Copyright © 2011 by Randy Christensen, M.D.
All rights reserved.
Published in the United States by Broadway Books,
an imprint of the Crown Publishing Group,
a division of Random House, Inc., New York.
www.crownpublishing.com
BROADWAY BOOKS and the Broadway Books colophon are trademarks of Random House, Inc.
Library of Congress Cataloging-in-Publication Data Christensen, Randy, Dr.
Ask me why I hurt : the kids nobody wants and the doctor who heals them / Randy Christensen with Rene Denfeld.—1st ed.
p. cm.
1. Homeless children—Medical care—Arizona.
2. Homeless children—Arizona. I. Denfeld, Rene.
II. Title.
HV4506.A6C47 2011 362.7—dc22
[B] 2010039947
eISBN: 978-0-307-71902-7
Jacket design and photograph by Daniel Rembert
v3.1
TO OUR MOTHERS
JANE ROGERS ELLIS
11/10/1942 – 2/18/1984
MARIA CARMEN CHRISTENSEN
6/6/1944 – 12/16/2009
Randy & Amy Christensen
FOR MY CHILDREN
Luppi Milov, Tony, and Markel.
Because no child should go without a family.
Rene Denfeld
CONTENTS
Cover
Title Page
Copyright
Dedication
A Note from the Author
1 Crisis
2 Moeur Park
3 Tell Me
4 Mary’s Journey
5 Donald
6 The Heart of Dixie
7 Too Soon
8 Roulette
9 Angie
10 Nicole
11 UMOM
12 Starfish
13 Sugar
14 Beginnings
FOR MORE INFORMATION AND HOW TO HELP
ACKNOWLEDGMENTS
About the Authors
A NOTE FROM THE AUTHOR
Dear Reader,
For many years now I have wanted to tell the stories in this book, needed to tell them. But having done so with similar stories in the past, I know the potential consequences. Years ago I introduced a reporter to a young street kid. She was eighteen years old and happily consented to an interview. Her story hit the papers and she was immediately and violently persecuted by some on the street. To this day I am still unsure what grave secret she disclosed. But to some people she knew, her disclosures mattered. I committed myself then to ensuring that such a situation would never arise again.
The stories here are true. The successes and the tragedies are all true. If anything I worry that I have not shed enough light on those dark places where we are all afraid to tread. In order to protect the kids involved, I have changed identifying characteristics such as their names, physical attributes, and identifying diagnoses. These children have already lost so much—the last thing I want is for them to lose their privacy as well. Instead I hope that this book will bring attention to their plight and in some way help to give them a chance at the good life they deserve.
—Randy Christensen
1
CRISIS
When I first saw him, I could tell he was sick. His face was pale. The look in his eyes was vacant and confused. He held the side of the van wall, looking as if he were on the verge of collapse. His short brown hair was sweat stained. His wide mouth was rimmed in white, and his broad forehead was beaded with sweat.
He was wearing khaki trousers and a blue shirt that had the name of a tool company on the front. His arms were tanned; his face was broad with sun-bleached eyebrows and blue eyes. If I’d walked past him on the street, I would never have known he was homeless. He looked like your typical teenage boy, with an athletic build and a friendly smile, the kind of boy who could have been an all-star athlete or a gifted student or the editor of the school newspaper, if only he hadn’t been sick and homeless. But he was homeless. And the day he came to the van, one late afternoon on a day blistering with heat, he was ready to die.
“Randy.” It was my nurse-practitioner, Jan Putnam.
I had been in one of the van exam rooms, stocking supplies, and at the alarm in her voice I stuck my head out. I could tell immediately he was very ill.
I took three long steps to grab him. He fell limply against my shirt. My heart lurched, and I felt galvanized into action.
“Jan, let’s get him in the back room. We need vitals right away.” But she was already pulling out the equipment. She could always anticipate my thoughts.
