by Cathy Glass
It was half an hour before the female nurse returned and called Zeena. ‘You’re next, love,’ she said, with a smile.
Zeena took hold of my arm. ‘Come with me, please,’ she said anxiously.
‘I will.’
I stood, dropped the magazines into the rack and then went with Zeena to the nurse. ‘Is it all right if I come in? Zeena would like me to.’
‘Yes, of course,’ the nurse said cheerfully. ‘We’re going to have a chat first before Zeena is examined by the doctor.’
She led the way through the door, carrying the registration form Zeena had completed. ‘I’m Chloe,’ the nurse said, smiling.
‘I’m Cathy,’ I said.
‘It’s a nice day out there,’ she said, making conversation.
‘It is,’ I replied.
She showed us into a small consulting room, which was also bright and newly furnished. ‘Sit yourselves down,’ she said, drawing up a second chair for me.
Zeena and I sat next to each other as the nurse sat behind the small desk. She set the registration form on the desk and then took another form and a Biro from the top drawer.
‘Is it your first visit to the clinic?’ she asked Zeena.
Zeena nodded.
‘It can be a bit daunting,’ she said kindly. ‘But honestly there’s nothing to worry about. I’m going to start by taking down some background information. Then we’ll talk about your symptoms and you’ll see a doctor if necessary.’
‘Thank you,’ I said, and Zeena gave a small nod.
With her pen poised over the registration form the nurse asked Zeena: ‘Do you want your doctor to be notified of any test results? It’s up to you.’
Zeena didn’t know so I stepped in. ‘I’ve registered Zeena as a temporary patient with my doctor,’ I said. ‘Those are her details on the form. I’m fostering Zeena – I don’t know how long for.’
‘We can send a copy of the test results there then, and they’ll be added to Zeena’s medical record and then sent on to her permanent doctor.’
‘No, I don’t want that,’ Zeena said, glancing at me fearfully.
‘That’s fine. It’s not a problem,’ the nurse reassured her. ‘Many of our patients don’t want their doctor notified.’ She made a note on the form.
‘It was the doctor who suggested we come here,’ I said, feeling this was relevant. ‘We saw her yesterday evening and she diagnosed Zeena with herpes.’
The nurse nodded and made a note on the second form. ‘Did the doctor prescribe an antiviral?’
Zeena shook her head.
‘She said it was too late for the drug to be effective as Zeena was over the worst,’ I said. ‘She suggested warm salt baths, which she has been doing.’
‘Yes, and some people find an icepack helps. Although it’s a bit awkward to apply.’ She threw me a brief smile and returned to the form. I thought you had to have a sense of humour in this job. ‘I’ll need a telephone number or an address so we can notify you of the test results,’ she said to Zeena. ‘A telephone number is best, as it’s quicker.’
I glanced at Zeena but she didn’t reply. She sat tense and anxious, chewing her bottom lip. ‘Can the clinic have your mobile number?’ I asked Zeena. ‘Or shall I give them mine?’
‘Give them yours, please,’ Zeena said quietly.
I gave the nurse my mobile number. She wrote it on the registration form under ‘Contact Number’, and added a note saying it was the foster carer’s number and not the patient’s.
‘So, you’ve been suffering from herpes?’ the nurse now said kindly to Zeena. ‘It can be very painful. Burning, discharge, with pain in the legs. Sometimes swollen glands. Did you have flu-like symptoms?’
‘Yes,’ Zeena said quietly. ‘Before I came to Cathy’s.’
‘Has that gone now?’
‘Yes.’
‘And what about the other symptoms? Are they getting better?’
‘Yes,’ Zeena said.
The nurse made a note on the second form. ‘Do you have any other symptoms that you’re worried about?’
Zeena shook her head. The nurse had a gentle and reassuring manner and was going out of her way to try to make Zeena feel at ease.
‘Now I need to ask you a few questions about your sexual history,’ she said. ‘When did you last have sex? Not necessarily full intercourse. It includes oral sex and heavy petting.’
Zeena kept her eyes down. There was silence before she said quietly: ‘About two weeks ago. When the sores first appeared.’
