I could hear Wendy on the phone. “How do I get her to see a psychiatrist?” There was a silence. “No, I understand you won’t do that. I just want to understand how it works.… OK.” There was a scratch of a pen. “So you’re saying first we have to get her on the state Medicaid insurance.… I know she needs valid identification.” There was another scratch of the pen. “I understand. But here’s the problem. This girl is too delusional to even tell us her name. Obviously I need to get her evaluated and medicated. But I can’t get her evaluated without identification. You see the catch-22.”
Wendy was quiet for a moment, listening. I heard her lower her voice. “I know you didn’t invent the system.… OK. But what if the child is too delusional or psychotic to cooperate?” There was a pause. “I understand you can’t help until she has identification. Once she gets the identification she still has to sign up in person. Then what happens? She has to request the provider? … OK. Which one offers mental health services?” Another scratch. “So you are saying that none of the providers offers mental health. So even if she gets on the insurance, how can she see a psychiatrist then?”
The pen scratched. “OK. So you’re saying that after she gets on the insurance, she needs to enroll in the mental health program. Then she needs an intake assessment. Then can she see someone? … Oh. She has to find a psychiatrist who will accept the insurance. Can you give me an idea of how many do? … Oh, my. No, I understand. So from start to finish, how long will it honestly take before she sees a psychiatrist, provided we can get her identification?” The pen wrote and then paused. “Wow. No, I understand.… OK.” I heard the phone go back in its cradle. Wendy sighed. “Six months to a year.” I heard her whisper to herself. There was the sound of phone keys being punched. “On hold,” I heard her mutter to herself. Twenty minutes later she was still on hold. I heard her tapping her pen.
I left for a meeting and returned an hour later. I walked by Wendy’s cubicle to check in. She was still on the phone. Her face was a tight, frustrated mask. She had a notepad filled with angry doodles. I left to take the van out for a quick visit to the domestic violence shelter. When I came back that night, I found a note on my computer. “Sorry, Randy, still working on it.”
Driving home that night, I decided to call my sister. The truck had turned into my de facto time to make calls. With the kids at home to take care of, it was becoming harder to keep on top of Stephanie’s medical issues. I felt guilty because I knew she was having more trouble with her MS. It had been flaring up. “I’m using a walker now,” she said. “But no way am I going to be in a wheelchair. I’ve got two crazy boys to keep up with.” Stephanie and Curtis had two beautiful boys named Matthew and Trevor, both blond-haired, bright-eyed, and full of happy intelligence.
“That’s the spirit,” I said. It was hard to think of her limited mobility when I remembered how carefree and energetic she had been as a child.
“Have you talked to Mom lately?” she asked.
“Yesterday. I was planning on calling her tonight.”
“Dad says she’s not feeling very good.” I opened the front door to the sound of shouting and crying. Amy had one crying child, Charlotte, in her arms, and the twins were wrestling on the living room floor. Charlotte was now eighteen months old, and the twins were four years old and in preschool. Amy turned to me and saw I was on the phone. She looked tired.
“I know,” I said. Both Stephanie and I were in close touch with our parents, often speaking to them daily.
“Her pains are getting worse.”
My mother had started having symptoms of colon cancer when I was in the third year of my residency. Then, two weeks before my wedding, I got a call from her doctor. He told me that Mom had colon cancer. I was floored when her doctor asked me to be the one to give her the news; his request was incredibly unprofessional. If he is this inept, I thought, I should be the one to tell Mom. The news was devastating. I knew as a doctor that her prognosis was not good. She needed surgery and chemotherapy if she was going to have a shot at remission. I vowed to keep this knowledge to myself. The first thing my mom said was, “I don’t want to miss your wedding.” She insisted on waiting until the wedding was over for her surgery and treatment.