The van was a mobile medical unit, as close to a real hospital as possible, if a hospital can be crammed into a Winnebago. The exam room was only feet away, down a tiny hallway. Everything was sparkling clean. I laid him down. He moaned, the paper cover on the exam table crackling under him. The white lights above were bright.
He looked defenseless in his blue shirt, baggy tan pants, and tennis shoes. It seemed like a lot of clothes to be wearing in an Arizona heat wave that was topping 108 degrees. “Tell me how you are feeling,” I said, pulling on gloves.
“Sick, dude.” He opened his bleary blue eyes at me. “Man, I’m tired. I’ve been sleeping now for … days.” His voice trailed off. His skin was flushed, and I could feel the heat coming off him. It was probably from the sun. There was an underlying sweet smell of sickness on him. Sweat rolled down his cheeks, the tops of which were stained bright by fever.
“Sleeping where?” Jan asked, bustling around the exam room.
“Uh, under some bushes. Not far.” He closed his eyes as if dizzy. “I can’t even remember how I got here. Guess I walked.” He made a small choking cough. “Dizzy.”
“Just hang tight,” I said soothingly. “We’re going to take your vitals.”
I started with his temperature. It was a 101—elevated. Maybe it’s heatstroke, I thought. I took his heart rate. It was 112, also only slightly elevated. His blood pressure was next. It was perfectly normal, 110/75.
Confused, I removed the cuff. These were the vitals of a healthy person. This boy was presenting as extremely ill, yet his vitals were almost normal. I leaned over to look into his eyes. The pupils were dilated, outlined with a clear sky blue. His breathing was labored. His chest rose and fell with effort. What was wrong with him? A hundred thoughts ran through my mind. Maybe it was drugs. Maybe it was the flu. Maybe it was food poisoning. Maybe it was an allergic reaction. No, that didn’t fit.
Back at Phoenix Children’s, the hospital where I worked, there would have been other doctors and nurses and lines of equipment for tests. We would have tackled this boy’s sickness with all the power of an army. I’d have asked his parents everything I needed to know: How long has he been sick? Has he had any other symptoms? What has he eaten lately? Is there a chance he could be on drugs? Does he have any medical conditions?
But I wasn’t in the hospital. I was in a mobile medical unit surrounded by empty lots in the middle of a rough area on the outskirts of town. The only things out here were sandy wastes, boarded-up houses, homeless kids, and the criminals who preyed on them. I was out here in a medical van with a patient I knew nothing about: no history, no known allergies, nothing.
He muttered something. His cheeks were starting to sink. I was watching him decline in front of me in a matter of seconds. His eyes flashed at me. I had seen this look before. It signaled profound distress, crisis. A wave of panic passed through me, and my mind raced. My experience as a doctor told me something was terribly wrong, even if his vital signs were not that abnormal.
I looked over at Jan. She was my BMX-riding, fiery red-haired nurse-practioner who tolerated no cussing, no guff, and certainly no b
ack talk. We had only just started our operation with the van, but already the homeless kids we treated loved her. She was watching the boy with concern and attention.
It came to me. “Let’s do an orthostatic.”
An orthostatic is a different kind of blood pressure test. Because young bodies are so strong, often they can mask the worst illnesses. Their blood vessels are elastic and will adapt and hide even bad infections. A child in the midst of shock can have perfectly normal vitals, which, in medical terms, is called compensated shock. It is something usually encountered only by pediatricians. The problem is it can last until it is too late. By the time the victim crashes he or she is close to dying. By moving the boy from lying down to sitting up and then to standing up, I could break through his body’s coping mechanisms.
I let him rest a moment. Then Jan helped me lift him to a sitting position. Up close he smelled of unwashed clothes, sweat, and hair that needed a shampoo. His carefully maintained appearance melted away up close, and it was clear now that he was homeless. To me it was the vulnerable smell of despair. He leaned against me in his weakness. When his head rolled against my arms, he felt like a large child in my arms. I helped him to a standing position. He wobbled on his feet.
