Amy had postponed the birthday party for the twins until I got home. I had missed their birthday on September 15. I had missed our wedding anniversary on September 19. I had hungered to come home, and now I felt out of place. I needed some time, I told myself, to adjust. It would have to wait until we had the party for the twins, I thought. Amy had asked me if I wanted to cancel, and I had automatically said no. There was nothing I wanted more than to return to normalcy, I thought, and the party represented normalcy.
I stepped out of a long, hot shower. I stepped on the scale. I had lost fifteen pounds. Cleaning the fog off the mirror, marked with the palm marks of our children, I saw the weight had melted off all the wrong places. I looked drawn, my temples hollowed, my cheeks drooping. There were dark shadows under my eyes. In the living room the children played quietly. They were subdued as if playing in the presence of a stranger. Since I had come home, the kids had been whiny, difficult, and tantrumy. Amy looked more exhausted than I had ever seen her before, even after the birth of the twins. She had lost weight too. Her slender frame looked gaunt.
“Do you really want to do the party?” I kept asking her. My voice sounded funny even to me. I wondered if it was culture shock, from returning. She nodded. We had talked about the party while I was gone. It was like a thread leading me back home.
“They need to know you are back,” she said. “The party is something they looked forward to doing with their dad.”
The twins were mad for snakes and reptiles, so Amy had decided the theme would be all about reptiles. She had even hired the Phoenix Herpetological Society, which brings real live creatures to children’s parties. As the guests arrived, I walked around feeling like an outsider. I felt as if I were living under a dome. I watched the kids and their friends play but had a hard time focusing on them. Normally I would have been gregarious and outspoken, but now I felt like one apart. I had a hard time following the conversations of the adults. As bright and hot as the sky was that day, it seemed dark, and the shapes of my own wife and children were indistinct. When others talked, I watched their lips move, and I heard them, but nothing really made sense. A few of the parents asked about Katrina. I jerked back from their questions, looking at their flushed, happy faces. My answers sounded incoherent and awkward, and I watched their faces cloud with confusion. I walked away. Kids were walking around with pythons draped around their necks. A staff member of the Herpetological Society let a small alligator swim in the pool. Its dark scales splashed in the blue water. Amy walked with the kids in the yard. I saw them as if in a snapshot: the twins holding hands, toddler Charlotte trying to keep up. The sun was darkly burnished on Amy’s hair.
All through Katrina I had dreamed of coming home safe and sound. What’s more, I had dreamed of coming home with a feeling of accomplishment, of a job well done. Well, I had made it home safely. But how sound was I? And how much had I really accomplished? I had left thousands of people still suffering. What was more, they would continue to suffer. I had come home, but part of me was still back there. I’m suffering, I realized with a shock. The tragedy I had witnessed was too vast, too shattering, and too poorly handled to understand. Like the kids on the van, I thought. Their pain was often too vast to understand as well. For the first time in my life I felt overwhelmed. There is too much suffering in the world, I thought. You can’t fix it all. You have to choose what you can do. You know you can help many children on the van. That’s what you need to do. No more trips.
I sat by the pool in one of our lawn chairs. Amy came and sat next to me. For once in my life I had nothing to say. I saw trees bending in the wind; I saw them scattered over roads. I saw cottonmouth snakes, angry at the storm, writhing in swamps. I heard people talking about eating alligator. I saw a landscape that looked as if the force of the earth had exploded it outward, rupturing the world, as we knew it. The lives of the homeless children I tried to reach were like this. The lives of my own family could be like this.
Amy put her hand on my knee. “I’m sorry,” I said. I turned to my wife and buried my face in her neck.
10
NICOLE
I had thought it would help to be back on the van. I thought it would be good to be back with familiar voices and the nostalgic smells of gasoline and disinfectant. But for weeks the sense of dislocation following Katrina remained. I felt as if I were swimming in the bottom of the ocean. I knew rationally that the kids I was seeing were no different from before. But the world felt harder.
