Ask Me Why I Hurt Read online

  Family members had left a gift basket by her bed. It had a sign on it that said FOR AFTER YOUR OPERATION. She often looked at the basket. You could see the treats inside, under the red cellophane wrapper. It was a reminder to keep hoping and fighting. She saved it. “For when I get well,” she said.

  Then one night she died. I came in the next day, self-consciously petting the sparse mustache I was trying desperately to cultivate, wondering if she would notice it and say anything, and I walked into her room and saw the bed was empty. My throat trembled. The blankets were gone. The basket was gone. She was gone.

  Losing that patient taught me that there are times when you do get close to your patients. The mantra of the field was wrong for me. It seemed to me that I could get close but also maintain my objectivity. It would make me a better doctor. There would always be the risk of attachment, and with attachment came the potential for loss. I felt it sharply at that moment, looking at Mary. I cared for her. It was as if she were my child. Whatever happened to her would affect me. I didn’t want to make any mistakes. I knew people who cared deeply but had trouble maintaining their professional boundaries and critical thinking. I knew others who didn’t seem to care at all about patients. If I was going to do this work, I thought, I had to find the balance.

  I cleared my throat. “You know, Mary, I really care about you.” I was looking at her directly. “I think about you sleeping in the hole, and I worry.”

  Her eyes jumped, and what passed between us was like electricity. It hit me that maybe no one had ever told her he cared about her. I saw something in her eyes that was like hope. Under that hope was a terrible black fear. It was the fear of everything that had ever happened to her. It was time. Maybe it was past time.

  “Mary, please tell me: Why do you hurt?”

  She didn’t respond, just stared, her eyes dark and huge. I had a sudden, deep conviction that what had happened to Mary was deeper than memory. Even acknowledging it would bring it all back. She reached down and rotated the bracelet with one hand.

  She began talking. The words came out in a monotone at first. Each one was laced with acid because what she was telling me was so painful. Her voice was flat. I could sense her shame. It was almost like a physical presence. She spoke for what seemed like a long time, her hand ceaselessly circling the bracelet. The more she spoke, the larger and darker her eyes grew. She got closer to what she needed to say. Tears formed almost unwillingly, increasing until they finally slid down her cheeks. I felt dizzy with pain myself.

  As she talked and cried, the daylight outside seemed to grow brighter, and I could hear each and every sound of the van around us: the clink of metal in a tray, a series of low voices, the hum of the machines, a bird singing in the distance. If Mary had looked up, she would have seen herself, reflected in my glasses, a little child alone on an exam table, a doctor standing nearby. The tears were all over her hands, like raindrops from a passing storm. And still her story kept coming, in little choked pieces and brutal bits, with a hurt that ran so deep I could see her skin crawl. She told me, and I listened.

  When I walked into my house that night, I was feeling wrung out, emotional, exhausted, sick, hopeful, angry. There wasn’t a feeling I wasn’t having. I thought about what Mary had said her father had done and how unthinkable it was, how it was the worst betrayal. Even to think about it roiled my stomach. I wanted—I needed—to talk to Amy.

  People didn’t understand why Amy was so supportive of my working on the van. After all, I could have chosen a field that made better money. Instead I had a job that paid less than many of my colleagues’ salaries, and I was gone for sixty hours a week. Yet Amy always encouraged me.

  I had been smitten with Amy since the first time I’d seen her. “This is your new boss,” one of the doctors had said, introducing her. I turned to see cute curly hair and a nose that wrinkled with laughter. Amy was the senior resident, and I was her new intern at the children’s hospital. I was bowled over. She was warm, with an infectious smile, but she was also vulnerable and reserved. She was as interested as I was in serving the poor. She had requested her weekly clinic to be at the Thomas J. Pappas School–based clinic for homeless children, just as I had. I got to know Amy well during our weekly rotations at Pappas. I saw how gentle she was with children, how easy to laugh and have fun, and how stoic and strong when something went badly. Amy had integrity.

