Ask Me Why I Hurt

by M. D. Randy Christensen

  Hearing my pulse in my ears, I saw nothing until the next exit. I pulled off the freeway into a McDonald’s parking lot and saw the nose of my truck as I parked. My mind a blank, I watched people pull into the drive-through. Dead, I thought. I saw a woman ordering food. She had a full carload of kids, with a baby screaming in the back. Her blond hair was plastered to her cheek with sweat, and she looked harried. As I watched, an older boy leaned his cheek against his fist and looked out the window at me. I thought of Nicole. I thought of her being Becca, the child she always was for me. I looked at the red stone hills in the distance, and I imagined Nicole in a parking lot, dying. Who was Nicole, in those final minutes? Was she that little girl who would have been terrified and all alone? Was she the young brash man? Was she the dark, closed person? Would it make a difference for me to know?

  I put my head in my hands, and I cried. The tears felt as if they had been pent up for years. I cried for Nicole and I cried for her scars and I cried for all the other kids I had seen who had been hurt and those who had died. I cried for the people of Katrina and the kids I wasn’t able to reach. I cried for our country and the fact that despite our greatness in so many ways, we had failed this child and many others. More than anything, I cried for the realization that this precious girl was gone and would never return. Our chances had run out.

  I pictured her sitting up on my exam table, asking in that childlike voice, “Am I healthy, Doctor?” And what had I said in response? “Healthy as a horse.” She had said, “See? I knew I was brave enough to do it.”

  Yes, Nicole, I thought, you were brave enough to do it.

  By the time I drove to the van I had a handle on myself. Jan met me, wiping her eyes. I spent the day in silence, helping new kids but haunted by remorse, plagued by thoughts of what I could have done for Nicole. Why hadn’t I done more? I should have pressed for mental health care. I should have called members of Congress. I should have yelled from the rooftops. I had done none of those things, and the guilt pressed on me. I was sickened at how our system had failed Nicole. If only for a piece of identification she might have gotten help. But I was also angry with myself. Maybe I could have done more too.

  My thoughts were interrupted when Jan poked her head into the exam room where I was finishing with a girl with diabetes. I was explaining to her how difficult it is to manage diabetes while homeless.

  “Randy? There is a detective here that would like to see you.”

  I met him outside the van. He was a short man with red hair and very fair skin that had been damaged by the Arizona sun. Red spots of damage showed across his forehead. “Are you Dr. Christensen?”

  “Yes.”

  “We’re investigating the death of a young Jane Doe. I’ve spoken with some police who suggested she might be a patient of yours.” He described her briefly.

  I nodded. “She was our patient.” I took a deep breath. “We never knew who she really was. We called her Nicole.”

  “No last name?”

  “No last name. No real name,” I answered. “No identification, nothing. The jail had her for a few days. Maybe they have a better idea. She was disturbed. Deeply disturbed …”

  He made a few marks in his notebook, more doodles than anything. “I was there when the medical examiner was examining her.” He paused delicately. He raised his red eyebrows to me. “There were scars.”

  “Yes,” I said. “There were scars.”

  The detective and I held eyes for a moment longer. I wondered if he had children. I saw a wedding band on his hand. “I don’t think there will be any next of kin,” I said. “If you find them, let me know.”

  He nodded. He put his notebook away.

  “So that’s it?”

  He gave me a look of compassion. “No one wants a girl like this to get hurt,” he said softly. “We will do our best. But you probably already know that cases like this are hard.” He paused. “There are some people who target homeless victims. They’re easy targets. And there is no family to see that justice is done. But I will.”

  “I hope you can,” I said. Before he left, he gave me his card in case I heard anything more.

  That evening, when I walked through the door, Amy enveloped me in her arms. I had called her in advance to tell her what happened. I was doing better, I hoped, at sharing with Amy.