A few weeks later Amy and I went on our honeymoon. We kept telling each other how wonderful it was not to hear anything about the surgery, because no news was good news. I even expressed the naive hope that my mom would be one of the “lucky ones.” It didn’t occur to me that my dad and she would wait with the news. For the first time my parents hid information from me. The cancer had metastasized. For six months she did chemotherapy and eventually seemed to be in remission. But there were complications wrought by the radiation. Mom was often weak and in severe pain. We all had learned to live with her illness as a family, just as we were learning to cope with Stephanie’s MS. But it was never easy.
“Dad says her intestines are having trouble absorbing nutrients,” Stephanie said.
“She had a lot of chemo,” I said. I had been hoping this alone was the cause of the increased pain. “That can lead to scarring and kidney damage.”
“Are you going for Sunday supper?”
“We’re planning on it. When is your next doctor visit?”
When I finally got off the phone, I glanced at my watch. I was surprised to see it was past ten. I checked on the kids. Charlotte was conked out in her little bed, but Reed and Janie were still awake in their beds. I quietly encouraged them to go to sleep. I walked back out, and Amy was at the counter, making a shopping list. I reminded myself she was putting in her own long hours, as well as doing most of the child rearing, and we had three children under age five.
“Do you mind going to visit my parents this Sunday?” I asked.
“No. That’s what we usually do,” she said, crossing out “pot roast” and writing “chicken” with a question mark after it.
“My mom’s stomach pain is getting worse.”
“I don’t want your mom to feel she has to cook. We’ll make a casserole.”
That Sunday Mom looked drawn. I didn’t want her to think I was worried, but in truth I was. Maybe the cancer was back. Her face had the tight look of someone in pain, and she walked slowly. Dad spoke to me quietly. “We’ll have to just keep trying to figure out why the pain is getting worse. We’ve got another appointment in a few weeks.”
On Monday my week started with an early-morning team meeting. I left the house while Amy and the kids were still sleeping. After the meeting I took the van to downtown Phoenix for the day. We treated dozens of kids, including Nicole, who had shown up with mysterious bruises all over her thin legs and arms. She was out of it and seemed unable to explain anything. As soon as we docked, I ran off for more meetings at the hospital. By the time I got home it was 8:30 P.M. I had been gone for thirteen hours. When I left, the kids were still asleep. Now they were back in their pajamas, bouncing off the walls, with Amy trying to wheedle them into bed. Bedtimes had turned into epic marathons for the four-year-old twins, and I blamed the fact that we had coddled them so much when they were young. They had not learned to self-soothe. Amy looked frazzled, trying to clean up the toy room while Charlotte whined for soy milk. I filled her sippy cup and went into the home office. I had a million e-mails to catch up on and a speech I needed to draft. By the time I came out the kids were asleep and Amy was in bed, watching television. We went to sleep in silence.
Tuesday was no better. I had another morning meeting, another trip out with Jan on the van, this time to where the kids squatted in the abandoned house, only to find them gone. I rushed out of the hospital office to an evening meeting. This time it was for the American Diabetes Association. I got home after 8:00 P.M. I came home to more pajamas, more bedtime meltdowns, and more tired Amy. The house was a mess. Ginger needed to be walked. She stared at me with reproachful brown eyes, her body trembling in anticipation. Dishes were piled in the sink, and a part of me wondered why Amy hadn’t done them already. She had got of
f work earlier after all. She could have at least done the dishes, I found myself thinking. Janie and Reed, usually so compatible, picked a fight with each other and started screaming. Amy swooped in, separating the kids. I grabbed the leash and took Ginger for a walk. When I got back, Amy was bathing the kids. I didn’t know why she insisted on bathing all of them every night. I had argued with her about it. When I was growing up, a bath every few days was good enough for a growing child. I turned on my home computer and found an avalanche of e-mails. By the time I crawled into bed Amy was asleep.
Wednesday morning I woke to hear Janie singing through the house. “Daddy’s taking us to breakfast, Daddy’s taking us to breakfast.” Amy was up early, sitting at the counter with her head in her hands.
“Daddy isn’t taking us to breakfast,” I said, walking in.
