Ask Me Why I Hurt

by M. D. Randy Christensen

  I sat next to her on the couch, holding her hand. “It is the badness that is so bad I don’t even want to think about it.”

  I told her about Nicole. It was cathartic to talk. Her face was calm, that was a relief. “It was never so real to me before,” I said. “I mean, it was real before. But it was real for the kids I treat, not real for my own children. Now all of a sudden I feel like it could happen to them. How do we prevent that from happening to our kids? What if we can’t prevent it?”

  “We do our best,” she replied calmly. “What happened to Nicole was because no one knew or intervened. We have each other, and we have extended family. We can teach our children how to come to us for help.”

  “I don’t know how to help her,” I said. “That’s the really hard part. She’s been coming to the van longer than I want to admit. It’s been two years. Two years, I haven’t been able to help her.”

  “Maybe you can’t,” she said.

  “When she is Becca, I feel like I am letting an eight-year-old wander the streets.” I felt close to breaking down. I remembered the rage and frustration I had felt in Katrina at how the government had failed all those people. Now I felt the same rage at how our country was failing this mentally ill, sexually abused child.

  “I feel like there is something wrong with this world.” For a moment my emotions overwhelmed me, and I couldn’t explain the depth of what I was feeling.

  “You’re trying to help,” she said.

  “I wish I had talked to you before. I was afraid you’d think less of me, for getting in over my head.”

  She rubbed my head with her knuckles and gave me that sweet, teasing smile. “Honey, you’re always in over your head. That’s what I love about you.”

  After six years our morning meetings at the HomeBase office had finally smoothed into a pattern. It usually involved Jan and the rest of the team bossing me around, or so I complained. Often Jan had some new procedure she wanted to implement, and Wendy, Michelle, and Julie had lots of energetic ideas and opinions too.

  Today Wendy had news. “Nicole is in jail.”

  “What?”

  “I guess she went into a Circle K and starting trashing the place. The clerk called the cops. They took her to jail. But it might not be as bad as it sounds. I called over there, and they said they have her in their psychiatric unit. She’s getting evaluated and treated. The jail staff that I talked to said that she seemed to be doing really well.”

  “Well, I guess it’s not terrible news,” I said. “But how sad that she has to end up in jail to get help.” I had a lot of respect for law enforcement, and from my interactions with jail staffs, I knew they agreed that jails were not the place to treat mentally ill people. But with all the program closures they often ended up doing exactly that.

  “At least she is safe in there,” Wendy said.

  “So she’s getting medicated?” I asked.

  “That’s what they said,” Wendy said. “I’m eager to see what she is like once they get her stabilized. Won’t it be something to meet the real Nicole?”

  It was with a slight feeling of optimism for Nicole that we moved on to the next item on our agenda. I made the announcement. To my surprise, Darlene at UMOM had wrangled together enough funds from private donors to hire a nurse. “I think it would be fantastic if you guys could have your own little clinic here,” she had told me, almost sanguine about the huge coup she had accomplished. “The nurse could see the parents and their babies. And maybe teach some basic parenting and health skills while she is at it.”

  I knew from hiring Julie Watson, the new nurse, in 2007, that the addition of one nurse could treble our efforts; strong nurses were like a force unto themselves. I told the team that I knew whom I wanted to hire. She was a great nurse who had climbed the ladder at the Phoenix Children’s Hospital from floor nurse to educational manager for the emergency department. Kim Williams-Smith was the perfect person for the job. The problem was Kim made good money. And what we were going to offer her was not half as good.

  That day, after the meeting, I approached Kim at the hospital.

  “Are you kidding?” she said. “I’m in.”

  I tried to make sure she understood she would be giving up a lot of financial security, but she was adamant. “I went into pediatric nursing because I like to take care of children. I especially like to deal with emergency and difficult situations. If I wanted to get rich, I would not have picked this field.” She smiled at me, glowing.