  I surprised myself by asking her out after only a few weeks. Usually I would have been too shy. She gave me that huge smile. “Nope,” she announced. I was taken aback. She saw my hurt look. “Look, I don’t want a relationship. I’m a senior resident. Next year I’ll be out of here. I could get hired in Minnesota for all I know. Or Guam,” she said, with a teasing look that I came to know well. So we became fast friends instead. She invited me to go house hunting with her. For months we went to look at little houses in the Willo and Encanto districts of Phoenix, older houses with few modern conveniences. I watched as Amy made plans to buy a house that would contain only her. “I don’t have a lot of clothes,” she once said, excusing the fact that a little cottage had no closets.

  I cleared my throat. “What if you get married?”

  Amy looked as if that were way off in a foggy distance. I began to suspect her reservations about a serious relationship ran much deeper than just job choices.

  Amy was there for me when my sister, Stephanie, began having troubling symptoms of MS, including numb feelings below the waist and difficulty walking. She listened when I told her that Stephanie’s doctors had told her it was all in her head. They wanted her to see a psychiatrist. In the meantime they ran an MRI. I was doing a rotation at the hospital when the neurologist called. He sounded humbled. “We think your sister has multiple sclerosis,” he said. I immediately went to my boss and asked to leave early, so I could talk to my sister.

  It was Amy I turned to later for support. We sat on the back porch of the house she rented with her roommate, Angel, a southern girl from North Carolina, drinking Diet Cokes. “Look,” Amy said, and pointed to a shooting star. “What do you wish for, Randy?”

  I looked at her profile. “I wish my sister’s MS would go away,” I told her. She turned and looked at me abruptly. Maybe, I hoped, she was seeing something new in me.

  But after months of friendship I was starting to feel Amy would never develop romantic feelings for me. I wondered if the loss of her mother when she was young had made her fearful to grow attached again. Her father lived in California. Amy was alone. Maybe she wanted it that way. I reflected on my life so far. Each time I had fallen in love, it had been hard and with a woman who never felt the same way. These infatuations had lasted for years. When it finally became clear that a relationship would not happen, I fell into a deep depression. Now I worried I was falling into the same trap again.

  In April 1997, when I was ready to give up, we both were invited to the wedding of her roommate. It was in Las Vegas and two months before the end of Amy’s residency. We were coming out of the parking garage elevator, talking about nothing, it seemed, just the comfortable everyday stuff we always discussed. Amy suddenly stopped. Her eyes were large and bright. We stared at each other, and she stepped forward and kissed me. The kiss seemed to last forever. When it was done, Amy tucked her face against my pounding chest. “What are we going to do now?” she asked. It was a telling sign of our relationship that after we returned to Phoenix, we started the process of buying a house together. We had been looking for weeks before one day Amy turned to me in my truck and said teasingly, “We love each other, and yet we’ve never even said it.”

  I turned around, took a deep, delighted breath, and responded, “I completely and totally love you.”

  I was thinking of that magical moment when I came through the door and unloaded the contents of my pockets onto the side table. I jerked them out in a hurry: phone, keys, codebooks. I opened my mouth to call Amy. But there was something about the atmosphere in the house. The air felt different. There was a p
alpable tension. I walked into the kitchen. Amy was sitting where I expected her to be, an ignored magazine in front of her.

  “Honey?” I asked, coming in.

  She turned to me, her face bright, incandescent, and beautiful.

  “I’m pregnant,” she said.

  I felt all my worries about the van fall away. I stepped forward and gave her a huge hug. Amy was ecstatic. I felt that together we were seeing the same vistas, embarking on the same journey. My heart raced with excitement. I’m going to be a father, I thought, I will have a son or daughter. I realized that along with my joy came brand-new concerns. Suddenly I had worries I had never had. Was our budget enough? Did I need to plan for college? I remembered all the times as a doctor I had seen new fathers, and they had told me about the pressures of fatherhood. Now I understood. Along with those worries were some that came from my experiences on the van. My world was full of kids who had diseases and problems. I wanted desperately not to have these worries for my own children. I held my wife and kissed her, rocking back and forth in our joy.