“Why not?” Janie asked.
“Because he’s going to work,” I told her.
“You’re going to work?” Janie asked me. She looked crushed. Tears formed in her eyes.
“It’s a workday,” I said, bewildered.
I raced to the hospital for my work there while Jan took the van out. Amy worked late on Wednesdays, and it was my day to get the twins and Charlotte from day care. We were blessed to have them all attending day care at the Shepherd of the Valley church, where we went for services. As soon as she got in the van, Janie began chattering about an art project she was supposed to do at home. Homework in preschool? I thought. The world is getting crazier all the time. “Sure, I can help, honey,” I said idly while buckling Charlotte into her seat.
“I’m hungry,” Reed said from the backseat.
Charlotte was babbling something about horses. “Later, honey,” I told her.
I herded them in the house and opened a box of crackers for a snack. I cut oranges and pulled string cheese from the fridge. I looked at my watch. It was close to 6:00 P.M. I dashed into the bedroom. By the time I came out Amy was coming in from work, dropping her purse with exhaustion. I was buttoning a fresh shirt.
“What did you make for dinner?” she asked. She frowned. “Why are you putting on a tie?”
“I have a diabetes camp meeting tonight,” I said.
“I thought that was yesterday.”
“That was for the diabetes association. This is for Camp AZDA.”
“When?” she asked, plaintive.
“Now. I’ll be home later.” I kissed her.
Ginger followed me to the door, wagging her tail and whining.
Thursday. I woke after less than five hours’ sleep. It had been weeks, probably months, I realized, since I had gotten a full eight hours of sleep. Thursday brought yet another morning meeting, this time with the children’s hospital. I took the van out with an intern. We saw a suicidal boy who had slashed his wrists. That evening I had a fund-raiser to attend. I called Amy. I didn’t have time to go home. I would eat on the road. I stopped at an Arby’s and wolfed a large roast beef sandwich, curly fries, and a Coke. There goes fifteen hundred calories, I thought, and once again, no exercise. I got to the fund-raiser just in time to give my speech. It was after ten by the time I managed to shake hands on the way out. As I walked in the house, I heard kids screaming. Reed and Janie were having a water fight in the bathroom. Amy was shoving a batch of laundry into the dryer. There were clothes all over the floor and dishes over the counters. Amy didn’t say anything to me. She slammed the dryer door.
It was midnight before I made it to bed. My eyes burned with exhaustion, and my body ached. Amy had the television blaring in the bedroom. I hated having the television on while I was trying to sleep. My legs burned with stress. I buried my head under the pillow. I thought about the next day. It would be Friday. I was scheduled to receive an award that night. I had been voted Outstanding Young Arizonan by the Arizona Jaycees. I was proud I had won, but it would mean another late night. I knew there was something I had forgotten too. I groaned to myself. It was Janie’s art project.
“Honey, did Janie get her art project done?”
“I helped her.” Amy’s voice was remote.
I tried to remember what we had to do that weekend. We had to go shopping and clean the house, and then there was church and Sunday night supper with my folks. How was I going to fit all that in? I still had to drop off the dry cleaning and a million other things. My mind began to race. Suddenly sleep seemed like a distant proposition. I was wide awake with adrenaline.
“Randy.”
I had felt the argument brewing all week. Amy and I rarely fought, but when we did, our arguments were emotional and intense. Neither of us liked to raise our voices, but somehow, even if we talked in low voices, there would be incredible amounts of feelings. Both of us, I thought, avoided issues until they were pent up. Here it comes, I thought.
She took a deep breath. “I feel like I’m doing all my stuff and I’m doing your stuff too.”
That was true. I felt an instant rush of guilt. But what was I supposed to change? I took my head out from under the pillows. I tried to apologize. I wanted to fix it. Right then. Whenever we argued, this was my response.
“Let’s hire a nanny,” I said immediately. “We can get someone to help with the housework—”
“That is not the issue,” Amy said heatedly.
