Ask Me Why I Hurt

by M. D. Randy Christensen

  I knew as a doctor that people made self-destructive choices. They ate too much even when they had serious complications from obesity. They kept smoking when they knew they could die of cancer. They didn’t exercise or eat right or take their medications. I had seen adults die because they refused to take simple steps to save their own lives. Even some doctors, like me, were guilty. I ate too much junk food and didn’t sleep enough. That Sugar had survived this long was like surviving a game of Russian roulette with HIV and violence.

  I thought that for Sugar even to come to our van was an act of courage. For some kids that alone was a huge step. Someplace inside her there was a voice that was telling her that she did deserve help. Someplace inside her was a fighter who had decided that even for just a few minutes she deserved care. I felt hope entwining with darker emotions. Sugar had a chance. I didn’t care how slim it was. I was going to fight for that chance. If it took years, I would keep trying to save her.

  When I walked back in, both the twins were crying. They were now almost a year old and getting into everything. Time seemed to be flying by. There were times I still veered around the oxygen tank in the living room, but it was long gone. Amy handed me one of the twins as soon as I came in. I knew instantly from the weight in my arms it was Janie. “You were right, Amy,” I said.

  “Right? About what?” Amy held Reed while she pulled forks out of the drawer. I noticed how gangly he was getting. He kicked his legs in dismay. He wanted down, so Amy put him on the kitchen floor. There was a delighted look of freedom on his face, as if he had just discovered the magical world of drawers and knives and electric sockets.

  “Reed!” I said as he reached for the stove. It was way too high, but still, I worried. He grinned at me, his new teeth coming in. Janie babbled in twin sympathy to him. Our dad, she was saying, is a mean old man.

  Amy was saying something over the din of my thoughts.

  “What was that?” I asked again. “What?”

  “I’m pregnant again,” Amy said, stepping toward me. I froze. “Pregnant.”

  I felt the same wave of excitement I had felt before. Only this time it was tempered with more notes of caution. The miscarriage; the endless months in the hospital; the exhausting nights spent feeding preemies: it all came back to me.

  We both had wanted large families and from the early days of our marriage had made plans to have many children. Four or five or even more kids were what we had dreamed. In those early talks we had never considered we might have a problem with pregnancies. Amy was so healthy; why would we think there would be a problem? I knew it was so important to her to have children that she would try again and again. I saw how happy Amy was, and I was happy too. But I didn’t see the same worries in her eyes that I felt in my heart.

  In only a few weeks we were back in the hospital for an early ultrasound, receiving the brutally familiar news, a cruel déjà vu. I felt as if I had stepped into a time tunnel. Waves crashed in my ears. Once more our baby was dead.

  “There is no heartbeat,” said the doctor. How could this happen again? We had told each other the first miscarriage was random. We had told each other that Amy’s illness with the twins was bad luck. But a pattern was emerging. Our efforts to have babies seemed to come with terrible risks. Amy and I touched hands. Her face was calm.

  “We have two options,” the doctor told us. “We can do a D and C right now to remove the dead tissue.” I envisioned our dead child being taken from Amy’s womb. I knew how Amy would react to this. “Or we can wait a week or two. The chances are your body will expel the dead tissue.” Like last time, I thought.

  I remembered waking to the sound of Amy crying in our bed. We would have to go through that again. I wasn’t sure I could do it.

  “We’ll wait,” Amy said.

  I had expected the miscarriage to happen quickly, like the last time. I thought it might be that night or the next day, maybe a few days at most. But weeks passed. Amy became quieter. I thought it was a mistake to have waited. She was walking around with a dead baby inside her. Still, she went to work. Her own practice was in a small family clinic. I wondered how she felt, holding those babies in her hands while we waited for ours to leave. Both of us had immersed ourselves in the lives of children, at home and at work.

  As the weeks passed, we both went back to work, with Amy caring for the twins as well. She had made an appointment with her doctor to get the D & C. She was on a part-time schedule and was able to arrange her hours around day care.