  Within a few weeks I was helping Kim carry extra supplies up to her new nursing office at UMOM. She had turned one old room of the motel into her clinic. This permanent setup would be much easier than bringing the van. Suddenly I envisioned the van’s ability to expand from mobile care to creating little clinics like this one, right where homeless women and their children needed help.

  “Ta-da,” she said, opening the splintered door. I carried a box into a warm, cheerful room snuggled with pillows and places for little kids to rest. Kim had hung bright posters on the walls. “Brush Your Teeth,” advised one. “Helmets for Safety,” said another, showing a wide-grinning boy on a bike. In orange crates she had an assortment of books.

  “I needed something to hide the cracks in the walls,” she said happily when she saw me looking at the posters.

  “Kim, were you a cheerleader in high school?” I asked. “You’ve got to be the most positive person I know.” I dropped the box.

  She skipped down the stairs after me. “In a week my office will be crammed,” she said.

  “I wouldn’t give it that long,” I said. When we got back upstairs, there was a mother waiting for us. It was LaShondra. Her baby had been crying, her little face screwed tight with misery.

  “I think she got an earache,” LaShondra said apologetically. “I’ve been putting a warm washcloth on it.”

  Kim smiled reassuringly and offered her hands to the toddler. “You’re a good mom to bring her right away.”

  My own mom was in and out of the hospital again, having tests. The doctors had found large masses in her abdomen. They hoped it was scar tissue. When we visited her, she had done her hair before we came in, applied lipstick, and was wearing her favorite earrings. She talked about her pain a lot, to me a sign that it had become more pronounced. The pain also came out in the lines around her eyes, in the misery obvious when she thought no one was watching. I thought about how sad it was when pain becomes a person’s identity, and I wondered how much medical progress we were making in pain management. The heartache of it becomes so glaring when it’s your own mother who’s sick.

  “One of the doctors wants to do some complicated intestinal surgery,” she told me one day, sitting up in her bed. “But they said the surgery might kill me.”

  My dad turned to me. “There will be three surgeons,” he said. “It is the only way to repair all that scarring. The problem is one of the doctors thinks it is too risky.”

  “It could kill me too,” Mom repeated. Her mouth trembled. Dad went to her to hold her arm. My mother tucked her head, her brown hair shining under the hospital lights, under his shoulder.

  “Maria,” my father said softly.

  Mom decided to do the surgery. Not only was she in constant pain, but she was getting dangerous kidney and blood infections because of an opening in a kidney tube. Without the surgery she would die. But after ward she barely came through. It was touch and go for over a week, and we were by her side. I hoped this would be the end of the pain for her and a chance at health.

  On the way home from visiting my mom in the hospital, the kids were unusually quiet. “Tell us about your mommy,” Janie said to Amy when we were back at our house, climbing in her lap.

  “My mother’s name was Jane. When I was little, my mom did all sorts of things,” Amy said, and the kids listened carefully as she began telling them stories of her own mother. She was passing on memories.

  “What happened to her?” Reed asked.

  “She died when I was a te
enager,” Amy said, hugging him.

  Reed thought about this. “That’s like the kids that Dad helps. They’re teenagers too.”

  I held Charlotte in my lap. She sucked her thumb while she listened to Amy, dreaming against my chest.

  “I love Grammy Jane,” she said. I hugged her tight. Amy caught my look. Charlotte’s thumb was still in her mouth. “I’m going to wave to her in heaven.”

  Nicole was sitting on the curb outside the van with Lisa, who was patiently holding her hand. Nicole was wearing the same filthy clothes she had been wearing for months, before she had gone to jail, but she had pulled an old sweater on over them. It had a reindeer on the front and looked incongruous in the Arizona heat. Her hair was a tangled mess.

  “Here you go,” Lisa said, turning Nicole over to us.

  “Thanks, Lisa. Do you need anything?” I asked. Lisa was the kind of self-sufficient, streetwise teenager who often flew under our radar. She wasn’t as needy as the others.

  “I’m fine,” she said nonchalantly. “When I need money, I panhandle, and when I need a place to sleep, I find one.”