  “What happened, Daddy?” Janie asked, running up to hug my legs. I had recently remarked to Amy that as the kids got older, it was harder for me to keep things to myself; they were like emotional sight dogs, wired into my every emotion. Amy had told me it was a good thing. I wiped my eyes.

  “I lost a kid today, from the van.”

  Amy nodded to them. She looked as sick and sad as I felt. She herded the kids into the living room to watch a movie.

  “Daddy’s sad,” Janie said with worry.

  “Daddy will be OK,” Amy told her.

  We sat down to a late dinner, Amy pulling lasagna and garlic bread out of the oven while Janie told me fascinating facts about animals, trying to comfort me. Charlotte looked around. “Daddy had a bad day!” she exclaimed.

  “Do you guys know why Daddy does his work?” Amy asked them, sitting down at the table.

  Reed hesitated. “Because he’s a doctor.” He sounded older than seven.

  “That’s right. And what do doctors do?”

  This time Charlotte spoke up. “They give people shots.”

  Amy smiled at her. “They do that. They also try to help people get better.”

  Reed looked at her. “But Daddy said one of them died. On his Big Blue van.”

  “She didn’t die on the van,” I told him. “But, yes, she died.”

  “How come she died?”

  “We don’t know yet,” I said.

  Charlotte looked at me. “How come you didn’t save her, Daddy?”

  I swallowed my milk. “I tried, honey.”

  “Your daddy tried because he is a doctor,” Amy said in her calm, reassuring voice. “He tried because he cares about people and wants to help them. But sometimes it doesn’t work. The hardest part of being a doctor is knowing you can’t help everyone.”

  The kids were silent. Reed was staring at me with intensity. Finally Charlotte piped up. “It’s OK, Daddy.”

  I rubbed my face with my hands. I tried to protect my kids as much as possible from the sadness of my work. On the other hand, I also wanted them to live a life of courage. Death and loss were part of being a doctor. Risk and pain were part of helping others. The dilemma was how to teach courage without traumatizing them.

  We finished eating. I got up to help with the dishes, and as soon as I was done, Reed sidled up next to me. “Daddy, do you want to play with me?” he asked. “I got a cool new game called Cat in the Hat.”

  I dried my hands. “Sure. That sounds like fun.”

  He held my hand as we walked together into the living room. Amy, Janie, and Charlotte looked up at us. They all smiled. Reed sat down and set up the game. It required pulling cards that instructed us to take turns dancing around with a tiny cardboard hat and crawling under spindly canes or balancing pretend cakes on our head. Soon the whole family was playing. The kids laughed, and while the weight of Nicole’s death was still a stone in my heart, somehow I felt closer to them than I ever had. That night I kissed the children as I tucked them in, murmuring my innermost feelings for them, and when I went to bed, Amy was waiting for me.

  A few days later we held a little sunset service for Nicole. The whole team lit a candle for her outside the van. We had parked in the downtown area where we so often saw her. It was getting dark, and the sound of the freeway could be heard in the distance. We were alone, standing outside the van. It seemed like a small gesture for the end of a real person. Is this all? I thought. A girl has died at the end of years of torment and this is it? No one will ever know her. No justice will probably ever be done. There would be no headlines, no eulogies, no public record or memory that this was a missing child. Nicole had died and it wa
s as if she had never existed. In our country some kids are lost forever.

  I felt I had to say something. Jan passed me the candle. “I keep thinking about who Nicole was when she died,” I said to the stars. “I keep wondering if she was Becca, or the young man, or one of her other personalities.” I took a breath and continued. “All those people were pieces of Nicole she had to splinter apart just to survive. But now I’m thinking it doesn’t matter who Nicole was when she died in that parking lot. Because now she’s in a place where she can be whole.”

  I passed the candle to Jan. Tears were streaming down her face. She passed it to Wendy. Wendy took the candle and blew it out. We watched the wisp of smoke float up into the scarlet sky.

  “Good-bye, Nicole,” we said.

  “Jan, what do you think of this letter?” I asked a month later. “It’s to the governor.”