The nurse nodded and made a note. ‘It was too sore to have intercourse?’ she asked.
Zeena nodded.
‘The first outbreak is always the worst,’ the nurse said. ‘Some patients don’t have any more outbreaks, but we can talk about how to manage herpes later. Did you have unprotected sex the last time?’
Out of the corner of my eye I could see Zeena sitting rigidly upright, eyes down and wringing her hands. My heart went out to her. Only fourteen and having to answer these intimate questions – and in front of someone she hardly knew.
‘Are you comfortable for me to stay?’ I asked her. ‘Or would you prefer to speak to the nurse alone?’
‘I want you to stay,’ she said quietly.
There was another pause and then the nurse said gently: ‘Does your partner usually use a condom?’
Zeena shook her head.
The nurse nodded matter-of-factly and made a note. ‘We can talk about contraception and protection later too, and I can give you some condoms before you go.’
‘Zeena doesn’t have a boyfriend any more,’ I said.
‘We will need to contact him though, if possible, so he can be tested,’ she said. ‘It’s likely he’s infected too. Do you have his mobile number?’ she asked Zeena.
Zeena didn’t reply, although I knew she had his mobile number; indeed, she had a second phone dedicated to him.
‘If you don’t want to tell him yourself,’ the nurse continued, ‘we can tell him. We call it patient notification, and he won’t know the referral has come from you. Your name won’t be mentioned.’
But this didn’t seem to help Zeena. She shook her head and then her face crumpled. ‘I really can’t tell you,’ she said, her voice breaking. She was close to tears.
‘All right, love,’ the nurse said kindly. ‘Don’t upset yourself.’
‘He wouldn’t know it was you,’ I said to Zeena. For I knew from my foster-carer training that STIs were spreading so rapidly that it was important to trace carriers and treat them. But Zeena remained silent.
‘Phone us if you change your mind,’ the nurse said, leaving the box on the form blank. ‘How old is your boyfriend – sorry, ex-boyfriend?’
Zeena shrugged and then said: ‘Same age as me, I suppose.’
This seemed an odd reply, but I assumed she was just overwhelmed with all that was happening and couldn’t think straight.
The nurse wrote fourteen. ‘Are there any others, apart from your ex-boyfriend, we should contact?’
It took me a moment to realize that the nurse was asking Zeena if she’d slept with anyone else, which hadn’t crossed my mind as she was so young. I was relieved when she shook her head.
The nurse made a note and then looked at me. ‘Our service is completely confidential, but as Zeena is a minor there may be safeguarding issues. She’s in care, so presumably she has a social worker?’
‘Yes, Tara —,’ I said, stating her full name.
‘Does she know you are here?’ she asked as she wrote.
‘Not yet. Zeena was only diagnosed yesterday evening. I left a message on Tara’s answerphone this morning to call me. Zeena understands that Tara has to know so she can help her.’
‘Good,’ the nurse said positively, making another note, then she set down her pen. ‘That’s all the form filling for now,’ she said to Zeena. ‘Is there anything you want to ask me?’
Zeena shook her head.
‘OK. I’ll take these f
orms through to the doctor and she’ll be in to see you shortly.’
‘Is it a lady doctor?’ I asked.
‘Yes. Dr Collins is lovely, so try not to worry.’
With a reassuring smile the nurse picked up the forms and left the room, closing the door behind her.
‘Are you all right?’ I asked Zeena.
She gave a small shrug. ‘I guess.’
She looked far from all right. The nurse had been so kind and reassuring that I had felt a bit easier, but then of course it wasn’t me who was going through this ordeal. As we waited I glanced around the room, which was a typical medical consulting room with shelves of plastic trays containing sterilized packages, and a couch along one wall. My thoughts went to Zeena’s nameless ex-boyfriend whom she’d told the nurse was the same age as her. I wondered what his parents or guardians would say if they knew he’d been in a sexual relationship with another fourteen-year-old and was carrying the herpes virus.
We waited about five minutes before the nurse returned with the doctor.
