Ask Me Why I Hurt

by M. D. Randy Christensen

  But in 1999 all that changed. Phoenix Children’s had teamed up with a program called HomeBase Youth Services, an agency serving homeless youth in the Phoenix area. It had a drop-in center and a separate long-term shelter. The Arizona Republic newspaper ran an article drawing attention to homeless kids needing medical attention The article got the attention of the hospital administration, and soon the idea of a mobile medical unit was proposed. A grant was written and funded. Dr. Irwin Redlener of the Children’s Health Fund came to town to give a talk. He and singer Paul Simon had founded the Children’s Health Fund to help bring health care to America’s most vulnerable children. When he heard about the idea of a mobile medical unit to serve homeless kids in Arizona, he eagerly got on board and offered to help.

  As soon as I heard about the plan, I ran into the office of my boss at the hospital, Jeff Weiss. I wanted to run the van, I told him. I needed to run the van. But he wasn’t so convinced. I was young, he said. I had barely started my career as a doctor. It was the kind of position that called for a doctor with tons of experience who possessed more than a little street smarts. Besides, funding was iffy. There probably wouldn’t be enough money for a director for the van, he warned me. But I insisted. Finally, after weeks of my constant lobbying, he relented. I suspect he thought I’d never give up. There was still no money for my position, but I was confident it would all work out.

  When I called my wife, Amy, to tell her I had been offered the position, my childhood stutter had returned, as it often did when I was excited. I had to take a few deep breaths and avoid the problem words that sometimes tripped me. Finally I got it out. “I got the job,” I said.

  It felt more like a question than a statement because I needed Amy’s support. I felt the world stop until she answered.

  “Go for it,” she said. So I said yes, with neither a moment’s hesitation nor the faintest idea of what I was getting into.

  “OK, what do we do next?” I asked the folks who had gathered to help plan the launch of Phoenix’s newest mobile medical unit. It was our first meeting. I was bubbling over with enthusiasm and so excited I could barely sit still. Silence greeted my question. Embarrassed, we all looked around the table. How did one start a mobile medical unit?

  “Are there any books on the subject?” someone asked after a long pause.

  Someone else opened up a laptop to do a search. More silence. “Apparently not.”

  “Well, one thing is clear,” a colleague said. “We have no idea what we are doing … yet.”

  “We can at least start with a name,” I said.

  “How about something after Jim Crews?” a HomeBase staff member asked. Jim Crews was the CEO of Good Samaritan Hospital and a big supporter of the van. “Something like the Crews’n Healthmobile.”

  “Perfect,” I said.

  It turned out that making a hospital on wheels was incredibly complicated and expensive. The first step—getting an RV to remodel—was probably the easiest. Jim Crews arranged for the donation of a 1991 Winnebago. When the van arrived, I ran out behind the hospital to take a look. It was an old Winnebago, sure enough, but to me it was beautiful. The hard part was going to be turning it into a functioning hospital. Months of meetings were spent finding out the regulations on everything from which oxygen tanks we could use to what medical equipment would fit. We wanted a van that could offer high-quality hospital-level medical care, which meant having the right equipment that met hospital-level standards. The Children’s Health Fund donated thousands of dollars, the Phoenix Children’s Hospital and HomeBase chipped in, and the Flinn Foundation contributed huge amounts in a seed grant. The donations and grants were a godsend, yet the costs were staggering.

  But finally the van was finished. We celebrated with verbal champagne, telling one another, “Well done,” instead of the real stuff because not only were we completely out of money, but we’d gone way over budget.

  One of my first duties as the still-unpaid director had been to hire a nurse-practitioner. Jan Putnam was the first person I interviewed, and as soon as we were done talking, I knew she was the person for the job. She was trained in emergency care and was an excellent nurse-practitioner. More important, she had experience with at-risk populations. It was hard to believe this peppy lady was fifty. She had the zip of a woman half her age. Jan took to the job immediately. She was already looking over the budget in painstaking detail. It was the sort of job I detested, but fortunately Jan was good at it.

