Ask Me Why I Hurt

by M. D. Randy Christensen

  “I still don’t hear the heartbeat,” the doctor said.

  I turned to Amy. Her face was bleak. All of a sudden she knew. And because she knew, I knew. The doctor’s face took on a watchful, careful, and measured expression. I knew the look. I had practiced it enough myself. Soon, I knew, she would turn to us. Her eyes would be kind. They were. I wanted to shout at her for ruining our hopes, for hurting my wife. Amy shook her head wildly, her curls flying. “I’m sorry,” the doctor said.

  I woke up in the middle of that night, and there was an empty space in the bed next to me. Amy wasn’t there. The bathroom door was open, a slash of light showing a damp bath mat. I got up and saw that Amy was sitting on the edge of the bed in a triangle of moonlight coming through the wavy brick glass of our bedroom. The moonlight was very strong, and it illuminated the room. She was wearing one of my shirts and my matching boxers. She was crying very softly, almost in a hushed lullaby sound. Her head was bowed into her hands. It hit me then, with a pain I had never understood could feel so sharp, that we had truly lost our baby. Her devastation was so profound it was a presence in the room. I had never seen Amy so sad, so mournful, and there was nothing I wanted more than to help. “Is there something I can do?” I whispered, and then I went to her.

  5

  DONALD

  We parked the van in a lot near Fifth and Roosevelt in downtown Phoenix, in the midst of an empty urban expanse bordered with crumbling 1950s buildings. The kids were lining up outside, and I was pulling a cockroach out of a girl’s ear.

  When we pulled into the lot, we noticed kids all around us. They had bedded down for the night in groups of twos and threes, some in sleeping bags and others just wrapped in their own arms. There were perhaps twenty homeless kids spread across the empty, rutted lots, all in their little camps. They had risen slowly in the early-morning gloom. It reminded me of something out of a zombie movie. A medical student named Scott had joined us after expressing an interest in working on the van. I was eager to find help and happy to have him join the team. Scott was a thin, earnest young man with a long face. Seeing the kids pop up like that, he got a shocked look on his face. This happened with all the volunteers, it seemed. The first day on the van, I had warned Scott, could be an education.

  Right away it became clear it would be a shocking education for him. The girl came over screaming with pain, cupping her ear with one hand. Immediately I suspected a cockroach. I had learned this was common. The kids would lie down to sleep in abandoned houses and filthy camps, and the cockroaches would run right inside their ears. Baby cockroaches in particular. Every few moments the pain lessened, and she sighed with relief. Then a moment later the screaming began again. The pain came when the insect pinched its spiny claws into her tender eardrum. When it relaxed its hold, the pain diminished. “I think she’s got a cockroach in her ear.” I spoke in a low voice to Scott as she came up the steps.

  “A what?” he blurted, and looked at me to see if I was kidding. I wasn’t.

  Murmuring soothing words, I led the girl into an exam room and examined her ear. Sure enough, there was a large bug deep in her ear. Not only was it a huge cockroach, but it had also wiggled way up the ear canal. How had it gotten that far up there? I wondered.

  “Here,” I told Scott, letting him take a peek with the light. His face went white. “Can you get me some lidocaine?” I asked him. I was experimenting with different methods to get rid of the insects. At first I tried mineral oil. But that left a thick, goopy mess and a dead cockroach inside the ear, the perfect invitation to bacteria and further infection. A doctor at a county hospital had suggested lidocaine. It numbed the pain and killed the cockroach. Jan jokingly called this the Christensen Method of Cockroach Removal. Someday, she said, I would be famous.

  His back against the wall, Scott watched. It was crowded in the little exam room. When I dropped in the lidocaine, the girl immediately relaxed. The cockroach was dead. I carefully removed the pieces of the corpse, dropping them onto the tray. I didn’t want to leave any behind because a subsequent infection would be even more painful than a live roach and, from a medical standpoint, more serious. The procedure took a long time. The lidocaine had dissolved the roach into tiny fragments. I had to make sure to get them all. The girl wept during the process, her damp hair swinging in her face. I felt sympathy for her. It had to be like hitting bottom.