‘Hello, I’m Dr Mary Collins,’ she said pleasantly, shaking my hand. Then to Zeena: ‘You must be Zeena?’
Zeena looked at her but didn’t say anything. Dr Collins sat in the chair behind the desk while the nurse stood to one side.
‘You’re Zeena’s foster carer?’ Dr Collins said to me.
‘Yes.’
‘I understand your doctor saw Zeena yesterday and diagnosed herpes?’
‘That’s correct,’ I said. ‘She suggested we come here.’
‘I’m sure her diagnosis is right, but I think it would be sensible for me to take a few swabs to confirm it. Some other conditions mimic the symptoms of herpes. Also, as Zeena has had unprotected sex, it would make sense to screen her for other STIs. In addition to the swabs, we’ll take urine and blood samples. It’s standard procedure. Is that all right, Zeena?’
I looked at Zeena. She gave a small nod but didn’t meet the doctor’s gaze.
‘We’ll start with the blood test, then I’ll examine you and take the swabs,’ she said to Zeena. ‘It’s not painful, just a bit uncomfortable. Before you leave you can go into the toilet and give a urine sample. The nurse will show you what to do. The samples will be sent to the laboratory and the results are usually back in about a week to ten days. We’ll notify you of the results. Do we have your contact number?’ the doctor asked the nurse, turning over the top form.
‘It’s the carer’s number,’ the nurse replied, pointing to the entry on the form.
‘Fine. Would you like to wait outside now while I examine Zeena?’ Dr Collins said to me. ‘There are some seats in the corridor.’
I stood. ‘I’ll be just outside,’ I said to Zeena.
‘Don’t worry,’ Dr Collins said reassuringly. ‘The nurse will look after Zeena.’
‘Thank you,’ I said, and I left the room.
Outside, I sat on one of the three chairs in the corridor and took my mobile from my bag. There was a missed call from Tara’s office number and I played her recorded message. It said she was returning my earlier call and she’d be in her office until two o’clock. I’d wait until we were home and in private before I telephoned her.
A male nurse came out of one of the doors further along the corridor and disappeared into another. Although I knew Zeena was being well looked after I couldn’t help but worry. No mother wants to see her daughter go through this, and while Zeena hadn’t been with me for long I cared about her a great deal, and I wanted to protect her as I would my own. About ten minutes passed and then the door to Zeena’s consulting room opened and the nurse said, ‘You can come in now.’
I stood and went in. Zeena was dressed and again sitting on the chair in front of the desk. I went over and sat next to her. ‘OK, love?’ I asked her, touching her arm.
She gave a small nod but couldn’t look at me.
Dr Collins was sitting behind the desk and making a note on the second form while the nurse was labelling test tubes and placing them in sealed bags, presumably to go to the laboratory.
‘I’ve examined Zeena,’ Dr Collins said, now looking at me. ‘I’m confident your doctor’s diagnosis of herpes was correct, but the swabs will confirm it. Zeena is managing the condition and is over the worst, so I suggest she continues with the warm salt baths. She should be completely healed in another couple of weeks. I’ve told her she can contact the clinic if she’s worried or if her condition deteriorates and I’ll see her straight away.
‘Thank you,’ I said.
‘Do either of you have any questions?’ Dr Collins asked.
I looked at Zeena and she shook her head.
‘I don’t think so,’ I said.
‘I’ll leave you with the nurse then, but do phone if you have any worries. You’ll be contacted with the results in a week or so.’
I thanked her again and she left the room. The nurse labelled the last of the test tubes and placed it with the others in a plastic tray. She was so quick and efficient I thought she must do this many times a day. She then took a few leaflets from the shelf and, sitting behind the desk, placed them before Zeena and talked us through them. The leaflets were about contraception – the pill, coil and injection – with the emphasis on protection, not only from pregnancy but also STIs, which, as the nurse stressed, could only be achieved by using a condom – even for oral sex. I’ll admit I struggled a little with her direct and practical advice. Zeena just seemed too young to need all this, although I recognized she’d been old enough to have sex and contract a sexually transmitted infection. It was my feelings of protectiveness towards her that was the issue.