  “That’s not much of a life,” I said.

  “It’s cool,” she said, and wandered off.

  I led Nicole inside. “When did you get out of jail?” I asked.

  She stared at me in her mute, catatonic personality.

  “Are you OK?” There was no reply.

  Once we were in the exam room I saw an ugly gash on her forehead under her hair.

  “What happened?” I asked. She didn’t reply. She stared at me. Her eyes were blank.

  “Do you mind if I fix that?” Again there was no reply. I began cleaning the head wound. There was dirt caked in the dried blood.

  “Where’s Becca?” I asked tentatively.

  Suddenly she started talking in a rough, loud voice. I was startled. It was a new personality. “Shut up!” she yelled. “Shut your head!” She was full of malice. She looked like an angry older man. “Shut your head! Stupid!”

  “It’s OK,” I murmured. “It’s OK.”

  “Stupid! Shut that noise! You don’t need to cry about it!” she thundered. Her voice was incredibly loud and deep and reverberated off the van walls.

  My hands were almost shaking as I finished cleaning the wound. Nicole kept bellowing and thundering for me to shut my stupid head.

  There was a soft knock. It was Jan. She poked her head in. “Is everything OK? Need anything?”

  “Everything’s fine,” I said.

  Nicole twisted her angry old man’s face toward Jan. She looked at her blankly. “Shut up! Shut your stupid head.”

  Jan approached Nicole. She gently stroked her arm. “It’s OK,” she said. “It’s OK.”

  The baleful glare diminished. “Shut up,” Nicole said, her rough voice lessening. “Shut up. Don’t cry about it.”

  “OK,” Jan said, still calming her. “OK.”

  “What happened?” I asked at our next team meeting. “I thought she was in jail, getting help.”

  “She was in jail,” Wendy said with an edge. “I called this morning. They said when she was no longer a threat to herself or others, they gave her back the old clothes and released her.”

  I felt appalled. “You mean they didn’t even give her fresh clothes?”

  “That’s not their job,” Wendy said. “Apparently.”

  “I’m more baffled by the medication issue,” I said, taking a deep breath and a sip from my morning Diet Coke. “You said they stabilized her on meds.”

  “Yeah. They said they had her on antipsychotics. She stabilized really well. She was starting to act coherent. She was even saying something about her family. The officer said it seemed like she was really coming around.”

  “Then what happened?” Jan asked.

  “The district attorney dropped the charges. Like we all say, the jail isn’t a mental hospital. They can’t keep someone against their will. They released Nicole with two days’ supply of medication. And here we are. She is back to being psychotic, and we are back to ground zero.”

  A dozen questions ran through my mind. “Why did they give her only two days of meds? Did they at least get her on the Medicaid insurance while she was inside?”

  Wendy took the last sip from her water bottle and added it carefully to the others on her desk. I thought I saw her hand shake a little with stress and anger. “They told me they have the same problem we do. They don’t have the funds to supply patients with more than a few days of meds. I don’t know about the insurance. Maybe they can’t do that in there. You know what gets me? She had a few days when she was released when she was probably wandering the streets lucid for a change. There was a window of time when someone could have helped her, and no one did.”

  We were halfway back to the dock a few days later when smoke began curling from under the hood of the van. The needle bounced into the red zone. I steered the smoking behemoth off the side of the road.

  After a hefty tow charge, the mechanics called the next day to tell me the entire engine had to be replaced. It would cost twenty-six thousand dollars. The amount boggled me. We didn’t have the money. Every dime from grants and donors we had budgeted for salaries, supplies, and medications. We were already surviving month to month, always in a state of anxiety about what grants we might get. I fretted at home, on the phone, at our offices at HomeBase. For days the dead van stayed docked. I paced the halls at the hospital. At night I had anxiety dreams. I saw Nicole, alternately yelling at me to shut up and turning into Becca. She was lying on the street. Donald appeared. He was still by the Dumpster. The pastor, he told me, wasn’t real; he was just a silly dream. He needed me to come get him because he was going into the hospital and he had a hole in his head. Other kids appeared, crowding up with sores on their arms. I woke up, my heart racing. I wanted desperately to get the van going again. I could not imagine returning to a time when it was not running.

