“How sad,” Amy said, glancing at the girl as we pulled up to the light.
“Why do you think a girl like that wouldn’t want to get help?” I asked Amy.
“What do you mean?”
“If you offered a girl like that other options, why wouldn’t she accept them?”
The girl turned her face toward Amy and then quickly turned away when she saw us looking. I saw a car across the street slow down. The girl’s face migrated to it as if by instinct. A frown line appeared between Amy’s eyes.
“I imagine she would be afraid,” she said slowly.
“Afraid of what?”
“She’d be thinking she didn’t deserve any better.”
“Why?”
The light turned green. The car across the street had stopped, and the girl was sashaying toward the open window. The man inside had to be three times her age. The girl was leaning through his window as we drove away.
“Why do you think?” Amy said softly.
Jan was bouncing with pep, having just racked up yet another BMX win. She was now a national champion. I didn’t realize how big this was until some of the kids on the van went gaga over the news. Her taut forearms had a fresh set of freckles. She showed off her new trophy. I watched with bleary, tired eyes. Between the van schedules, my hospital work, cramming nonstop at night for my certification tests, Amy’s pregnancy, and the troubling ongoing severe nausea, it seemed I never got sleep. I felt constantly stressed, and the pressures were only rising. I was on call for two hospitals along with the van and working nineteen and twenty days straight at a time, with only one or two days off a month. It was becoming typical for me to work eighty- to ninety-hour weeks, and I wondered how long Amy would put up with it. My mind shied away from the worry.
“You won against women twenty years younger than you,” I told Jan, yawning. “Aren’t you ashamed?”
“Not at all,” she said. “Hey, I made a new schedule.”
I yawned again. A new schedule, I thought. OK. She handed me an extremely detailed chart. For a moment the lines moved into a wavy pattern and then reorganized back to where they had been. I really needed to start getting more sleep. “What’s this?” I asked.
“I told you, it’s a new monthly schedule. See? Here is all the places we take the van, here is how many hours we spend in each location, how many times a week, and when we finish for the night. Over here I have the staff and interns and medical students and their availability. I worked it all out so we aren’t so short staffed, and the kids know where to expect us and when.”
For a moment nothing she said made sense. I had to think about it. A new schedule. Right.
“When did you do this?”
“Last night, after I got back from the race.”
“You must have been up all night.”
“Only until one or two or so,” she said. “But I had to get up at five to do the laundry and get my lazy teenagers out of bed.” She drank a slug of water and smiled.
“You are crazy. Really, Jan. Stone-cold crazy. I’ll present this to the administration at our next meeting.”
“When will that be?” She looked cross.
I glanced at the calendar on the wall. “Next month.”
“You remember how long it took them to approve the intake forms I made,” she said. “And then as soon as they did, it was like everyone agreed they had been needed all along.”
“We can’t just make big changes without going through the administration and our supporters,” I said, “no matter how good the idea.”
Jan had a reputation for going toe to toe with people. Just the other day she’d had a huge battle with one of our supporters. For religious reasons, he was opposed to giving out birth control. While I diplomatically tried to handle the issue—or so I thought—Jan marched into his office and asked him how many child prostitutes he wanted to see die because they caught HIV. I had heard the fireworks were pretty spectacular. While I agreed with her, I also worried about losing a key supporter.
She pursed her lips and went back to work. We were quiet as we took the van out. It was Jan who made an overture later that day. She touched my forearm. “I have a feeling you’re mad at me.”
We have to work as a team, or this will never work, I thought. In order for the van to be successful, I have to create a strong team. I can’t do it by myself. And one of the first things I need to accept is that I can’t always be the boss. I needed to learn to meet Jan halfway. I knew she cared about the kids as passionately as I did. We just had different styles, and it occurred to me I should probably back off and let her do things her own way too.
“I’m used to working with administrations,” I said. I explained to her I was willing to work slowly because I knew there could be big results down the line: funding, support, ongoing programs. I didn’t want to anger anyone or turn people against our work.
