Ask Me Why I Hurt Read online

  Jan came back in a few minutes with a large burrito. We led Donald outside to sit in a chair under our new awning. The Jaycees had given us yet another generous gift, this time bringing shade to our patients. The girl who had had the cockroach in her ear was sitting in a lawn chair. Scott joined her and began talking about why she was homeless and what we could do to help. Donald sat in another chair and began eating with small, hasty bites. Jan and I talked in low voices.

  “I don’t know if he is brain damaged from the beatings,” I said, “or perhaps he has some congenital problem; even some infections can affect the brain at the time of birth. In any case he needs some sort of work-up.”

  “I’d be brain damaged if someone beat me in the head with a board,” she said.

  I felt the anger that was there and pushed it down. “We need to get him tested in a hospital,” I said. “He needs a full work-up with neurological tests. If he has brain damage, we need to know.” Sometimes brain damage came with life-threatening seizure disorders.

  “He won’t be able to get tested without insurance,” she said.

  “Do you think we can get him on AHCCCS?” I asked. This was Arizona’s Medicaid program, the state insurance for the poor. The initials stood for Arizona Health Care Cost Containment System. I was starting to suspect that the way the state contained costs was by making it impossible to get services. We had discovered very few of the homeless kids had insurance, while getting the insurance was a nightmare requiring multiple personal visits to a building downtown, along with proof of identity. It amazed me that the government expected homeless children to take all these steps by themselves.

  “It will take a good three months,” Jan replied crisply. “And that is after he applies in person and with identification. If he doesn’t have identification, then he can’t get on it.”

  “We’ll have to get him identification first then.”

  “You know how hard that can be,” Jan said. We had friends at HomeBase who helped get the kids their identification, which itself was a huge challenge. Before anyone got identification, a birth certificate had to be obtained. Not many homeless children had their birth certificates, and efforts to track them down from uncooperative or imprisoned or addicted parents often proved fruitless.

  “We can’t just let him wander the streets for three months,” I said. “He’ll starve or get killed.”

  Donald ate his burrito while we saw other patients and pondered his future. A homeless boy walked by, looking surly. He let out a cussword at another kid, and Jan swooped down on him. She had her hands on her hips. By the time she was done reading him the riot act he was as passive as a kitten. I held back a smile when she offered to fetch a bar of soap and clean his mouth herself. The next time I checked, Jan was bringing Donald a box of apple juice.

  “Have you found my cousins yet?” he asked.

  “Still looking,” I said. I wasn’t about to crush the spirit of this delayed boy by telling him what I really thought, which was that the cousins had never existed and his father had abandoned him, shipping him on a bus to nowhere.

  All that day Donald sat outside the van. I was at a loss. I knew the shelters were above capacity, and the current wait for a bed was months. With the budget cuts to social services many shelters had closed or sharply reduced their number of cots. In reality Donald should be in a hospital, I thought, getting those head injuries looked at. But if he walked into a hospital without insurance, he would be turned away.

  I felt I was leaving him to get hurt. He’d probably end up spending the night outside with the kids in the Dumpster cave. Maybe they could at least protect him. They did that for one another. But it seemed like no choice at all. I went out to tell Donald we were leaving. He tilted his head back to look at me. The vulnerability of the gesture struck me. His blue eyes were rimmed with pale, sun-bleached eyelashes. The scars and knobs of his scalp were visible through his short hair. The scars looked like silverfish against the pinkness of his scalp.

  Across the street a familiar car pulled in. It was the pastor. He came quickly across the lot, breathing lightly.

  “Sorry, in a hurry,” he said. “Suppertime. Wife’ll get mad if I’m late. I wanted to check on this boy here. I’ve been thinking on him all day.”

  I explained to him the problems of finding Donald shelter or getting him admitted to the hospital for tests without identification. The boy had no place to go. The pastor stopped me with a wave of his hand. “I’ll take him,” he said without hesitation.

  I was flabbergasted. “You’ll take him?”