I spent the day in downtown Phoenix with Wendy. A boy came up to the van carrying a broken bicycle. It was missing its front tire. He had carried it for miles, he told us, intending to fix it. It was old and rusty and worthless. I had seen kids lug around all sorts of crazy items. Sometimes they had computer parts in their backpacks or old toys or teddy bears from home. One girl had a broken laptop she had found in the trash. She was convinced she was going to learn how to repair it, and when she did, she could find work as a computer expert. These items represented hope, I realized. After I examined him, the boy sat down outside next to his bike and idly spun the working back wheel. I sat down in the chair next to him, and he told me how he would fix the bike and then ride it around town, and from the tone in his voice, it sounded as if the bike were a magic talisman that would fix his life—if only he could fix it. I looked at the rusted, bent bike and wished this could be true.
The next patient was a huffer, an addict who sniffs glue, paint, or other noxious substances to get high. Huffing is among the worst of drug addictions, because it can cause horrific, irreversible brain damage. Huffing was making a resurgence in the area, and Jan and I had seen dozens of kids with permanent neurological damage, some of them no more than thirteen or fourteen.
This boy was tall and praying mantis–thin with long arms and stick-thin legs in skinny jeans. The area around his mouth was stained with the gold spray paint he had been inhaling. He held his plastic bag clutched in his hand, as if he had forgotten it was there. The bottom of the bag was stiff with the residue of the spray. He looked at me with empty eyes. When he tried to speak, nonsense words came out. It was the garbled sound of brain damage, a television set to a broken transmission. “Wab-ottle,” he kept repeating.
“What is it you need?” I asked patiently in the front of the van.
There was no flicker of light in his eyes. “Wab-ottle,” he said.
“Oh. You want a water bottle.” I gave him one. He was still holding his paint bag, the insides flecked with dots of dried shiny gold. It looked like Christmas glitter.
He couldn’t get the top of the bottle up. He pulled at it with numb hands. I gave him a hand. He spilled water all over himself, trying to drink. His empty dead eyes looked right through me. “Wab-ottle,” he said.
I wondered what I could do for a boy like this. His circuits were fried. I wished I could help him, but I didn’t know how. If I called the police, they would tell me they couldn’t arrest him unless they caught him huffing. If they did catch him, they might take him in for public intoxication. He would be booked and released right back onto the streets. There was little chance of finding any programs that offered the intensive treatment he needed. They just didn’t exist. In all likelihood his brain damage was permanent. If there was help for him, I didn’t know what it was or how to find it. He went to sit in a chair outside the van, spilling water down his front. Watching him go, I pulled off my gloves and rubbed my face with my hands. I felt the overwhelming despair that seemed to be a constant in the background of my mind since Katrina.
Wendy called me for the next patient. I pulled on a fresh pair of gloves and went to see him. The boy had a rugged nose and perfect blue eyes. He could have looked like a movie star if his blond hair hadn’t been matted with grime. His eyes had dark circles. Almost every visible part of his body, from the sides of his face to his neck and arms, was covered with red sores. Each sore was hotly inflamed.
I almost involuntarily stepped backward. “Do you remember how you g
ot these sores?” I asked him immediately. He looked at one arm and, as if remembering, scratched it.
“I don’t know,” he said. “It keeps happening at night, and then the bites like get infected or something.”
“Please don’t scratch.” I surmised he had been bitten all over by bedbugs. They had become epidemic in squats and shelters. Now, because this boy was in poor health and living in dirty conditions, a staph infection had set into the bite wounds. I closely examined his arm. A tiny circle of soft, damp, dead skin surrounded many of the bites. I rubbed a cotton-tipped swab over the wound to collect material for a culture. I suspected the infection was MRSA, methicillin-resistant Staphylococcus aureus, the drug-resistant staph infection commonly called the flesh-eating bacteria.
“Where are you sleeping?” I asked as I carefully swabbed the area.
“I was staying in this shelter downtown. I got beat up outside by these guys, so me and my friends have been crashing in an empty house.”