  The day we announced the van was done Jan came to my hospital office. I was supposed to be answering e-mails, but in truth I was floating on a cloud of daydreams, seeing myself at the wheel of our van for our first day out, which was slated in a week.

  “What’s up?” I asked her, dubiously eyeing the stack of papers in her freckled arms.

  She walked in and unceremoniously dropped the papers on my desk. “This is the budget,” she said. There was a friendly smile on her sunny face, but her eyes were sober.

  “OK,” I said, looking at the papers as if they were distasteful. I didn’t reach for them.

  She flipped a few pages. “We’ve gone way over, but you already know that.” I nodded. In my faith, I was sure we would make ends meet. Somehow.

  “And we didn’t budget any money for medications.” She crossed her freckled arms. “The van has no medications.”

  I jerked abruptly to life. “Medications?” I felt cold water dash down my spine. In my daydreams I froze at the wheel.

  “I know it probably came up in meetings,” she said forgivingly. “I’m sure people figured most of our patients will have state insurance. But I’m not so sure they will, or will be able to get it. Even if they can, do we really want to give some homeless child a scrip for a lifesaving med and tell him to go find a pharmacy to fill it? How is that supposed to work? We need to have at least a basic supply of meds for uninsured people and for emergencies.”

  “Jeez.” My mind went into calculator mode. I knew it was extremely expensive to stock medications. Just a month’s supply of some psychotropics can cost close to a thousand dollars, and that was one month for one patient. A full stock of everything from antibiotics to asthma meds for the unit was going to be astronomical.

  “It’s an understandable mistake,” Jan said soothingly. She was right. Most of the patients at the children’s hospital had private or state Medicaid insurance. Even if they were poor, their meds were covered. But it was very possible that most homeless kids would not be insured, and I wasn’t familiar with how to get them eligible for the state medical insurance. I needed to research these procedures. One more thing to do.

  “As understandable as it is,” I replied, “we don’t have a dollar left for it.”

  “I know,” she said compassionately. “But we can figure it out, Randy.”

  I was very depressed when I went home to Amy that night. Her dad was in town, visiting from California, and we all had planned to go out to his favorite hamburger joint for dinner. I was quiet as we ordered. Amy asked for her usual cheeseburger and added tons of fixings. Absently I made mine plain. Just salt and ketchup were enough for me. I was thinking that there was no way I would ask any of our donors for more money. Already they had given far more than they had planned.

  “You’re quiet tonight,” Amy whispered to me.

  I didn’t want to spill such embarrassing news in front of her father. He would think I was incompetent. But he asked about how the van was proceeding, so finally I confessed the problem. We talked about it as the waitress brought our sodas.

  “I can’t believe I overlooked something so essential,” I said.

  Amy’s father listened. He was a shrewd businessman. He began peppering me with questions. For the first time I found my plans for the van closely questioned. It had been easy to talk in ideals. It was much harder to explain exactly how the van would work. How long had we budgeted our money to last? What exactly were our goals, and how would we determine if we were effective? How many kids did we plan
to see? How would we track our successes and our failures? The more questions he asked, the more I felt I didn’t have any real answers. I started to flounder and heard my stutter come back.

  The waitress brought our burgers. “Why not take all that money and just put one homeless kid through college?” Amy’s dad asked, picking up a fry and dipping it in ketchup. “Might be more effective.”

  “We want to reach a lot of kids,” I said.

  “Hmm. Seems like stocking this medication unit would have been a big part of your thinking then.”

  “I guess we just assumed they would have insurance,” I said, feeling I was struggling to explain myself. I felt defensive. The last thing I wanted was for my wife’s father to think I was a fool, and it sure seemed I was doing a good job of it. It occurred to me we could have used someone like Amy’s dad on our planning committee. He would have pierced right through my pie-in-the-sky thinking. I berated myself for not having been more prepared. We needed someone like him.

  “Eat your burger,” he said, pointing to my plate.