“Yeah, but I like to get things done,” she said.
“That,” I said with a laugh, “is abundantly clear.”
I had been excited all morning. Mary’s aunt had called and said they were coming from Chandler into Tempe for the annual Tempe Arts Festival, the local art-crazed street festival that drew people from all over the state. Afterward her aunt was taking her out to lunch for her birthday. Mary was turning eighteen. They had promised to stop by the van and say hello.
I kept peeking out the door of the van to see if they were coming. The street festival was only a few blocks from where I was parked. I was busy. Several kids had told me the festival was a good place to panhandle and get free food. Jan poked her head into a room where I was finishing with a kid. “Guess who is here?” she said.
A suddenly grownup-looking Mary was carrying a balloon and had her cheek painted with a little flower. Her hair was longer, the dark silky strands growing past her shoulders. She had clipped the hair in front into straight bangs. The style showed off her features, her high cheekbones and dark eyes. I suddenly realized what a pretty young woman she was.
Her aunt’s face was flushed with heat. A large purse was slung over her shoulder. “This is an amazing festival,” she said to me. “We visited all the booths. I got a paint set for Mary for her birthday present.”
“Can you come to lunch with us? Please?” Mary asked. “We’re having Mexican.”
I hesitated. In general I didn’t see the kids outside the van. I wanted to maintain good professional boundaries. But we had decided as a team that while it wasn’t direct medical care, there were times we might want to celebrate a milestone with a child. Giving cards for birthdays, for instance, seemed appropriate. While cards were OK, we had drawn the line at giving out money or expensive gifts. When a child asked for money for a Greyhound bus home, or there was some other legitimate need, we dealt with it on a case-by-case basis.
“It’s not expensive or fancy,” her aunt hastened to say. “Just that little Mexican place down the street.”
“It’s my birthday lunch,” Mary said.
“Go,” Jan said, making shooing motions. “I can handle it here.”
On the way out I opened a storage cupboard up front and took out a small envelope. Jan had gotten Mary a birthday card. She had picked out the card because it looked artistic, with beautiful watercolors on the front. The inside read that we were wishing Mary the most wonderful year. I put the envelope in my pants pocket.
“It turns out Mary is a computer whiz,” her aunt told me as we scooped up warm artichoke dip with tortilla chips in the restaurant. She was proud. Mary stared at me briefly over her plate, her cheeks high with color. Her dark eyes studied me intently. I wondered what she was thinking.
“I made new friends at school,” she said.
“They’re all computer kids,” her aunt said with a laugh. “She fits right in. She’s smart.”
Mary dug into her food. I noticed she held her fork awkwardly, like a spade. Her aunt reminded her gently about “manners” under her breath. Mary immediately switched the fork to the other
hand. She soon scraped her plate clean. “Can I be excused for a second?” I watched as she stopped and asked a waitress where the restroom was. Her shoulders were back, and she held her head high. She had gone from looking like a fearful animal to looking like a confident young woman.
Her aunt spoke quietly. “She spaces out sometimes. The counselor says that will get better over time. She’s got PTSD, you know.”
“You must be proud of how far she has come.”
“Dr. Christensen, she’s never celebrated her birthday before. Not once in her life did that girl have a birthday.”
When Mary came back, I handed her the card. “Happy birthday, Mary,” I said. Her eyes widened. She opened the card. This is amazing, I kept thinking. When I met her, she couldn’t remember her age.
7
TOO SOON
It’s kind of hard to celebrate the pregnancy when you are puking so much.” I tried to tease Amy as she knelt over the toilet bowl. She wiped her mouth and gave me a look. We were enjoying pregnancy, despite the still-sharp memory of the miscarriage and despite Amy’s constant sickness. But she was not gaining any weight, and I was getting more concerned all the time.
“What happened to my famous cast-iron stomach?” she said, moaning.
“Remember how you used to drink milk that was weeks old and not even notice?”