  I took the van out by myself. Jan was off for the day. I had parked in outer Phoenix. It was a fine, sunny day, and the blue sky seemed to stretch forever without a single cloud.

  A Phoenix police car pulled up in the dusty lot. The kids waiting under the awning fell silent. A young police officer jumped out. He looked to be of Native American descent, with bronzed skin and shiny black hair cut into a military crew cut. He opened the back door of his car. The teenage boy who got out was what we call in medical terminology cachectic, or extremely emaciated. His hipbones jutted out of his jeans. Skin was stretched tautly over his cheekbones and jaw. I could see the shadow of his teeth through the thin membrane of his skin. He looked like the survivor of a death march. If I’d had to estimate his fat percentages, I’d have guessed in the single digits. He had lost much of his muscle mass as well. Right away I thought he must have a terminal illness or be anorexic. Rarely had I seen such emaciation, even among addicts.

  The police officer shook my hand. “I found this boy here sleeping in an alley. You’ll see why I got concerned. I’d heard about this Big Blue van, so I thought you should check him out. He hasn’t done anything wrong, by the way,” he quickly added. “He just needs help.”

  I thanked the officer and watched him leave, his car tires crunching in the dry sand. I led the boy inside. The kids waiting outside started playing a game of hockey with two sticks and a ball of wadded-up newspaper.

  “How come you’re so thin?” I asked the boy once we got in the exam room. I had discovered sometimes it was best to be direct. Without saying a word he lifted his baggy shirt. There was a hole in his stomach. I recognized it as a G-tube site for tube feeding.

  “I was a preemie,” he said. “I guess my intestines never developed or something. If I eat, I get really sick and bad diarrhea. I’m supposed to get fed with a tube.” He shrugged as if it were hopeless. I thought of my own preemies, now thriving because Amy and I had insurance and could afford the astronomical cost of their extremely expensive specialized formula and the medical equipment and the months in the hospital. Had we been poor, would they be doing as well today? I doubted it.

  “Where have you been living?” I asked.

  “I was in foster care. But I turned eighteen, so they kicked me out.” This was common, I was discovering. Once kids turned eighteen in foster care they were on their own, with no home to return to for emergencies or holidays. “I ran out of tubes,” he said. “I haven’t had a feeding in a long time.”

  He yawned and, once he started yawning, couldn’t seem to stop. The exhaustion was probably the result of his malnourishment. I decided to call the children’s hospital. I wanted to get him a supply of G-tube feeds and some high-octane formula nourishment. We had a protocol for feeding infants and children on tubes. He would not be much different.

  My phone rang. It was Amy. “Randy, you need to come home.”

  “What for?” I asked.

  She stopped. “I’m sick,” she said. “Please come.” I felt a tug of frustration. I was out by myself. I didn’t want to make this kid leave and then drive the van back to the dock to get my truck.

  “Excuse me,” I told the boy.

  I stepped outside the room. “Can it wait?” I asked.

  There was a huge silence. “Just come.”

  I apologized to the boy and made a call to HomeBase to let it know he was on his way. He would need to get the G-tube feeds and be seen by a doctor. He was uninsured. My phone rang. It was Amy, her voice q
uerulous.

  “Randy, are you coming?”

  “I’m taking the van in right now.”

  I walked into our house. Sun slanted in the living room window. Ginger greeted me, whining in the back of her throat. There was a dripping sound. The faucet, I thought. I walked into the kitchen. Amy was sitting in one of our wicker kitchen chairs. Her face was pale. She had a wad of towels between her legs. They were saturated with blood. Oblivious, the twins were toddling around. Janie had blood smeared on her cheek. It was the miscarriage, finally arriving.

  A wave of guilt and anger swept over me, yet at the same time, I wasn’t really tuned in.

  “I’m OK,” Amy gasped. “I just need to get cleaned up.”

  “Cleaned up?”

  “Before we leave. I’ll take a shower.”