  4

  MARY’S JOURNEY

  When Mary told me her story, she disclosed her real name. I called Child Protective Services the next day. Mary, it turned out, was seventeen. Her father had been sent to prison for sexually abusing her. The original charge was rape, but he had pleaded guilty to the lesser charge of sexual abuse instead. During the years he molested Mary he had kept her secluded from her other family members. He threatened to kill her if she told anyone what was going on. Mary was terrified. After his arrest Child Protective Services had found Mary a home with an aunt who lived in Chandler, right outside Phoenix. But when the aunt went to school to pick Mary up, she had already run away. “Mary was sixteen at the time,” the social worker said. “She’s been missing ever since.” She paused and then asked curiously, “Do you know where she was hiding?” I thought of the hole in the desert. I wondered how long Mary would have kept living there if she had not come to our van.

  There was a storm of phone calls. By the time we were back in Tempe the following week the aunt was coming to get Mary once again. The social worker assured me that the aunt was nothing like her brother: “The two haven’t talked for years. He never let her meet Mary.” As remarkable as this story sounded, I wasn’t surprised. In my work as a pediatrician I had often been struck by the fragmentation of the American family. I asked what the aunt was like. “She works in a nursing home. She’s a nice single lady, a bit of an old maid, to use an old-fashioned term. No criminal history, not even a traffic ticket. Apparently her hobby is needlepoint. She’s never had any kids of her own but said she’d be happy to take Mary.”

  Mary was waiting outside in one of the folding lawn chairs, biting her lips. “I didn’t even know I had an aunt,” she mumbled. “Maybe she won’t like me.”

  “She’ll like you just fine,” Jan said. “What’s not to like?”

  I felt just as nervous as Mary. Her aunt drove up in an old Datsun. When she got out of her car, she was crying. She hugged me, tears wetting my shirt. She was crying so hard she could barely speak. “I almost gave up,” she said.

  Mary stood off to the side. Her aunt approached slowly. She touched Mary’s hair and then gently brought her close. “I know we’ve never met,” I heard her whisper into Mary’s hair, “but we’re still going to be family.”

  We hugged Mary good-bye. I gave her a little stuffed bear I had found. It had a heart sewn on the chest. “Friends Forever,” it said. Hokey, I thought, but I wanted her to know she could always come back.

  “If you need medical care for her, or for any reason, bring her back,” I told her aunt, whose name was Diane. “We’d love to see our Mary.”

  Once inside the car, Mary waved a little. She held the bear up, bending its arm as if it were waving good-bye. I was shocked at the changes in her life. It was as if Mary had been a piece of luggage sent here or there. I knew it was wonderful she had a place to live. But I had mixed feelings. I wanted Mary to be safe. I wanted her to be successful. I wondered if this was possible after what she had been through. Could a girl who had lived in a hole make the transition to a normal life? Would she be able to go to high school? How would other teenagers treat her? Could she fit in? Could she recover? Or did her past mean she was damaged forever? Still, I knew she had to try. And we all had to help. There was no alternative.

  Monsoon season struck a month later. Dark and gray, the dust storms came over downtown Phoenix. We called them Arizona dusters; they were great black and gray roiling clouds that came in solid walls over the city. It was like watching something from a natural disaster movie. The man on the radio had warned drivers to pull over, far off the road, and turn off their lights. If you were driving and got caught in those storms, it was like being immersed in black soup. When the monsoon season came, I worried for the homeless kids. Arizona storms are nothing to ignore. Homeless people have drowned after falling asleep in the washes and getting caught in a flash flood.