I stopped. “We should get your friends in here and take a look at them. Sometimes this infection spreads to others in the same household.”
“Yeah? I think some of them left for the train yards.” This was how illnesses got spread, I thought. MRSA was spread easily in places where people came into close contact, like prisons and squats.
MRSA wasn’t called drug resistant for no reason. Only a few antibiotics are effective against this particular staph species. Sometimes even they were not enough, and the only cure was a surgical debridement to remove the infected flesh. This meant actually scraping off the flesh; amputations were not uncommon. Though it was in the beginning stages, this case seemed particularly bad because the infection seemed to be all over the boy’s body. I called Wendy in. She was wearing a white hospital smock over clean trousers, her name tag on the smock, her long hair shining and clean.
“Have you heard about diluted bleach baths in conjunction with other treatments for MRSA?” I asked her.
“Yeah, something like that. Weren’t you saying they were used at the hospital?”
“That’s right.” I remembered. “I heard it in the dermatology department. They said it works. The bleach water kills the staph on the skin better than a lot of antibiotics. The problem is it needs to be done pretty regularly.”
“Does it sting?” the boy asked curiously.
“Probably not if it is diluted.”
“OK. But where am I going to take a bath?”
He was right. “Do you have any place to take a bath?” I asked him.
“No.” He thought carefully. “I don’t think so.”
“The shelters only have showers,” Wendy said.
We all were silent for a moment. “I don’t think there is any place for a homeless person to take a tub bath in the entire city of Phoenix,” Wendy said.
I sighed. “I’m going to give you a nose antibiotic instead,” I told the boy. This was a topical gel that was placed inside the nostrils for the first four or five days of each month for six months. I hoped that along with oral antibiotics it would kill the staph organism. “The problem is you are going to keep getting infected as long as you squat in that house. The place is probably crawling with infection. We need to get you to a shelter.”
“I’m already on all wait lists,” he said. “None of them have room.”
In the van bathroom I scrubbed my wrists and hands. I didn’t want to take the staph home to Amy and the kids. In my mind I saw one of the twins or Charlotte in the hospital, hooked up to an IV, being treated for MRSA. I looked in the little mirror. I wished I felt better, but I didn’t. “I’m fine,” I told myself, knowing I wasn’t fine at all.
“Randy?” It was Wendy, calling me to the front. “You’d better come here now.” Her voice was calm, but the tone told me it was important.
When I stepped out of the van that moment and first saw her, I thought of broken toys. She was as tall and slender as a wand, and as she came swaying up to the van, people fell silent and stopped to stare at the heart-shaped face, at her wide, beautiful eyes, at the wavy hair that caressed her shoulders. Her blank eyes turned this way and that, seeing nothing. There was something mechanical about the way she moved her head.
A tough-looking blond girl named Lisa was leading her. Lisa was a street-savvy girl who often took a mothering attitude toward the more vulnerable kids. Wendy stepped out of the way as I came down the steps.
“Dr. Randy?” Lisa’s clear voice called. “Can you help this girl? We call her Nicole.”
“What’s wrong?” I asked.
“She’s really messed up in the head.” Lisa paused. She lowered her voice, though the girl didn’t seem to be aware of her surroundings. “Lots of times she acts like different people.”
I took Nicole inside to an exam room. I didn’t get far in questioning her. She simply stared off in the distance. She sat on the edge of the table. Her long arms were limp. There was something yellow, dried mustard perhaps, smeared around her mouth.
“I’m Dr. Christensen,” I said. “What’s your name?”
She didn’t respond. I was not a psychiatrist, but I thought I was looking at psychosis. Then all of a sudden a light flashed in her eyes. She smiled and giggled behind a dirty closed fist. “My name’s Rebecca.”
“Rebecca. Pleased to meet you.”
She held her hand out briefly and then snapped it back. The giggle came again. She looked coyly up from under her lashes. She pulled a lock of her hair.