  “Really, Amy …” I said, and didn’t finish the sentence. This is madness, I thought. And then my phone rang. It was another doctor. He was someone who I knew would call only with a medical emergency.

  “What about the twins?” I asked her, holding the phone out.

  “We’ll take them after I get cleaned up.”

  I answered the call, and she staggered off to the shower. I could hear the water running. I didn’t want the doctor on the call to know I had a family emergency, so I tried to talk as normally as possible. I knocked on the door.

  “Amy, we really should leave,” I said, cupping my hand over the phone.

  There was silence. The water stopped. I waited for her to get dressed while I finished the consultation. Then I calmly loaded the babies into our van. My wife came out of the shower, already bleeding through her pants. Her cheeks were white.

  All of a sudden it was as if I had snapped to life. “You should have called nine-one-one,” I said, helping her into the van and jumping in.

  “You should have come when I called,” she said, gasping. “I’m getting blood on the seats, Randy.” I felt a rush of fear. What had I been thinking? How could I be so attentive to my patients yet so out of it when it came to my own wife? I was realizing that I was completely in control and clear-eyed only when I was working as a doctor. When it came to my own loved ones, I suddenly became flustered and had a hard time making decisions. It was as if my love for them were a barrier to my taking care of them as a doctor or even, I worried, as a husband and father.

  The houses raced past. I called my friend Ron and my parents and asked them to meet us at the hospital to help with the twins. I held Amy’s arm as she stepped from the van. The doctors at her small clinic tried to do one procedure and then said the words emergency room. I led her outside to drive the few blocks from the clinic to the hospital down the street. She swayed on her feet. Blood streaked down her legs.

  She’s bleeding out, I thought. I’m going to lose my wife in a parking lot because she wouldn’t call 911. Another voice intruded: Because you didn’t come when she called, and when you did come, you took a damn phone call rather than attend to your wife. In minutes she was being rushed into surgery for an emergency D & C. She was hemorrhaging so badly, the doctor said, that if they didn’t remove the dead tissue immediately, she would die.

  Two weeks later Amy was still weak. We talked.

  “You could have died,” I said, still traumatized. Amy was on the couch while the twins toddled around. She just looked at me calmly.

  “You seem to be handling this better than I am,” I told her. She picked up Reed and grabbed a children’s book from the edge of the couch. It was Brown Bear, Brown Bear, What Do You See? I saw. She cuddled Reed in her lap and opened the book. Janie toddled closer and swayed while holding on to the edge of the couch. Amy turned a page and began to read out loud to the kids.

  I scooped Janie into my lap and curled up close. The twins were healthy babies now, fifteen months old and chubby, with no signs of special needs from their past. There was no reason to think of them as preemies. But the shadow of the past was still on them, at least in my mind. I still touched them like a gentle doctor, not like an assured, rough-and-tumble father. They were cutting their first teeth. The magnesium that Amy had had to take in such high doses before had affected their baby teeth, which were discolored, striped with pale marks.

  I listened to Amy read. Her strength frightened me. It was as if she were capable of handling far more stress than I could ever handle. I thought we should talk about the miscarriage, about our children, about the kids on the van. But I was afraid to say anything because I knew Amy wanted to try again. I could see it in her face, in her eyes. I knew she would want to keep trying to have children even after this.

  I didn’t want to confront my own fears, my own incapability of dealing with these losses. There might have been a part of me that sensed she was furious with me for how I handled the miscarriage. But Amy, I thought, was the kind to let things go. If she were angry, she probably wouldn’t tell me. She would do anything, and perhaps put up with anything, to have a family and keep us intact.

  I had just gotten back from speaking at a conference, and Jan and I were in the office, trying to work on a new grant. Jan grimaced at the dreary office surroundings. There was a fresh water stain on the ceiling. Sometimes we heard mysterious bumps from the condemned floor above. Jan joked that there were giant monster rats.

  “Guess where I was last night?” she said.

  “Where?” I was clearing a stack of books I had left on her desk.