  “The who?” She was immediately interested.

  “I’m asking for change with the Medicaid insurance,” I said. “I’m telling the governor we are saving the state money by taking care of these kids for free. I’ve shown with these statistics how much money we are saving them. But we need to revamp the system. We need to make it easier for homeless kids to get help, especially the ones with mental health problems.” There was insistence in my voice. “We need to make it easier for kids like Nicole to get help.”

  Jan looked up from the letter. Her eyes were somber. “You’re taking this pretty seriously.”

  “I’m mad.”

  She cocked her red hair to one side. The sun coming through the van’s windshield showed the freckles on her face. “Usually you preach patience, at least with administrations,” she told me.

  “You’ve rubbed off on me. There’s a time to fight too.”

  “Good luck. You’ll probably get a form letter in reply.”

  “The voice of experience.”

  Later I ran into my boss at the hospital, Jeff Weiss. I told him about the letter and Jan’s comment. “Oh, I’ve seen you get mad,” he said. “Usually it isn’t with governors, though. Other doctors, maybe. Come to think of it, I haven’t seen an angry e-mail from you in ages,” he said.

  “I guess I’m learning to channel my passions,” I said.

  He stared at me. “This one is really bothering you.”

  “Yes. This is one of the ones.”

  “OK.” He nodded. “That’s good you’re learning to talk about it.”

  “Was I bottling it before?” I asked, surprised.

  “Oh, Randy, you are the king of bottling. All these years you’ve been so worried we’d think you weren’t up to the job you never complained once. Let it out.”

  A few weeks later the FBI appeared. The agent waited patiently for the van to clear before he stepped aboard, showing me his identification. “We are investigating prostitution and sex rings in the area. The local police suggested I pay you a visit.” He had brought photographs. “I’d like to see if you recognize any of these girls. We suspect they were kidnapped or sold into the sex trade.”

  I thumbed through the photographs. Young faces stared out at me. Brown faces, white faces, plain faces, pretty faces. Some were very young, while others were teenagers. “We’re getting a lot of reports in the area,” he said. “We busted one house last month. The girls had been locked up for months.” He had deep brown eyes that looked as if they had seen far too much. His hair was receding, and lines were etched in his forehead.

  “Where do they get the girls?” I asked.

  “A lot of them are from Mexico. They’re illegal, they’re scared, and they don’t know where they are. It’s easier to keep them in a state of fear that way. But we’ve had plenty from around here too. Phoenix is turning into a hot spot. Some might have been homeless. No one notices they are missing.”

  I nodded. I had many girls tell me about being prostituted even as toddlers and young children. By the time they came on the van some had been in the sex trade for a decade, and they were only teenagers. Beyond getting them in shelters, I felt there was little I could do for them. They needed intensive, specialized counseling and a safe place to stay, and such places didn’t seem to exist.

  I thought about Nicole as I thumbed through the pictures. Some of the photographs were blurry. Others were grainy reproductions, many years old. Part of me was hoping, if only for a sense of closure, that I would see her in one. But a larger part of me dreaded it. None looked like Nicole. I handed them back. “We see hundreds of kids a week on this van,” I said. “Thousands over the years.”

  “I’ll be back in touch.” He looked around the antiseptic walls of the van. “This is a nice outfit you got going. There are some people who work with child sex victims, in case some of your patients need help. There are a few safe houses opening up.”

  “Please. That would be nice.”

  “I’ll be in touch then,” he said.

  13

  SUGAR

  In the fall of 2009 UMOM was in the process of moving its shelter from the old motel to a new and bigger facility. It was a huge improvement over the last shelter. Happy children played in a courtyard on renovated playground equipment. There was staff to guard the front. The shelter took in domestic violence victims as well as homeless families. The catering business was being reconstituted into a restaurant that would serve the public. I peeked through a dusty window. I saw leather booths and neon signs.

  “This is going to be a fantastic restaurant,” I told Darlene. “I can already taste the milk shakes.”