“Then what is the issue? You’re saying you have to do everything. I’m not arguing. You do have to do too much. If we get some help—”
“I don’t want any help.”
“Well, what do you want then? Do you want me to cut back on the extra stuff I do? Like Camp AZDA?” I would have given up the extra things I did for Amy and the kids. But I also knew that Amy really didn’t want that.
She sighed, exasperated. I felt my temper rise.
“If we got a nanny, then it would be easier on you,” I said, trying to keep my tone even. I remembered when Amy had had Jo Ann come stay for a month after Charlotte was born.
She stared at me. Her eyes were rimmed with red from exhaustion. From the set of her mouth I could tell she was furious. “I don’t care if you work sixty hours a week,” she said, her voice tight with tears. “I don’t care if you do all that extra stuff. I want you to help homeless kids. I want you to work the van.” The tears were getting closer. “But when you are here, I want you here. Not in your office answering e-mails. Not someplace far away while you think of the next thing you are going to do.” She paused and swallowed. She wiped her eyes. “I don’t care if it is only ten minutes a day. You need to find time for us. You need to talk to me.”
It hit me then. In the very beginning I had talked to Amy, but that had quickly ended. For years now I had not talked to her about the stresses in the van or the other issues in my life, thinking I was protecting her or perhaps protecting my image of myself with her. But what Amy wanted was closeness. She was probably the most understanding and supportive person about my commitment to the van. All she wanted was to share it, and I had kept that sharing from her.
It’s my emotional distance that she is angry about, I realized, not the hours. It’s me and how I handle stress.
“You’re right,” I said in a muted voice.
Her voice was sad. “Right when you started the van, we talked all the time. Remember how I suggested the paper gowns? But that disappeared so quickly. You stopped asking me for advice.”
“I’d like to get back to that. Please.”
She wiped her eyes. “Me too.”
I went to splash water on my face. When I came back, Amy was curled on her side. I curled against her and apologized. She took my hand in acceptance, and I told my wife how much I loved her.
“She’s getting a little strong-smelling,” Jan whispered to me. “I’d really like to at least change her socks.”
Whenever we stopped the van in downtown Phoenix, Nicole had been coming in with Lisa, who usually led her by the hand. Sometimes she was Becca, the eight-year-old girl. She did childish things. Once she came in with one of her ears packed with tissue paper. I carefully pull
ed it all out to find a pencil eraser stuck deep in the canal. She denied knowing how it got there. Other times she was a very friendly, outgoing young man. A few times she was a rough, sexual older woman. That woman rarely appeared at our van. Sometimes she was a silent, very dark person who refused to answer any questions at all. When she was this person, whoever he or she was, she stared at us from under a curtain of dark hair. The other kids told me that the rough, mean personalities appeared more often on the streets. Our van was a safe place for Nicole, I figured. It was where her childlike personalities came out. But try as we did, we could not get any meaningful history out of her, not even a former address, a name, or a sense of where she had come from. She was so deep in her psychosis that for the moment the information simply didn’t exist.
As the days passed, she still refused to get an exam. Sometimes, when she was the little girl called Becca, she would consent to let me listen to her heart. She would giggle. But her jeans and shirt stayed on, and so did her shoes. “Oh, no,” she would say as Becca when we asked to give her a full examination.
I did what I could. When the bug bites on her arms got infected, I washed them and medicated the sores. When her hair developed a large mat in the back from never being combed, I talked her into letting me comb it. She was Becca for the combing. She held very still while I combed her hair. The mat was too large to comb, so I cut it out, talking quietly to her as I snipped. She wanted to hold the clump I had cut out. She petted it like an animal.
The next time we parked downtown Nicole was back, still carrying the magic talisman of hair. Holding it, she sat on the exam table. Jan entered the room. As always, her eyes softened when she saw Nicole. “Hi there,” she said, waiting to see who Nicole would identify as being. “Who are you today?”
Ask Me Why I Hurt Page 20