  “The HomeBase graduation. They had a ceremony for all the kids who had passed either their general equivalency or work program.”

  “I’m sorry I was at the conference.”

  “Do you know who was there?” Jan said. Her old smile was back. “Donald. Graduating with a modified GED.”

  “Donald! How is he?”

  “You almost wouldn’t recognize him. His hair was nicely cut, and he was wearing trousers and a white shirt. A lot of girls were looking at him, I’ll tell you that much. He can read and write now. And you know the best part?”

  “What?”

  “I swear the pastor’s entire congregation was there. I talked to him and his wife after ward. They said Donald is still with them. He works in the church and does construction.” Jan also filled me in with the news of the other kids she had caught up with. Matthew, the skinny boy with the glasses who loved motorbikes, had also gotten his high school diploma and was moving into his own apartment. I felt that I was seeing success now with our programs. These kids hadn’t had a chance before. Now they were moving out into the world.

  A couple of months after Jan told me about the graduation celebration I was driving through Chandler, having been to Tucson to visit old friends. I decided to stop at a Subway off I-10 and have a footlong sandwich. On second thought, I told myself, looking down at my growing paunch, maybe I should make it a six-inch. I had gone from not eating at all because of stress to noshing mindlessly on whatever got in front of me. The result was obvious. I stepped up to the counter, still looking at the menu, trying to decide between a turkey or ham sub.

  “Dr. Randy!”

  I was startled and looked down. “Mary!” I couldn’t believe it.

  “I’m working here now,” she said. “Saving for college.”

  It felt so good just to look at her. “I was just thinking of how I used to get subs all the time when I was a kid in Tucson,” I said. “I used to sit in a corner booth with my friend Danny after our shift at the Golf n’ Stuff.”

  “You worked at the Golf n’ Stuff?”

  “Sure. I got paid two dollars and ninety cents an hour to wade after golf balls in a pondful of duck poop. I think for the better part of a year it was permanently plastered to my legs.”

  She giggled. “I went to the Golf n’ Stuff with my friends. We drove there with my aunt. We were trying to hit the balls into the duck pond. Sorry.” She smiled and smoothed the apron down over her midsection, and I thought, there is no way anyone would know how far she has come. How many other girls I saw in daily life, working behind counters or even in
business suits, had a past like hers? Maybe not as extreme, but it was a revelation to me how people can overcome such hardship.

  “I thought you were, like, raised rich,” she said.

  “I never even got on a plane until I was in college,” I said. “I grew up in an area like this, just regular houses and regular people.”

  “How is Jan doing? Is she still racing?” she asked.

  “Well, that got to be a bit much for her,” I said, waiting my turn to order. “But you know what? She took this welding class. She made a huge art installation for her lawn. It’s like ten feet tall and made of this scary dark bronze metal. I keep telling her it scares the neighbors.” Mary giggled again.

  “Jan is so cool,” she said.

  I became aware that someone had stepped behind me. I gave Mary my order. She made my sandwich and then handed me my change, her hand briefly touching mine. There was nothing on her wrists. She had taken off the bracelet. I wondered what she had done with it. Had she kept it, or had she ceremoniously thrown it away? But then I realized that I was warmly reassured not to know. Other people in Mary’s life, like her aunt, or her friends, or her counselor, would know. I suddenly was deeply consoled to know that Mary had found others to help her.

  I sat down to eat my sandwich in the hard booth and thought about Danny, who had encouraged me to go into medicine. I looked out the window into Chandler, and I could have been back in Tucson, both of us looking out for our dream car. I drank my Diet Coke and remembered my mom’s taking me to Kmart for school clothes. I remembered how once a month my parents would load up their dirt bikes on the trailer that Dad had made himself and take us riding out in the desert. I remembered my first day with Dr. Copeland. I remembered what it was like to be Mary’s age. I had felt so nervous and excited, as if my life were blooming in Technicolor. I remembered it all, and I wanted to tell Mary, “It is your turn now. Dream big.”