Then I took his blood pressure again.
It had plummeted within moments.
“Oh, my,” I said.
I took his pulse.
It had suddenly climbed to 150. I could almost see his heart racing in his chest.
“He’s in shock. It’s sepsis,” I said quietly.
My voice was low, but I could hear the stress. The storm was taking place, and I was in the middle of it. Jan knew what those numbers meant. They were the vitals of a patient in severe crisis, a patient whose system was crashing. I could have just as easily said, “He’s dying.”
“Why?” Jan asked softly. The traces of silver in her red hair caught the light.
“Bacteremia, I’m guessing,” I said. A huge blood infection.
I grabbed the stethoscope hanging around my neck and listened to his lungs. I had broken into a sudden sweat, and it was only the years of ingrained training that helped me stay calm. There it was, over the lung fields: a faint crackling like Rice Krispies. I held his wrist. His heart rate was climbing by the second. His body was done compensating. He was crashing. The boy who had weakly stepped into my van just minutes before was now moments from collapse and coma. If I didn’t do something soon, he would die.
“I’m guessing a pneumonia,” I said to Jan under my breath, “turned into a massive bacterial infection. The bacteria have spread, and they’re in his blood now, all over.” The blood vessels were leaking, like tiny hoses with holes in them. The leakage was making it impossible for his heart to take oxygen and nutrients to the rest of the body. He was going down rapidly, and what was I going to do? The boy’s eyes, blind with confusion, looked up at me. His face was now covered with huge beads of sweat. I could see his heart pound in his chest. “Get the IV started,” I heard myself saying. “Get some fluid in him. Vitamin R, quick.”
“Large-bore?”
“Yes. Saline at the same time.”
Jan was flying around the room. We both were in full emergency mode. The boy was losing fluid internally so rapidly that his veins had sunk deep inside his body. In seconds Jan had expertly located a vein, and the IV was up, delivering the strong antibiotic Rocephin into his system, along with saline. His body seemed to drink the fluids up. The next few minutes passed in a panic: I shouting orders, holding his wrist, talking to him; Jan on the phone to a hospital. The saline and antibiotic slipped into his body, and his cheeks slowly turned pink. His eyes opened and cleared, and his heart slowed. The antibiotics were fighting the front end of what might end up being a long war. But he was past the point of crisis.
Suddenly it was over. Maybe ten minutes had passed since Jan had called my name. The ambulance came screaming out to our deserted area and unloaded a stretcher. The boy was gone, on his way to the hospital.
I took a deep, shuddering breath. My hands were shaking. I held them out in front of my face. The daylight outside told me it had been a matter of minutes, not hours, since the boy had climbed our steps but it seemed like forever. The familiar metallic taste of stress was in my mouth. During an emergency I didn’t feel things too closely. I couldn’t afford to. But then afterward it all hit me. My skin tingled, and my heart lurched in my chest. Bottled-up adrenaline hit me like a wave. My skin was alive with nerves, and my stomach tightened. I felt as if I had been in a car accident. Oh, my God, I thought, that was close.
“That was close,” I heard myself repeat out loud, as if from a faraway distance.
Jan looked dazed. “No kidding.”
It wasn’t until that evening, when we shut down the mobile unit, that Jan and I talked about what had happened. My adrenaline was still running wild. There was the dark relief of knowing I had dodged a bullet, the skin-pricked elation and disbelief that come after ushering someone safely past the point of death. I kept thinking that boy had been so close to death he’d been touching it. But instead of reassuring me, the thought unsettled me. What if I hadn’t reacted the same way? What if I had still been too late? He might be dying in the hospital right now. When seconds count, you examine each one critically. I kept replaying the events in my head. I felt uncertain. Did I get it right? Should I have done anything else? Maybe I should call the hospital and ask if I was right.
I paced the empty van, talking a mile a minute. The feelings came rushing out, and I talked in the way that doctors do when a crisis is past.