  “Sure. Got a hot supper waiting. And there’s the kids’ old room. I’ve got a cousin staying there, but he can make way.”

  “You don’t have to—”

  “There’s always room for one more. I’ll put him to work tomorrow in the church.” He gave a throaty laugh. “He’ll earn his keep.”

  He went and touched Donald’s shoulder. Then the pastor turned to me. “I’ll be bringing him by, and soon. You’ll help him, right?”

  “Right.” My throat felt thick.

  Jan came out as the two were getting into the car. The pastor was opening the back door for Donald. He was crawling in, the dirty back seat of his coveralls visible. “You’ll never believe what just happened,” I told her.

  “What happened?”

  “People are good, Jan. That’s what happened.”

  That night I gave Amy a big hug. “It’s been a busy year, hasn’t it?” I said. “The van, the kids …” I trailed off. I didn’t want to say the word miscarriage out loud. It had been two months now since it had happened, and Amy seemed fully recovered. I was the one who still seemed bruised. She added a handful of fresh basil to the saucepan and gave me an amused look. “I’m trying this new sauce,” she said. “Want to try it?” I took a spoonful.

  “Spicy, in a good way,” I said.

  “It’s got red pepper in it,” she said, taking back the spoon. The cutting board was covered with chopped vegetables, and there was sausage sautéing nearby, along with a bowl of freshly grated Parmesan. I remembered Amy’s inviting me over to her place for Thanksgiving right after we had met. I had walked in expecting a few people and maybe a burned college student turkey. Instead I walked into a festively decorated, crowded room, Amy wearing an apron, her table set with linen and candles. She had been cooking for days. Something about the homespun Betty Crocker moment struck me as poignant, knowing that Amy had lost her own mother very early. Here is a woman, I had thought, who believes in family.

  “There’s something I want to ask you.”

  “Waiting.”

  “You know about Camp AZDA?”

  “Sure. I refer kids there all the time,” she said. Camp AZDA was one of the largest summer camps for kids with diabetes. It was held in nearby Prescott, Arizona. The camp was staffed by medical professionals who taught the kids how to manage their diabetes and live healthy lives.

  “Well, they want me to be their medical director. It means spending a week there every summer.”

  “Sure.”

  “Really?” As supportive as Amy was, sometimes her attitude was startling. The most important thing in the world to her was family. Why would she accept yet another drain on my time?

  She was wearing her glasses, which she did only when relaxed. One lens had a smudge on it. With her hair pulled back, no makeup on, and tomato sauce splattered on her apron, I had never loved her more.

  “It will be a lot of work, but you’ll enjoy every minute.” She stirred the sauce. She stopped. “You have good leadership skills. You should put them to work.”

  “Only if you come with me,” I said.

  That night I held Amy and felt her heart beating through the T-shirt she had stolen from my drawer for that night. Her bare leg touched mine. “I want to try again,” she whispered.

  “Isn’t it too soon?” I whispered back. Our doctor had told Amy that as long as she had a normal period, getting pregnant again would be OK. But I didn�
�t want her to hurt again. The days following the miscarriage it had hurt even to look at her. Amy had told me several times how normal it was for women to lose pregnancies.

  “You know, my grandmother lost four pregnancies before she had my mother,” she said. “Almost half of all pregnancies end in miscarriage. It’s part of life, Randy.”

  If only I could feel that way. “What about the baby we lost?” I asked her, our voices soft in the night. Outside I heard a dove call.

  “It was never our baby,” she said. “It was never meant to be.”

  I remembered when I had wondered if Amy’s losing her mother had made her reluctant to risk falling in love. But in that moment I saw how that loss had made her the woman she was now, strong and willing to take risks.