“Oh. Don’t talk like that.” She retched again. Her stomach was empty. “I’ve got to get to work,” she said, standing weakly.
I wanted to argue but didn’t. Amy was still putting in her own twelve- to fourteen-hour days as a pediatrician. Part of the reason she understood my dedication to the van was that she had the same dedication to her patients. She was a driven person. Amy was a hard worker. And stubborn too. I knew it wouldn’t do any good to argue with her.
“Some ginger ale?” I asked. We were trying everything for the nausea: wristbands with acupressure points, dry toast, frequent meals, and all sorts of liquids. Nothing quelled the vomiting. She shook her head. “You know, sweetie, we’re going to have to get you on nausea meds soon, if this doesn’t stop,” I said. “You’re losing weight, and that isn’t good for the babies.” It was still hard for me to believe that under my wife’s still-flat tummy lay two tiny babies, growing minutely each day.
“I know I can’t go on like this,” she said.
Mercifully, at sixteen weeks the vomiting finally stopped, thanks to a daily healthy dose of an antinausea medication. Amy felt strong enough in June to drive up to spend a day with me at the diabetes camp at the Friendly Pines campground in Prescott, Arizona. The work was exhausting. Thinking it had to be good preparation for parenting, I spent twenty-four hours a day with my young charges, testing blood sugar early in the morning and waking kids up for midnight blood sugar tests. It was around-the-clock work. The kids had quickly given me the camp name of Bill Gates. I told Amy it had to be because of my computer savvy and leadership abilities. Then Amy said the kids had told her the real reason. It was that I wore “nerdy-looking glasses.” This just killed Amy. She vowed that as soon as camp was over, she would take me shopping for new glasses.
She and I sat on a fence and watched kids ride ponies. One of the teenage counselors rode her horse next to a boy who was suddenly looking faint. She talked to him, he nodded, and they got off their horses to test blood sugar. Amy patted her tummy and turned to me. “Can we bring our babies here too?”
“I don’t see why not,” I answered. “Smooth sailing from now on out,” I told her.
Another ultrasound had shown us we not only had twins but had a boy and a girl. I thought of the names Amy and I had decided when we had found out we would have both: Jane Marie and Reed Coleman. I sat next to my wife on my break in the summer sun and felt happy.
“Let’s go to California for the Fourth of July,” she said. Her face was shadowed under the brim of her straw hat. “We can stay in my dad’s cabin at Lake Arrowhead.” It was a great idea.
“Bill Gates says yes,” I said.
“That reminds me.” She laughed. “We’re buying you new glasses first.”
Amy and I spent the Fourth of July weekend at her father’s cabin in California. We had taken my best friend, Ron. It was his father who was one of the Old Timers who had helped us so much. After two wonderful, relaxing days on the lake we drove back. I was thinking how nice it was to escape all the stresses of our lives, even for just a short time. It was on the long drive home that Amy began looking pale. Ron was driving, and Amy was sitting in the backseat behind him. I turned around and noticed the sick sweat above her upper lip.
“Are you OK?” I asked her anxiously.
“It’s just car sickness.” She adjusted her belt and took a deep, shuddery breath. Amy often got carsick, but I suspected we were dealing with something else.
“Let’s trade seats,” I said, and Ron pulled over. Sitting in the front didn’t help her at all. Oh no, I thought, the nausea is back. “Have you been taking your meds?” I asked Amy. She nodded, wiping her mouth with a tissue. By the time we drove into Phoenix she was leaning against the window, breathing hoarsely. Her face was actually a pale shade of green.
“What is it?” Ron asked.
“Stomach cramps. Must be something I ate.” I remembered the weeks of vomiting and felt a chill.
After we had dropped Ron off and pulled into our driveway, there was panic in her voice. “Randy, I’m having contractions.”