“Can you believe it, Jan? He was seconds away.”
“Yes,” she said softly.
“He could have died.”
Jan touched my arm. “Are you OK?”
I wiped the sweat from my brow. “Yeah, I’m OK. I guess I just keep thinking, What if he hadn’t come in at all? What if he had stayed under those bushes for just another hour or two?” Jan nodded along with me. “Or what if we’d had that flat tire today and not yesterday? What if we had parked somewhere else? Or if he’d shown up after we left? It was pure luck he didn’t die.”
“It was lucky that we were here,” she said. Her eyes were caring.
“I guess it really just hit me how alone we are out here.”
“Well, he was alone too,” said Jan.
That stopped me. It was true. I had been thinking earlier how if I had been at the children’s hospital, the boy would have come in with his parents to answer questions. They would have been able to tell us his medical history, his shot records, any allergies or surgeries or if he’d had a cough the past few weeks. What I hadn’t thought about was how those parents were also there to hold hands and comfort and take care of their children when it was all over. When this boy finally left the hospital, he would return to no one. He had come to our van alone, and if he recovered, he would do so alone. Out here on the streets, the homeless children came with nothing at all.
I was almost thirty-four when I started the mobile medical unit that became known around Arizona as Big Blue. I was a small-town boy, transplanted to Tucson, Arizona, where I played in the dry washes behind my family’s modest house. Inside, the swamp cooler constantly blew cold, wet air. I was a goofy-looking boy with a bad stutter who talked so much about wanting to be a doctor my schoolmates started to sarcastically call me Doctor or, even less nicely, Mr. Quack. But as much as I dreamed I really didn’t think it would happen. No one in my family was a doctor. Neither of my parents had a college degree, though I believed my dad had to be the smartest guy around. Both he and my mom expected me to do well in school, but exactly what my future was I wasn’t sure. As a teenager I worked after school at the Golf n’ Stuff, a miniature golf course and amusement park. After work my friend Danny and I would stop by the closest Eegee, to drink the fresh fruit slushies and eat footlongs. Somehow, when I talked with my best friend in that hard yellow booth, my childhood fancy of being a doctor started seeming as if it c
ould become real. One day I told Danny about a flyer I had seen posted at our high school. The local hospital was offering a special program for teenagers to learn about the medical profession. Danny encouraged me to apply, and I did. Suddenly I was going from the Golf n’ Stuff to the corridors of the hospital.
It was several years later, in medical school, that I first saw a mobile medical unit. This “hospital on wheels” amazed me. I was in a combined program at Tufts, where I was getting a doctorate in medicine and a master’s degree in public health. In one of my classes I learned about the Bridge Over Troubled Waters program, which had a special van that took health care to the homeless. I was immediately intrigued. I rode the Boston subway out to Harvard Square, where the van was parked, just to look at it. It was small and looked worn, but the homeless lined up outside looked eager for help. I was struck by the concept. How perfect, I thought. With a hospital on wheels, I could take health care to any child who needed it.
I was graduated from Tufts University in 1995 and began a combined program in internal medicine and pediatrics at both Good Samaritan Hospital and the Phoenix Children’s Hospital. Over the next few years I saw many homeless adults and children. As part of the residency we were assigned to a weekly medical clinic where we would practice “real world” medicine. For my pediatric clinic I chose the Thomas J. Pappas School, a school in a decrepit area of downtown Phoenix for children whose families were homeless, living in shelters, cheap motels, and cars or on the streets. The school allowed them to get not only educations but also social services. It had a clinic, staffed by local pediatricians like me, that opened once per week. For the first time I got to practice medicine in the community I wanted to help.
After graduation, I was hired on at the Phoenix Children’s Hospital as a faculty physician. I got married, bought a house, and fell into a busy life with a lot of work, extended family, and friends. With a full-time demanding schedule and the continuing work of the Pappas school clinic, my dream of the medical van seemed out of reach.
Ask Me Why I Hurt Page 1