  Scott had a dazed look I didn’t like.

  “Doctor?” It was Jan, poking her head in the room. “There’s a pastor on the phone. He wants to bring someone in.”

  “Sure, no problem.”

  A few minutes later the ear was clean. Inside, the canal looked raw. She had numerous other complaints, including a bad cough.

  “Have you been coughing up anything?” I asked.

  “Yeah, this green stuff,” she said.

  I looked at Scott. I waited for him to ask the next question. He spoke nervously. “Uh, how long have you been coughing?” he asked. His eyes kept going to the tray with the dead roach pieces. I whisked them out of the way.

  “A week or so, I guess.”

  I listened to her chest. She had bronchitis. “Have you ever taken antibiotics before?” I asked. “Are you allergic to anything?”

  She rubbed her ear. “I have trouble swallowing pills.”

  “This patient has a raw ear canal and bronchitis. Do you agree?” I asked Scott. He nodded. “Can you write her up a scrip for antibiotics?”

  “Sure.” He dashed one off and handed it to me. I read it.

  “Let’s talk outside the room,” I said to Scott in a low voice.

  “You’ve got this for fluoroquinolone otic suspension,” I told him after we stepped outside into the narrow van hallway.

  “Yeah?”

  “This girl doesn’t have any insurance. The choice you’ve given her will be far too expensive.”

  “Oh, boy, sorry.” He paused. “Uh, I also wrote an amoxicillin suspension for the bronchitis.”

  “How come you chose the suspension?”

  “She said she didn’t like swallowing pills.”

  I lowered my voice. “With antibiotic suspensions the medicine needs to be refrigerated. This girl doesn’t have a refrigerator. She needs medicine she can keep in a backpack.”

  He looked crestfallen.

  “Treating homeless kids is hard,” I told him. “You know how I know? Because I’ve made exactly the same mistakes you just made. I told one kid with asthma he should use a nebulizer. You know what he asked me? ‘Dr. Christensen, where do I plug it in?’ Just last week I saw rat bites and couldn’t figure out what they were. No doubt I’ll make more mistakes very soon. This is complicated work and nothing they teach us in school.” I paused and smiled. “I’m happy you were paying attention to the patient’s needs. That’s good.”

  “What should I give her?” He looked worried.

  “Well, what do you think? Give it some thought.”

  He took a breath. His forehead creased and then relaxed. “How about chewable amoxicillin? It’s cheap. No refrigeration. And since she can chew it, she doesn’t have to swallow any pills.”

  “Bingo.” I patted him on the shoulder. I was happy to see his face relax and light up. “That’s what this work requires. Thinking on your feet. You’re going to be fine.”

  He smiled. “Um, Dr. Christensen?” he asked before we went back in the room.

  “Yeah?”

  “That cockroach thing? Does it happen all the time?”

  “Quite a bit.”

  He swallowed. “OK,” he said. I could tell he was thinking what I had thought before and what nearly all the volunteers had told me: the life of a homeless child was way harder than they had ever suspected.

  I let Scott finish with the girl and stepped outside the van. The rocky ground was rutted and littered with trash. An empty Dumpster had been pushed over. It lay half buried in the dirt and sand, with mattresses over the top and around the front. The kids lived inside it like a cave. Th
at’s probably where the girl got the cockroach in her ear, I thought. Near the Dumpster the kids had set up a fake Christmas tree. Its limbs were knotted with old silver tinsel that glittered in the hot sun. The rocky ground under the tree was empty except for a crushed beer can. A group of kids were sitting in the chairs Jan had unfolded. She was doing intake forms with them one by one and lining them up for care.

  Scott joined me outside. He looked at the kids. One had a lank Mohawk that fell over one eye. In dusty black clothing and with tattoos, the young man looked like something out of a Road Warrior movie. “Are you ever scared?” Scott suddenly asked me.

  “Of the kids?”

  “Yeah. What if they decided to rob you or beat you up?”