My heart went cold. It was early July, and the twins weren’t due until November. Not again, I thought, remembering the miscarriage. We spent a long, anguished night in the emergency room. “You’re having premature contractions,” the doctors told her. They were finally able to get them under some control with medication. Amy kept hold of the babies, as if through the power of her own will. I pictured them as small as slips of paper, little paper cranes, tucked inside her, feeding gently on her spirit. After exhausting hours she slept, her face still in a circle of light.
After Amy was asleep, I walked to the window and studied the lights of Phoenix. I knew that Amy might be staying here for most of the remainder of her pregnancy—for however long that might be. Let it last, I asked God. Let her keep these babies long enough for them to be born.
Surprisingly, the next morning the doctors released Amy. With bed rest, they said, they hoped she would be fine. But we were back within hours. The contractions had returned with force. I couldn’t understand why my wife, a woman who was always strong and healthy, reacted this way to pregnancies. It was as if her body refused to be pregnant. The doctors put her on a heavy-duty med to relax the muscles of the uterus. It was administered through a pump into her arm. Amy was stoic. The medication made her feel jumpy, and I watched her eyelids twitch as she lay on the hospital bed, watching television. Still, the contractions continued. They broke right through the muscle relaxant. The doctors increased the dose. The contractions continued even more.
“If we don’t get the contractions stopped, she will miscarry soon,” one of the doctors said forcefully. I counted the weeks. If the twins were born now, they would die.
I knew Amy was nowhere near the weight she needed to be. I was overwhelmed with anxiety. My wife was in premature labor and might miscarry at any moment, and there was nothing I could do. It was a sense of helplessness that made me want to wring my hands and pace.
“What do we try next?” Amy asked, her eyes twitching.
“A high dose of magnesium,” the doctor said. “It may stop the contractions.” She explained the risks. “But such high doses can also lead to many other muscles of the body relaxing. This means the facial muscles may droop, and weakness can set in. And it means Amy stays here. If she is on the magnesium, we need to monitor her.”
Amy waved her hand in consent. Whatever works, her hand said.
“Randy, can you spend the night?”
“Of course.”
The nurse wheeled in a chair that unfolded into an uncomfortable bed. I reclined next to Amy and held her
hand. The magnesium carried her into sleep. When she was deeply asleep, I took my hand back. I was up most of the night, thinking about Amy. It didn’t seem fair that this would happen to a woman who wanted children so much. All the time I saw kids on the van who had parents who didn’t seem to care at all. The injustice of it stung. In the morning I rinsed my face and mouth in the sink, kissed Amy, and went to work. Luckily, I was scheduled for shifts inside the hospital.
I returned to find Amy looking comatose. Her wrists lay limply across the crumpled white sheet. Her head was turned toward the television. I wiped drool from her chin. Half of her face didn’t seem to be working anymore. I called the doctor, telling her she needed to come right away.
“Is this normal?” I asked.
“Yes,” she said. “Amy’s contractions are unusually strong. We had to up the dose. We’ve reduced the contractions somewhat, but I don’t think we’ll be able to eradicate them entirely.” She sounded apologetic.
I sat with Amy. “Can you eat?” I asked. She shook her head no. I felt strained with turmoil. The anxiety was only getting worse. I knew Amy could be in this hospital for the next few months, and each day would be high risk. I was glad the hospital had a lot of experience in multiple births. The doctors would know about retaining a pregnancy. But even under that assurance I still felt insecure. I didn’t know how to help my wife. As a doctor I wanted to fix her, make it all better. I had the irrational feeling that I was failing by not fixing it.
“Stay here again tonight,” she whispered.
While I was in the hospital, I checked on her throughout the day. But I had a responsibility to the van too. I tended to seemingly endless lines of needy kids. For the first time I saw them and later couldn’t recall their faces. I felt as if I were splintering into a thousand pieces. It was not the physical exhaustion but the stress that made my body hurt. I drove home only to feed and walk Ginger. The house smelled empty and lonely. I packed an overnight bag. Then I drove directly to the hospital, where I changed my clothes. I sat with Amy until she fell asleep, and then I unfolded the cot.
Ask Me Why I Hurt Page 13