  “I’m counting on getting that grant we applied for,” I told Jan.

  “Then you won’t like the news,” she said, handing me a printed e-mail. “This just came in this morning. Our name is not on it.”

  “Great,” I said, depressed.

  “I refuse to give up,” Jan replied.

  “Maybe someone will give us a ton of money and we can live without worrying for just a few months,” I said.

  “Are you dreaming or being your usual Mr. Optimistic?” Jan replied.

  “No, I’m trying to find a way to avoid more public speaking. You know I hate it. I always get all hot and sweaty, and my stutter still comes back.”

  She patted my arm. “I think you do better than you know.”

  I wanted to be out on the van, serving my patients. But I knew now just how crucial the speaking was—not just for getting money but also for educating people about the plight of homeless kids. So that afternoon I picked up the phone. I called agencies and groups and task forces. I asked to talk at conferences and galas and events and board meetings.

  At home I made notes about what I wanted to say. I didn’t just talk about homeless issues. I talked about the life of teenagers today. They were living lives of unimaginable stress, I thought. The days when a kid with a high school diploma could get a good blue-collar job, enough to raise a family and buy a home, were long over. As doctors we were seeing in children dramatic increases in adult disorders, like chronic stomach pain and fibromyalgia. Depression and mental disorders were rising rapidly. For the average teenager, I wrote, life already seemed impossible. Take all that, and then try being a teenager on the streets.

  That was the speech I soon gave at a statewide conference. I had just gotten back when I got a call from Irwin Redlener, from the Children’s Health Fund. “I just got off the phone with CNN,” he announced. “They’re starting a new segment called ‘Heroes,’ and it is about everyday people doing extraordinary things in their communities. Of course I suggested you. So don’t be surprised if you hear from them.”

  Sure eno
ugh, within a week Allie Brown from CNN was on our van, the cameras trailing cords behind her. Anderson Cooper narrated the segment, and I teased Amy, knowing she had a huge crush on him. She rolled her eyes. When the show came on a few weeks later, Amy and I sat on the couch, ready with a bowl of popcorn, the kids spread across the carpet. The van appeared onscreen, and Charlotte squealed before throwing an entire box of puzzle pieces in the air to celebrate. I leaned forward to tickle her.

  “Daddy’s famous,” Reed said.

  Amy corrected him. “Almost famous.” She gave me that sweet teasing smile. “We don’t want you getting stuck up.”

  Within days the letters and donations flooded in. I was most touched by the gifts sent in from children. One little nine-year-old girl from across the country sent us a care package with important hot-weather supplies: sunscreen, caps, and bottles of water. Support came from big companies like FedEx and Metronics and Wells Fargo Bank and from various medical departments inside the Phoenix Children’s Hospital. In the last several years, they told me, they had never known we needed money. I realized I had been too shy to approach other medical departments and ask for funds; it would have felt oddly like bragging. The van was getting more recognition now, and I had won humanitarian awards. Hospital staff had taken to teasingly calling me their rock star. I’d been afraid that if I approached departments for money, they would think the awards had gone to my head or that I was ignoring the contributions of my team, but now I saw how my shyness had kept us from getting the funds we needed.

  I was overjoyed. I had never known how terrible I would feel if I couldn’t work on the van; it was as if part of myself were missing. We had raised the money to fix the van. I was eager to get back to work. I wanted to see all the kids. As I showed up at the dock to greet Jan with a big bear hug, I thought about how much I had missed the kids, more than anything else, even the most difficult cases, like Nicole and Sugar.

  “You’ll never believe who is staying here,” Kim said when I stopped by the UMOM clinic. “They said they used to visit you on the van.” My mind raced through the possibilities.