  Over the next several weeks Donald came by the van regularly. He was still staying with Pastor Richardson, who genuinely seemed to like him. It was clear to everyone that Donald had some kind of impairment or brain damage, but we still had no idea why. We were making headway on his case, though. Pastor Richardson was taking him to HomeBase, and a staff member was working with him on getting identification. The immediate and pressing problem turned out to be his teeth. Donald was having lots of trouble eating, and his pain grew worse by the day. Like all homeless kids, he had no dental insurance and no way to pay for any dental care, let alone the money involved with getting his shattered teeth pulled and dentures made. I called a doctor I knew who provided emergency dental care to the poor.

  “We’ve got a long wait list,” he said. “But this boy sounds like he needs help now. Have someone bring him by tomorrow.”

  “Tomorrow is Saturday.”

  “Tomorrow.” And that was that.

  Later Pastor Richardson brought Donald by the van to say hello. Donald came running up, grinning with a row of even new white teeth. “I can eat anything with these!” Donald said.

  “And how,” Pastor Richardson added dryly.

  I was telling him how as a teenager I could put away an entire pan of enchiladas when Jan came into the van. She was suggesting a place that gave out food boxes to the pastor that he could use to feed Donald. But Pastor Richardson shook his head. “Someone else can use that more. It doesn’t take that much to feed a boy.”

  “It’s expensive, though,” I said.

  “True enough. But my wife can make some good beans and rice.”

  Donald grinned. “Those are good. But not with Tabasco,” he said. “Yuck. I hate Tabasco.”

  I thought about Pastor Richardson often. I saw kids who were homeless because their families were fragmented, destitute, traveling from one crime-ridden apartment to another, ravaged by domestic violence and drug abuse. They lived in isolation. By the time the kids took off by themselves, they’d lost contact with anyone who cared. Pastor Richardson, on the other hand, had a home to offer and a strong community. In his house there were cupboards with food and a stove to cook it on. There were relatives around and neighbors and a whole churchful of people to help out. If the stove broke, someone would have the tools to fix it. If his wife got sick, someone would be able to bring by a few dishes. A whole broken system could fail a child, but one solid family, or even one solid person, could save him.

  Amy gave her hair one final brush and adjusted her skirt. It was Halloween, and HomeBase was having a pumpkin-carving party at its shelter. It wasn’t far from the drop-in center where we had our offices and parked the van. The agency had converted a nearby house into a long-term home for homeless kids. Downstairs there was a kitchen and a dining room with cafeteria tables and a small community area for the kids to hang out in. A scuffed pool table stood off to one side, along with a bookshelf laden with well-read novels and skateboard magazines. Upstairs there were small rooms where the kids stayed. Each had a single bed and a dresser. A staff member was always on hand to act as a parent figure. To stay at HomeBase, you had to follow the rules. No drugs, alcohol, or sexual relationships were allowed.

  A skinny, nervous blond boy in glasses came trotting up to me as soon as we walked in the door. “Dr. Randy! Remember me?” he asked. I almost didn’t recognize him. It was Matthew, the boy who had been cutting himself. He looked completely different in his new glasses. The trench coat and the boots were gone. No more fear in his eyes.

  “I’m in the work program here,” he said. “I’m getting a job in construction. How is Jan doing? Is she still racing?” He began asking tons of excited questions. We caught up for a few minutes as the smell of food filled the air.

  “Guess what’s for dessert?” he asked.

  Amy laughed. “Pumpkin?”

  The staff had set out several folding tables in the downstairs area and spread them with newspapers. The donated pumpkins all were off size and lumpy. But the teenagers didn’t care. They were rooting out the seeds and laughing as they pulled at the gooey insides. Soon they were behaving like five-year-olds, laughing and throwing pumpkin seeds at one another. It reminded me of holiday times with my own family, when something as simple as a pumpkin and an old carving knife could make a memory.

  Sitting at the end of one table was Donald. His blue eyes were alive. Amy and I walked over.

  “Have you decided what to carve yet?” I asked.

  “Dr. Randy! Pastor Richardson said you might be here.”

  I introduced Amy. Donald took her hand with a blush. “She’s pretty,” he said to me in a loud stage whisper. We sat down.

  “What are you doing here?” I asked.

