right order form for that. I felt it would take me hours to get to the bottom of this one girl’s medical situation, and there were a dozen more like her right outside my door, all with just as many needs. I felt panicky. I wanted to go back and start all over again. Only this time I would have clipboards and pens and an even floor.

  “Randy.” Jan knocked on the door. She was holding a urine sample. It was the color of thick yellow soup. If I had been in my right mind, I would have looked at it and worried about a case of severe dehydration. Instead I just felt a sharp frustration.

  “Not now!” I snapped at her, and felt horrible. I sounded exactly like the kind of doctor I couldn’t stand. As I turned back to go to the girl, my hands were trembling with nerves, and the smell of hydraulic fluid rose to greet me.

  We drove in silence back to the loading dock that night. I felt shell-shocked. I was deeply dismayed at how badly the day had gone. I kept thinking, What on earth made me think I could do this? I had known the extent of the problem. I knew there were thousands of homeless kids ranged across the country. It was the severity of their needs that had made me want to help them. But reality is different from numbers. Numbers are never real. These kids were real, and I felt I had barely helped any of them.

  I didn’t want to admit it, but I had thought my job would be easier. I knew it was only the first day, but I had pictured myself having the time to make meaningful connections with the kids. I really thought I would be dealing with their situation in a straightforward manner. They would step on my van homeless, I would attend to their medical needs, and somehow this would help them get off the streets. I didn’t know exactly how I had come up with this naive idea. I had just assumed that once I gave them medical care they would be happy and healthy and somehow transition into rewarding lives. It would be fulfilling, and I would feel good about myself. What I had not envisioned was being soaked in hydraulic fluid, the nurse-practitioner I respected radiating disappointment next to me, and a tsunami of doubt flooding my heart.

  I looked out the passenger window. I tried to imagine myself doing this for ten years. Ten years of kids with infected bites and dirty clothes and distrustful eyes and immunization histories that were one long question mark. Ten years of teenagers who came to me with a list of problems that unfolded in layers, problems that spanned their lives and would not be solved in one visit, or even ten visits, or maybe even ever. Ten years of dealing with intractable problems that probably went back for generations. Could I deal with that? Could I deal with the prospect of kids whom I never helped?

  We stopped by the children’s hospital. It was late. I stepped out of the van weary. Jan followed. She was dragging a huge bag filled with the dirty gowns from the day. She looked uncharacteristically bushed. “I’ll get those,” I told her. Jan gratefully relinquished the bag. My first day ended with my lugging a bag of dirty gowns into an almost empty hospital, hoping to find someone to help me get them laundered. I had to smile at myself. I might have been the first doctor in the history of the hospital to finish his day by washing gowns.

  It was again past eleven when I got home. I wondered how long my wife would put up with this. Luckily as a doctor she was used to crazy long hours, but still. “How did it go?” Amy asked, yawning. She was fresh out of the shower and sitting at the kitchen island, an empty bowl of ice cream next to her. A medical journal was there. She had been reading it while waiting for me. I was touched she had stayed up.

  “It was hard,” I said. I kissed her. “I want to talk to my dad. I’ll be right back. Promise.” W
hat I wanted to say was that I had had a desperately terrible day and needed to talk to my father. I knew she understood.

  I took my phone into my home office. Maybe it was because I knew what he would say. Dad believed the first responsibility of a man was always to take care of others. When Amy and I started dating, I had taken her to visit my parents, driving up to their place in Gilbert, right outside Phoenix, in her little green Volkswagen. Amy had loved the rural Arizona farmland, with its irrigated pastures and horses nuzzling patches of green grass in the sun. My dad did not love her car.

  He took one look at her tires and began reading me the riot act. “Look at those tires!” he said once we were alone in the driveway. Amy was enjoying a soda in the cool, shaded living room with my mom and sister, Stephanie, who was over for Sunday dinner with her husband, Curtis, and their two young, boisterously happy sons. “Those tires are bald,” Dad said forcefully. “They could blow any time. Do you want Amy getting a flat tire when she is alone on the freeway?” I promised to have them changed soon. “Change them now,” Dad said, and went back in the house.