  “We had some concerns in the beginning,” I said. “We were especially concerned about female staff, like Jan and Wendy Speck, from HomeBase; you’ll meet her. You’ll notice there’s a panic button that triggers an alarm in the van. But we’ve never had any problems. There have been a few raised voices, mostly from kids with mental health issues. But the truth is I think these kids would protect me if something came up.”

  I noticed someone pulling into the lot in a wheezing old Honda that bumped over the rocky ground. That must be the pastor, I thought. He opened the back door. A large boy emerged, blond crew cut shining in the sun. The pastor was a small, wizened African American. The boy was huge and heavyset, easily topping six feet. He was wearing the faded blue overalls of a farm kid. His round shoulders were scorched with sunburn. Just looking at the way the boy ambled behind the man, I thought, There is something wrong with him. He looks delayed.

  “Are you Dr. Christensen?” asked the pastor. He held out his hand, which was dry and dusty, as if he had been working drywall. He had a small, narrow face, smiling eyes, and a small head crowned with graying short hair. “I’m Pastor Richardson. I found him this morning,” he said, nodding toward the boy. “He was sitting outside our church. He said he’s been lost. People been throwing rocks at him.”

  “How did you hear about us?” I asked, curious.

  He pulled a brochure out of his back pocket. It was one of the cheap ones we had made. “Gave the number right here.”

  “What’s your name?” I asked the boy. For some reason it was easy to think of him as a boy, though he was easily as tall as I was, and probably bigger.

  “Donald, sir.” He had a soft, eager-to-please voice. There was a soft southern accent.

  “Pleased to meet you, Donald.”

  “OK?” the pastor said. He held out his hand to Donald. “You be good.”

  I took him inside for what we called the H&P, history and physical. Jan’s intake forms were now being used by homeless health agencies around the world. We had recently gone to a conference hosted by the Children’s Health Fund, and Jan gave a presentation on her new forms, which were quickly scooped up by social service and medical agencies across the globe. But we were still working on the best way to talk to the kids. The standard questions I would ask of an adolescent—about high school, parents, friends—just didn’t apply.

  Donald sat on the exam bed. The knees of his overalls had hand-sewn patches. His hands were calloused, the nails splayed and horny, from hard labor. He had many scars on his arms and hands and even through his left eyebrow. His work boots were busted, with cracked uppers and a flapping shoe heel. I started with what doctors call the chief complaint.

  “How come you’re here, Donald?”

  With most kids, it’s a physical problem: an infection, asthma, or a fight that left broken bones. Donald just looked confused.

  “The pastor said people were throwing rocks at you. Did you get hurt?”

  He nodded shyly and held out an arm. There was a fresh bruise. I began examining it.

  “When did this happen, Donald?”

  “Last night.”

  “Who was throwing the rocks?”

  “I don’t know. Kids.”

  I kept up the flow of questions while I looked for other bruises. When I was satisfied that none of the rocks had caused serious injury, I asked permission to examine other parts of his body. When Donald opened his mouth I winced. He had a mouthful of teeth shattered by abuse and decay. He would need all of them pulled. Probably he had never seen a dentist. It had to be hard for him to eat. I felt sad. Here was a boy who probably needed dentures, and he wasn’t even old enough to vote.

  “How’s your throat? Any sore throat?”

  “No, sir.” His southern accent made him sound courteous.

  “You ever wear glasses? Have vision problems?”

  “Uh, I can see pretty good.”

  “You see out that window there?”

  He giggled. “It’s got shades.”

  “Well, see there, you aren’t blind.” I smiled. He smiled back. I listened to his heart. I watched him as I talked to him, sensing his trust growing. He became so relaxed by the questions he looked almost sleepy.

  “Do you have any headaches?”

  “My head hurts all the time.”

  “All the time?”

  “Yes, sir. All over.”