  “Making a pumpkin,” he answered innocently.

  “I meant, are you staying here now? Instead of with Pastor Richardson?”

  His eyes widened. “Oh, no. I’m taking classes here. They’re teaching me how to read. The pastor will be back.” He paused with uncertainty. “He promised.”

  “I’m sure he will.”

  Reassured, Donald relaxed again. I helped him draw the eyes and nose and mouth with a marker pen. He wanted to do the carving himself. He held the knife with surprising dexterity, and I thought he would make a fine artist or sculptor or carpenter. When he was done, he proudly showed his work to the staff.

  “My first pumpkin,” he told me.

  A few days later I had just finished giving a tour of the van to a local magazine writer. We had gotten some media interest. Jan said this was good because if people read about the van, they might want to donate a few dollars. I agreed, though I got tongue-tied and overly emotional during the interview, trying to tell the reporter how important medical care for homeless kids was and how much they deserved help. Talking about the kids and their needs, I felt tears come to my eyes. The minute the reporter left Jan was at my side. Her face was friendly but firm.

  “Randy, let’s talk.”

  “OK, what’s up?” I sat down heavily in the driver’s seat. Jan remained standing, holding lightly onto the back of the passenger seat.

  “I’ve asked you before not to refer to me as my ‘nurse-practitioner.’ ”

  “You have?” I looked around for something to eat. I had again let the day pass without eating. I was famished. “A hamburger sounds so good,” I said. “With bacon. And cheese.” I patted my growling tummy.

  “Randy, this is important. I want you to listen.”

  I didn’t see what the problem was. My face probably showed it.

  “My name is Jan Putnam. My name is not My Nurse-Practitioner.”

  “But that’s your title.”

  “All right then, the next time we have a reporter here, I’ll introduce you as My Doctor.”

  “But I’m not your doctor—oh.” I saw her point. “I thought I was being respectful,” I said. “Not everyone understands what nurse-practitioner means and that you have a lot of responsibility. Most people think a nurse is just a nurse.”

  Jan looked conciliatory. “I’d much rather have you introduce me by my name. You could say, ‘This is Jan Putnam. She is our nurse-practitioner.’ ”

  I still wasn’t sure of the difference, but I appreciat
ed her thoughtful explanation. She touched my arm. “Friends?”

  “Friends. Now, you know what sounds really good, Jan Putnam, nurse-practitioner? Mexican. A huge plate of enchiladas covered with cheese. And some beans on the side. Plus some guacamole.”

  “Randy, you’re always forgetting to eat and then getting hopped up about food. You’re going to make me fat just listening to you.”

  I missed Jan on the days when I took the van out alone. Since there were only two of us, Jan and I had decided it would be more productive to take the van out separately as well as together. Since I still spent many days at the hospital, this freed us both up to reach more kids. We were getting more interns, and we also had the two staff members from HomeBase, Wendy and Michelle Ray, but it wasn’t the same, I told myself, on the days without Jan. I had come to depend on Jan more than she probably knew. In addition to being a nurse, she was my role model. I often looked to her to see how she handled surly or reluctant teenagers.

  Because we could now have two teams, we were trying new sites. On this day I decided to park the van in a new place. It was in an area of Phoenix known for gang activity and prostitution. I had Wendy with me. Wendy was blond and strikingly pretty. She was also whip smart and good with the kids. At HomeBase she and Michelle been great at getting kids their identifications. But she wasn’t a nurse, and for the first time I found myself doing Jan’s nursing work as well as my own. It was turning out to be a lot harder than I had thought. Jan was an accomplished nurse who seemed to have the complex world of immunization schedules and blood draws memorized. Different immunizations had to be injected in different places, in different ways, and there were extremely complicated schedules that had to be followed on the order and timing of the shots. I soon felt I was floundering. I had to keep calling Jan. “Is the MMR shot intramuscular?” I asked.

  She coughed in alarm. “Randy! Subcutaneous. Under the fat. Do you want me to come in?”