  A few days later my father-in-law called me at work. He had talked to Amy’s brother and sister about their late mother, who had left a trust. He had asked them if some of the funds could be used for medications. Both Amy’s brother and sister said yes, though they were saying good-bye to some of their inheritance. “We all agreed it would have made their mother happy to help homeless kids,” he said. It was a huge gift, and I was overwhelmed by gratefulness. This was an inheritance that Amy’s brother and sister could have kept. Instead they were giving it away. When I told Amy that night, she just hugged me and said she wasn’t surprised. She was low-key about it, but I knew that was her family’s way. “You seem much happier and more relaxed,” she said.

  “A huge obstacle was just overcome,” I said. I hugged her back and thought that now Amy was even more a part of the van, and so was her family.

  Once we had the meds all ordered, we had a party at the Dial Tower to celebrate and to thank our financial supporters. We parked the remodeled van in front of the building. It was gleaming with new blue paint and our new Crews’n Healthmobile logo across the front. The back of the van held a dedication to Amy’s mother. When her father saw it, he got tears in his eyes. It was March in Phoenix, perfect light jacket weather. All the supporters were there. A local chef made soup, which we served in blue bowls, to illustrate how homeless kids need more than soup kitchens to get by. Amy had brought cases of beer and wine from Costco, along with water and soda and iced tea. We didn’t want our supporters to have to spend any more money. I sweated through a speech in a blue suit I had bought for the occasion. I had never organized such an event, let alone been the subject of such attention. Jan navigated the crowd, a dazzling smile on her face.

  I felt a tremendous sense of pride as I led tours of the van. Everything was ready. The meds were stocked. The oxygen tanks were on the walls, along with a defibrillator machine. There was a big examining table in the back room and smaller tables along the sides. The walls were painted a crisp hospital white. Tubes for blood draws were lined up on sparkling counters. There were two fridges, one for lab work and the other for vaccines. There was the reassuring smell of antiseptic. In my mind I could already hear the hum of the centrifuge machines. I was elated. Taking health care to homeless children seemed like my life’s calling. I must have told myself that a hundred times that night. I felt a surge of happiness, of anxiety, and, more than anything, of conviction.

  The van was finally ready to go. I woke up before dawn that Monday, having tossed and turned all night from nerves and excitement. I was usually such a sound sleeper. These nerves were new to me. I put on my new work uniform: cargo pants, loafers, and one of the new bright yellow shirts we had made for the few of us working in the van. There would be Jan and I and sometimes a volunteer or two. Our Crews logo was proudly displayed across the front of the shirt. I briefly thought about putting on a tie. As a pediatrician I had a collection of Disney ties that I had worn to work at the children’s hospital. But that seemed like a bad idea. The last thing homeless teenagers would appreciate seeing was a reminder of their own lost childhoods. With my stethoscope around my neck, I was ready to go.

  I had always worn cargo-style pants to work because the pockets are perfect for medical codebooks. These are informational books doctors are always carrying around, and mine were extremely important to me. They can list everything from what kind of antibiotic should be given to kill a specific bacterium to the symptoms of obscure illnesses. I also had the keys for the new van in one pocket, the keys for the office in another. As helpful as the codebooks were, I worried that my obsession with them bordered on obsessive-compulsive disorder. There had been times I had gotten all the way to the hospital before realizing I had forgotten one. I had turned around and driven back home, calling in frantically to say I would be late. I worried at times that this OCD behavior was a sign of stress, but as much as I tried, I could not control the ritual.

  Codebooks in the right pockets, I kissed Amy’s sweet sleepy face—she was getting out of bed for her own job as a pediatrician in a family clinic—and drove to the HomeBase drop-in center, where the van was parked. A can of Diet Coke sloshed in my stomach. I had been too nervous to eat anything more substantial. HomeBase had kindly offered to let us use some of the space in the drop-in center for our offices outside the van. The building was old. The second floor was not fit for habitation, and we had only a small corner of the first-floor building to ourselves. We were not complaining. We needed someplace to store files and make calls. Our offices were small, with walls painted a dull, heavy blue. The desks were old green metal army desks, and the office chairs were a mismatch of swap meet finds. The carpet was ancient, and there was an unpleasant smell about the place. The roof had leaked over time, causing the ceiling on the condemned floor above us to buckle with damage. I suspected there might be mold problems. We planned to spend as little time in the offices as possible and as much on the van.