  I began to gently examine his skull. My hands stopped immediately. The back of his skull was covered in scar tissue. It was like passing my hands over a warm moonscape of ridges and bumps. I parted his hair with my fingers to examine the scars more closely. There were dozens, hard and thick and raised, crossing his scalp. Some were old; others, more recent. Of greater concern were the hard, raised knobs. I felt them carefully. These bony knobs were the result of skull fractures. When broken, the skull doesn’t mend, or what doctors call remodel, the way that other bones do. A weight-bearing bone will remodel after a break to an eventually smooth surface, but the skull will heal with a bony outgrowth. I thought about this as I counted the bony knobs. There were at least eight. His head lolled against my hands. It was as if he were seeking affection from my touch.

  “How did you get all these scars, Donald?”

  There was a slight pause. Then quietly he said, “My dad.”

  “Why did he do that, Donald?”

  “He wanted to make me mind.”

  “Did he hit you?” I felt his ear. It was lumpy with scar tissue.

  “Uh, yeah.”

  “What did he hit you with, Donald?”

  “A board.”

  I cupped my hands over his head above his ears again and felt the scars and knobs. He turned his cheek slightly into my hand. I felt I was absorbing his pain as I touched him.

  “How many times did your father beat you with the board, Donald?”

  “Lots.”

  “Did he ever take you to the doctor?”

  “When I was little, maybe.”

  “What did he do when you got hurt from the beatings?”

  “He put a towel on it.”

  “Donald, where are you from?”

  This time came another smile. “They call it the Heart of Dixie.”

  It wasn’t until later I figured it out. “The Heart of Dixie.” Alabama.

  I was discovering that many of the physical problems ailing these kids—the untreated asthma or the cutting or the drug use—had roots in their past. They were homeless for a reason. Sometimes it was poverty at home, abuse, or neglect. Other times it was their parents’ alcoholism or drug addictions. A surprising number had parents with schizophrenia, bipolar disorder, or clinical depression. Understanding their family backgrounds, I thought, was key to understanding their health.

  My questions seemed casual to outside observers, but actually followed a pattern. I started easy and broad. Who was at home when he was growing up? Donald said it was just he and his dad. His mom had left when he was young. Did they always live in one place? Yes. The farm. Did he remember going to school? He remembered a nice teacher in first grade. How long did he go to school? He wasn’t sure when he left, but it was when he was young. Did he ever see a dentist? One time. He couldn’t remember. Did anyone ever evaluate him for learning problems? He wasn’t sure w
hat that meant. But he mentioned that a home nurse came by a few times and told his dad something.

  The longer I spoke with Donald, the clearer it became. He had significant developmental disabilities. The only thing I didn’t know is whether the delays were caused by prenatal or birth issues or acquired through the injuries he had suffered at the hands of his father, or both. Complicated questions boggled him. But he was sweet in nature. I began to get more specific, gathering a picture of his past. I asked about his favorite meal when he was growing up. He smiled. He liked spaghetti, the Chef Boyardee kind that came in the can. Did he get fresh milk? Yes. How did he spend his free time? He worked the farm. Did they have a television? Of course, he said. Did he read books? He wasn’t too good at reading, he said. Had he ever used drugs? Never. Coffee, tobacco? No. Sex? He blushed when I asked. No. Had he ever left home before? No, he said, suddenly sad, his eyes starry with tears.

  “How did you get all the way to Arizona, Donald?”

  “My daddy put me on the bus.”

  “The Greyhound?”

  “Yes, sir.” He looked at his calloused hands.

  “That must have been a long bus ride.”

  “Oh, it was.”

  “Did your dad tell you why he put you on the bus?”

  “He said I was going to stay with my cousins. He couldn’t take care of me anymore.”

  “What cousins?”

  “I never met them. I got their address here.”

  He handed me an address written in crude block script on the back of a feed store receipt. I knew Phoenix well enough to know there was no such place. The boy’s father had put him on a bus to nowhere.

  “I kept looking,” Donald said. “I couldn’t find the place. Those kids were throwing rocks.”

  “How long have you been looking?”

  He suddenly looked close to breaking down. “That nice man found me. I’m hungry.”

  I asked Jan to get him something to eat. I knew she wouldn’t mind running for food; it would give her and Scott a chance to take a break. “Make it soft,” I said, looking at his teeth.