‘Would you like some condoms to take with you?’ the nurse concluded by asking Zeena. ‘They’re free from the clinic.’
Zeena shook her head.
‘Is that because you’ve split from your boyfriend?’ she asked her kindly.
‘No,’ Zeena said.
I saw the nurse hesitate, a little puzzled, as Zeena’s response didn’t really make sense. ‘Well, if you do need any, you can drop in any time we’re open and pick some up,’ the nurse said. She closed the leaflets and gave them to Zeena, who passed them to me to put in my handbag. ‘Depending on the test results you may need a follow-up appointment.’
‘Why?’ Zeena asked, daring to glance up.
‘If the samples show you have another infection it may need treating with antibiotics.’
I thought this was highly unlikely given her ex-boyfriend was only fourteen. Zeena didn’t comment. I thanked the nurse again and we stood and followed her out of the consulting room into the main reception area, where we said goodbye. The waiting room had filled; I guessed there were a dozen waiting now: couples, single men and women, and two young men together. Outside in the main walkway I asked Zeena if she would like to go to the hospital café for a drink and a snack, but she didn’t. ‘Can we just go home?’ she said.
‘Of course, love.’ We began towards the main entrance. ‘You know you don’t have to worry any more,’ I said as we walked. ‘The diagnosis has been confirmed and you’re getting better now.’
‘But supposing I’ve got something else?’ she asked anxiously, glancing at me. ‘Supposing those tests come back positive?’
‘I don’t think that’s likely,’ I said. ‘But if they do, you’ll be treated, and you’ll know to be more careful next time.’
She suddenly stopped and turned to me. ‘Oh Cathy!’ she cried, throwing up her arms in despair. ‘You don’t understand. It’s not up to me!’
We were by the main entrance and I drew her to one side. ‘What do you mean, it’s not up to you? It’s your decision who you sleep with and to take proper precautions.’
I looked at her. Her eyes filled. ‘If only it were that simple,’ she said, and walked on.
Chapter Ten
Optimistic
As we continued towards the car I asked Zeena what she had meant by her comment, but she shook her head and said she couldn’t tell me. While
I drove I tried again to persuade her to tell me what was wrong and reminded her she was safe, and that Tara, Norma and I could help her, but I had no success. Each time I said anything she withdrew further into her shell, and we finished the journey in silence. I was very worried and would mention Zeena’s comment to Tara when I telephoned her.
Once home Zeena poured herself a glass of water and said she was going to her room to lie down. I made a coffee and swallowed it down with a couple of biscuits. It was 11.45 and I would make Zeena and myself some lunch after I’d spoken to Tara. I fetched my fostering folder containing my log notes from the locked drawer in the front room and took it into the living room where I sat on the sofa. Opening the folder I picked up the phone from the corner table and keyed in Tara’s number. She answered straight away.
‘Is this a good time to talk?’ I asked her.
‘Yes. I’ve been worried since you left your phone message this morning. Is Zeena all right?’
‘Not really. We had the doctor’s appointment yesterday evening, and she referred us to the sexual health clinic. We went this morning and we’ve just returned.’
‘Oh,’ Tara said, immediately understanding the implications. I then told her all that had happened, both at the doctor’s and the clinic, including the examinations, tests, diagnosis, treatment options and Zeena’s understandable upset, and her comments.
‘Zeena wouldn’t disclose her ex-boyfriend’s contact details,’ I concluded. ‘But when the nurse asked her his age, she said, “same age as me, I suppose”, as though she didn’t know. I’ve tried talking to her and reassuring her that she’s not in any trouble and that you and I will support her, but she says she can’t tell me.’
There was a small silence before Tara said, ‘I expect her ex-boyfriend was older than fourteen, possibly an adult. That’s why she’s not saying anything. If he’s an adult, then having sex with a fourteen-year-old is a criminal offence. If they’re both fourteen and it’s consensual sex – that is, they have both agreed to it – then the police aren’t likely to prosecute unless it involves abuse or exploitation.’