  Dad listened to the stress in my voice. I had pulled him from bed. He waited until it all came out. “Son, remember that time when you were little and your sister bonked you on the head with a hammer?”

  “How could I forget?” I said, laughing.

  “And what did I tell you?”

  “I should have ducked.”

  “That’s right. Not because she was right to hit you. But life isn’t always fair or easy, and the sooner you learn to handle it, the better off you will be. Now, you wanted this, right? Then figure out what you can do to make it work. You got that smart wife of yours. Isn’t Amy an adviser on this van?”

  “She is.” When her father gave us the gift from their family trust, we had created an advisory board. I had remembered how important her father’s questions had been and asked several professionals to sit on a board to give us guidance and ask those hard questions. Amy was now on the board, as were several hospital and social service administrators.

  “Then why are you talking to me and not talking to her?” he asked pointedly.

  Good point. Because I’m embarrassed to tell her how horribly it went, I thought.

  “That’s what an adviser is for,” he said. “They give advice. But you got to ask for it.” He waited a moment. “Don’t be too proud to ask for help, son.”

  “Thanks, Dad.”

  He chuckled before hanging up. I pictured him and mom in their house in Gilbert, a home with its neat rows of family photographs in the hallway, the hobby shelf with my mom’s miniature adobe houses, and the little guest room with my childhood bed. Whenever I thought of my dad, I would remember Kremmling, Colorado, where my sister, Stephanie, was born. It always came back in the bright memories of childhood: the times spent fishing at the lake, the gentle jokes at the dinner table about our Lutheran gringo dad marrying a Catholic Mexican girl. We were proud of how my parents were so in love they weren’t going to obey the rules of the time. My dad had always lived by his own heart. When I was growing up, I wanted to be just like him.

  “Amy?” She was barely awake. “Sorry that took so long.” I crawled into bed, wearing my pajamas, my breath clean. I curled against her back. I smelled her clean damp hair, and I felt a lot better.

  The next few days were a firestorm of activity. We ordered many of the supplies we had found ourselves needing, including clipboards. At home I began regularly running problems by Amy. She immediately had an answer to the laundry problem: disposable paper gowns. It was a genius thought, and I ordered them immediately.

  Jan was busy creating new intake forms. She had reviewed dozens on the Internet and found none to her liking. Not one, she told me, was appropriate for a homeless child. There were intake forms for regular children, the kind that parents fill out, and there were forms for adults. But none was for an unaccompanied teenager. So she was making her own. One morning I went into our offices at HomeBase and found ten different samples waiting on my rickety swivel chair. “What do you think of this one?” Jan asked, handing me a form. At the top was a place for the kid’s name. The first question was, “Where are you currently living?” Under the answer section the choices read: “Street,” “Shelter,” “Friends,” and so on. The second question was, “How long have you been homeless?” On down the list the questions went, from abuse at home to depression and suicide attempts.

  “This is great,” I said.

  “Can we use them?” she asked.

  I thought for a moment. “Sure. But let’s run them by administration first.”

  Jan frowned a little but didn’t say anything. It occurred to me that I was used to working with bureaucracies while Jan was not. I didn’t want to upset anyone in administration by using intake forms it had not approved. The van was considered a clinic under the Phoenix Children’s Hospital; the administration was essentially our boss, I felt, and we needed to follow its rules and regulations.

  Before I knew it, we were parked again in Tempe. A week had passed since our first visit. I was hoping to see the girl with the cherub’s face, but she didn’t appear, and when I asked the other kids, no one seemed to know who she was or where she had gone. The kids came all day, in dusty waves. They came with uncontrolled asthma, injuries from fights, broken teeth and noses, tooth abscesses, old scars from beatings, and long lists of symptoms that sometimes began in early childhood. I was already learning that this would be a typical day. None of the kids came with easy solutions either. As soon as I treated one symptom, a child would nonchalantly mention another. “I’ve had this bad cough now for months,” he or she would say, or, “My tummy hurts all the time.” Under it all was a desperate need for help: for shelter, housing, a search for relatives or friends to take the child in. But at least today I felt the day was going better. Jan had the kids organized and the new intake forms made care much easier. Jan was seeing as many patients as I was, or even more. We dashed in and out of the rooms, calling names.