“My stepdaddy calls me Becca.” There was another twirl of hair.
“That’s nice.”
“Sometimes he calls me Cupcake.”
She made a quick, girlish gesture by folding her legs up, so her feet were almost tucked under her. I was about to ask her what had brought her to the van when the gesture caught my eye. I knew what I wanted to ask first, her age. She smiled a smile that almost made me believe she was gap-toothed and in second grade, though I knew she had adult teeth.
“I’m eight,” she said proudly. “I just had my birthday too.”
“What can I do for you, Becca?”
“I got an owie.” She showed me a tiny mark on her wrist.
“Would you like a Band-Aid?”
She gave the same little-girl smile. There was dried food on her chin and mats in her hair. I pulled out a box of Band-Aids. We kept Disney ones for the little babies we saw at the domestic violence shelter. She looked delighted. She patted the Band-Aid on her wrist.
“Do you have any medicine?” she asked.
“Like aspirin?”
“I’m too young for aspirin, silly.”
“How about some Tylenol?” The conversation was surreal. The longer I talked, the more convinced I became that Nicole was eight. If it was an act, it was pitch perfect.
I got out a sample of Tylenol pills. She shook her head, her eyes wide. “I don’t like pills.” Without saying anything I put it away and found some liquid baby Tylenol. Now her face split into a smile. I poured the red liquid in the measuring cup for her. She drank it daintily. When she was done, I gently cleaned the dried food off her chin with a wet wipe.
“Where are you from, Becca?”
Suddenly the blank look returned. I waited for a long time. She just looked vacant.
“How did you get to Phoenix? Do you live around here?”
Then she smiled at me, again a little girl.
“I’d like to give you an exam,” I said. She shook her head rapidly. The little girl was back.
“Oh, no. My mommy told me not to take my clothes off for strangers.”
“She honestly seemed to believe she is eight years old,” I told the team at our next-morning meeting at our HomeBase offices. We were now regularly meeting to go over our patients, and budget and other issues, though we all still dashed out to the van as soon as the meetings were over. Wendy and Michelle said the smell of the offices made them sick, and I knew the air aggravated Michelle’s asthma.
“What happened when you asked for h
er history?” Wendy asked.
“All of a sudden she lapsed back into that nearly catatonic character,” I said. “I wasn’t able to get any information from her at all.”
“Do you think she is really multiple personality?” Jan interrupted.
“I don’t know enough to say,” I replied slowly. I tapped my hand on her file. “Only a psychiatrist can tell us that. Which is why we really could use one on board.”
Jan pointed out that we’d never be able to afford it.
“I know. But the longer we do this, the more I think it’s what we really need. We see so many kids with depression, bipolar, or the onset of schizophrenia. We are not equipped to diagnose or treat them. Heck, we can’t even afford to keep medications for them on board.” Jan nodded in understanding. We had realized early on that we simply could not afford to stock medications for the mentally ill youth. A month’s supply of a common medication for schizophrenia could cost nine hundred dollars. Often teens came to us with empty bottles, pleading for their psychiatric meds. We had none, and if they had no insurance, there was no way they could get their prescriptions filled. It was a situation that made me angry every time we dealt with it, which was sometimes several times a day. We had a few pills for emergency use only, and that was for kids with existing diagnoses.
“Can we even get her to a psychiatrist for an evaluation?” Jan asked.
“You can try,” I said hopefully.
“I’m on it,” Wendy said.
“In the meantime what do we call her?”
Wendy spoke up. “The other kids called her Nicole.”
“Good enough for now,” I said.
The next morning I stopped again at the HomeBase offices. My own desk was a mess. Jan’s desk was surrounded by a huge collection of training manuals and medical documents. I swore she kept every training manual from every conference she had ever attended. Michelle’s desk was quiet and orderly just like her. Wendy’s desk was surrounded by empty water bottles. Wendy was the queen of recycling and would even scout our trashcans for water bottles. I was sometimes tempted to leave some in my trash with notes just to tease her.
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