  Inside the main building there was a beautiful new clinic. I marveled at its size. Before, Kim had had one tiny room. This time there were four beautiful exam rooms and an office, all tucked inside the main floor. Already Kim was taping up posters and gleefully stocking cabinets. Once again the community had helped. Wal-Mart had donated sixty thousand dollars. A group of Boy Scouts was inside, trying to earn their Eagle Scout badges by stuffing fifteen hundred hygiene bags to hand out to the children.

  “I can’t tell you how amazing your nurse Kim has been,” Darlene said as we walked the grounds. “Did you know that she’s now gotten sixteen of our moms into nursing school? I don’t know what strings that woman pulls, but she pulls them.”

  “What do you mean, she got them into nursing school?” I asked. Since I was often on the van, and Kim was at the shelter, I wasn’t able to follow her achievements as much as I wished. I knew Kim was extremely competent; I just wanted to share in the challenges and successes she seemed to be experiencing in the shelter.

  “You didn’t know? From homeless to nursing, I can’t believe it myself.”

  One thing I admired about Darlene was that she saw the big picture. As wonderful as UMOM was, it was not meant to be a permanent home. The goal was to move the families on to self-sustained stability. I thought of all the benefits I had had growing up. We didn’t have a ton of money, but we had stability, and so much of that stability was rooted in my parents’ owning a house. It was because we had a home that Stephanie and I were able to stay in the same schools, get good grades, make lifelong friends, and experience success in life. These children and their moms deserved the same stability.

  I found Kim in the back, unpacking books. Her short hair was pulled back, and her tanned arms glistened with sweat. I helped lift a box.

  “Kim, are you really getting these moms into nursing school?”

  “Sure deal.”

  “How do you pay for their tuitions?”

  “Oh, you know. I asked around and got some scholarships.” She made it sound as if it were easy, and I realized once more how lucky I was to be surrounded by such dynamic, driven people. I listened to Kim chatter about her plans for the clinic and how this one baby was dealing with an eye infection and another mom also wanted to be a nurse, as I helped her put away books and thumbtack up new posters.

  That afternoon I parked in the rough area of town. A slender blond woman was standing at the top of the van steps, blinking and readjusting her sight, having ju
st come into the shade from the sun. I know this woman, I thought.

  I thought about the first time Sugar had come swinging up into the van, so many years before. The false sexuality was gone now, burned out by the hard life she had lived. Her curly blond hair had been hacked off into a rough cut. But despite the facial scars, she was still pretty.

  My heart warmed to see her. “It’s good to see you,” I said sincerely. It had been so long, and I had worried over her.

  “Can you see me right now?” she asked.

  “I’d be happy to.” I led her to an exam room. She was unusually subdued. I wondered how old she was now. She had to be in her mid-twenties. Her eyes looked much older and sadder. I would have to tell her she was too old for the van. Our funding allowed us to treat children and young adults under age twenty-five. In the early days we were limited to age twenty-one, but this had changed. Soon I’d have to tell Sugar that she would need to find other medical care. I doubted she would do this. I didn’t want to tell her that she couldn’t return. I knew I would miss her and worry about her.

  “What can I do for you today?” I asked.

  She sat on the edge of the exam table she knew so well. How many times had she sat there, getting tested for STDs? More than I wanted to count. But there was something different about her this time. The dissipation had gone out of her face. It had been replaced by something new. I wasn’t sure what. She placed her palms on her legs.

  “I think I’m pregnant,” she said.

  I wasn’t surprised. It was a risk of what she did to survive. “How long has it been?”

  “Since I missed my period? I’m not always regular anymore. I think like three months.” The lack of consistency in her cycle also didn’t surprise me. It was common with women who had suffered from poor nutrition, repeated STDs, and repeated sexual violence.

  “Would you like a pregnancy test?” I asked.

  “I’m pretty sure I’m pregnant.”

  “How can you tell if you often miss a cycle?” I asked, curious.