  The day whizzed by. My last patient left, carrying a new inhaler. It had to be close to quitting time, I hoped. I stretched my back and looked at my watch. It was past eight, and I was starving. I hadn’t eaten all day, let alone taken a break. I stepped outside the van to take a breather. Dusk was falling. The heat was still a heavy mantle over my shoulders. Fresh sweat trickled down my back.

  That was when I saw her. She was sitting in one of the lawn chairs outside, as if waiting for someone to notice that she was there. I hoped she hadn’t been waiting the whole day. I grabbed a bottle of water and took it to her.

  She was slender and waiflike, almost ethereal. She had dark hair cut in elfin wisps around her face. She was far too pale for Arizona, a porcelain girl in the desert heat. Her jeans were stained, and the hems dragged in the dust. Thin adolescent shoulders jutted out from her T-shirt. She was just sitting there, slumped in her chair, looking exhausted. Her arms seemed immobilized from weariness, almost dead in her lap. I noticed she wore something on one wrist, a bracelet.

  I sat in the chair next to her.

  “I’m Dr. Christensen,” I said. “What’s your name?”

  The moment stretched out. Finally she answered. “Mary.” It was a small and unimportant voice, the voice of a girl who has learned how to be forgotten.

  She took the bottle of water, reaching in slow motion. The bracelet swayed. The pockets of her jeans were pouched and grimy, and her fingernails were dirty. She obviously needed a bath and a change of clothes. She slumped back in her chair as if I weren’t there. The sun was setting, and the sky was aflame in streaks of magenta and orange, while the red stone mountains stood in sharp relief. The smell of citrus from ornamental orange bushes was heavy and florid, a thick perfume. In other places of the city people would be getting ready for dinner. They would be having meals in air-conditioned restaurants and later strolling in cool malls where fountains tinkled. Tempe was such a beautiful city, crowned with tall palm trees and rimmed with r
ed mountains. Yet even here, like everywhere else, there were children like Mary.

  I sat next to her for a moment, making conversation, trying to help her feel comfortable. I sensed a fear about her, and I worried she might bolt. She sat with her hands loosely folded in her lap. We watched as a group of kids played hacky sack outside the van against a backdrop of the setting sun. Even in one-hundred-degree heat they would play, stopping every now and then to pant. Jan came out with several water bottles and left them on a chair for the kids.

  In that crystalline moment, my eyes dropped to Mary’s wrist. It was very thin and white, and I could see the tender knob of the ulna bone. The bracelet, made of large letter beads strung together into a sentence, was large and conspicuous.

  I read the beads she had strung together. It took me a moment to absorb what they said:

  ASK ME WHY I HURT

  For a moment I was so caught off guard I thought my heart had stopped. My breath caught. I wanted to ask her what painful memories had left their mark so deep that she needed to wear this naked plea around her wrist. But she suddenly turned to me with a look as if to say, “Don’t ask. Not yet.” Her eyes were dark.

  I saw Jan poke her head back out of the van. She was looking at us. “You’re next, honey,” she called, smiling at Mary.

  “Let’s get you taken care of,” I said to her, and the words I had often spoken to children as a doctor now seemed to have special meaning. I stopped at the van steps and let her go first. I watched her as she entered the exam room and slowly climbed on the table. I watched her breathing rate and how she spoke, to see if she showed signs of a condition like asthma. I watched her eye movements, mouth, head, and neck to evaluate what we call the twelve cranial nerves, or the main nerves of the head. I observed her skin color, which can give clues to problems like anemia. From the way she moved it appeared she had good muscle function, but she also moved slowly, as if depressed. I wished at that moment I had a psychiatrist on board. Even in our first week we had seen kids with mental health issues. Some had been outright delusional or suicidal. I felt poorly equipped to deal with these problems.