  The van itself was parked behind a tall wire fence, gleaming in the dawnlight. Jan was there waiting. She too was wearing one of our new yellow shirts and looked to me to be the picture of unstoppable health and energy.

  “I’ll drive,” she announced, bouncing into the huge driver’s seat.

  “Sure,” I said, and handed her the keys.

  She gave me a wink. “Leave the driving to the pro.”

  I smiled. As a boy I had driven hay trucks on my grandparents’ farm. But it had been years since I had driven such a huge rig and was relieved she was doing it.

  On the dashboard were some of our first brochures. They had been Jan’s idea. We had printed up a bunch of them dirt cheap on paper that we had folded ourselves. In one crazy blitz we had left them in libraries, bus stops, and churches. We had a lofty mission statement that was quite a mouthful, pledging to provide “homeless, runaway and thrown away and at-risk youth” with comprehensive medical services. The inside of the brochure promised we would be appearing at sites from Mill Avenue in Tempe to local parks to downtown Phoenix. Social workers in particular needed to be able to find us. I took a deep breath. My new life was starting.

  That first day we drove to Tempe, one of the largest college cities in the country. It was reputed to have a shocking number of homeless kids. There were over five thousand homeless kids in Maricopa County alone, which included Tempe. These kids lived on the streets and in shelters. The largest percentage came from backgrounds of poverty, neglect, and sexual abuse. Many had parents with drug and alcohol addictions, and still others had untreated mental health issues or substance abuse problems themselves. Some had left bad homes, while others had no homes to go to: their parents were in jail or had turned them out. We had asked the HomeBase outreach workers to pass the word that we would be arriving, but we weren’t expecting to see too many kids the first few weeks.

  Jan pulled into an empty lot and parked. I jumped out of my seat ready to set everything up. But when we lowe
red the jacks, there was a horrible hissing and grinding sound. I jumped out in a panic and ran to the front of the van to examine four hydraulic jacks, designed to raise and lower the twenty-six-thousand-pound van. Instead of lowering properly, the front right one had stopped midway. Hydraulic fluid was jetting in a thick, oily stream. Already it had made a huge puddle over the gravel. Oh, no, not now, I thought. The van was sitting on a slant. Everything on the van, from the medical equipment to the refrigerators, was designed to work on a level surface. We couldn’t see patients on a lopsided floor.

  Jan hopped out through the narrow door behind me. “I’ll take care of it,” I told her. I crawled under the van, squirming. Fluid was still squirting out of the jack. Maybe I can pull it down in place myself, I thought. I put both hands on the metal. Hydraulic fluid poured down over my arms. As hard as I pulled, nothing moved. The thing was frozen. I crawled back out, my cargo pants ruined with dust and grease. The front of my yellow shirt was smeared with oil. I wiped my hands on my pants and began punching numbers madly into my phone. I was calling the mechanic who had helped us renovate the Winnebago.

  Then I stopped. In the midst of my consternation, which had completely absorbed my attention, I looked up absentmindedly and beheld a sight that took my breath away. Homeless kids had materialized, seemingly out of nowhere, and were lined up next to the door of the van. Their silent faces confronted me. I had dealt with the occasional homeless teenager before but had never seen a line of them, and their physical reality was a shock. I could see road dust on their clothes. Some had packs across their backs. Others were empty-handed. One girl had a wide cherub’s face. When she turned to look at me, I could see an infected sore on her cheek. I had yet to set out lawn chairs for seating or to organize anything, for that matter.

  “Are you the doctor?” the girl with the cherub’s face asked.