  When the rush of patients subsided, we stood for a moment in the van door way. The distinctive smell of the creosote bushes drifted from the desert, and the hum of the cicadas was so loud it sounded like the buzzing of hundreds of rattlesnakes. It brought back old memories of monsoons, time spent as a kid playing board games with Stephanie inside our house and listening to the rain roar down the washes, or sitting in a café while the rain poured in sheets outside. After, I knew, the air would smell fresh. The streets would be washed, and all of Arizona would seem clean. But for the homeless kids it was different. The storms left them soaked, miserable, and sick. Their socks and shoes and sleeping bags became sodden. Infections and illnesses quickly set in.

  We watched as the sky turned the thick, menacing dark color of dust clouds. A boy came running ahead of the storm toward us, the sheet of black dust behind him. He was coughing as he ran—asthma, I thought. “Hurry!” Jan called.

  She interviewed the boy with the new intake forms she had created. He said his name was Matthew and he was seventeen. He had been sleeping under an overpass since his stepdad had kicked him out of his home. He had been mugged repeatedly. “He’s lost count of how many times he has been assaulted,” Jan had written. I took a deep breath and went into the exam room.

  He was small and thin, with thick blond hair. He wore a dusty long trench coat over black clothes. My heart knitted a little bit at seeing the outfit. It looked like the sad posturing of a boy trying to look tough. But he didn’t look tough at all, not with thick glasses mended with Scotch tape and rubber bands. One lens was shattered inside the frame, and he kept turning his head to look at me through the good lens. I could see from their thickness that he had very poor eyesight. I thought he looked like a walking target, a boy so demoralized he was open to attack.

  “What happened to your glasses?” I asked in a friendly voice.

  “I got jumped. I was trying to fight them off.”

  I examined his teeth. The ones up front were OK, but there were huge gaping holes in his back molars, the result of years of untreated cavities. He would need intensive dental work.

  “What can I help you with?” I asked.

  “My feet. They hurt.”

  I looked down. He was wearing heavy boots.

  “OK, how about we take them off for a look?”

  He hesitated. “It’s OK,” I told him.

  When he unlaced his boots and pulled them off, the smell was profound, putrid. I struggled to keep my face even. I carefully lifted one foot. Humiliated, he put his head down. His once-white socks were stuck to the soles of his feet. I could see damp blood and pus through the thin fabric. Parts of the socks were embedded in the rotten flesh. He probably hadn’t changed the socks in weeks. Months even. How could he change them? He was homeless. He didn’t have access to a bath. The lack of shelters meant the kids had no way to get clean.

  He began slowly peeling one of the socks off his foot. A layer of skin and pus came with it. I could tell immediately his feet ha
d a bacterial superinfection from an untreated fungus. I examined the soles. Along with raw infected flesh there were deep holes that looked to be a good quarter inch deep. Of more concern were his toes. The tips of two were black and spongy. It had to be incredibly painful just to walk. He kept his head turned down, his eyes at his knees. The smell filled the room. He was embarrassed. How hard this must be on him, I thought. He was at a time in his life that he should be feeling ready to take on the world. Instead he was at rock bottom.

  “I can take care of this,” I said, trying to reassure him, to take away the humiliation.

  “Really?”

  “Sure. These kinds of foot infections go crazy in the heat, especially in monsoon weather like this. First I’m going to get rid of these socks,” I said, picking them up with my gloved hands and dropping them in the trash. “I’m going to get you some new socks and shoes. We’ve got extras up front. But before that I am going to treat your feet. I need to spray them with medicine. Then we’ll get some clotrimazole cream. I’m also going to put you on Keflex, since the infection is bad. It’s an oral antibiotic. You’re going to get the triple whammy.”

  After I had treated his feet, I finished the rest of his exam. What I’d thought was asthma turned out to be a mild case of bronchitis. On his arms I noticed a series of unusual symmetric scars. They were neat, almost orderly, as if his forearms had been caught in some form of machinery. I turned his arm gently and examined the scars further. They weren’t identical. They had a hand-hewn look, something I had seen as a pediatrician, though usually in girls.