Ask Me Why I Hurt (2 page)

“I’m guessing a pneumonia,” I said to Jan under my breath, “turned into a massive bacterial infection. The bacteria have spread, and they’re in his blood now, all over.” The blood vessels were leaking, like tiny hoses with holes in them. The leakage was making it impossible for his heart to take oxygen and nutrients to the rest of the body. He was going down rapidly, and what was I going to do? The boy’s eyes, blind with confusion, looked up at me. His face was now covered with huge beads of sweat. I could see his heart pound in his chest. “Get the IV started,” I heard myself saying. “Get some fluid in him. Vitamin R, quick.”

“Large-bore?”

“Yes. Saline at the same time.”

Jan was flying around the room. We both were in full emergency mode. The boy was losing fluid internally so rapidly that his veins had sunk deep inside his body. In seconds Jan had expertly located a vein, and the IV was up, delivering the strong antibiotic Rocephin into his system, along with saline. His body seemed to drink the fluids up. The next few minutes passed in a panic: I shouting orders, holding his wrist, talking to him; Jan on the phone to a hospital. The saline and antibiotic slipped into his body, and his cheeks slowly turned pink. His eyes opened and cleared, and his heart slowed. The antibiotics were fighting the front end of what might end up being a long war. But he was past the point of crisis.

Suddenly it was over. Maybe ten minutes had passed since Jan had called my name. The ambulance came screaming out to our deserted area and unloaded a stretcher. The boy was gone, on his way to the hospital.

I took a deep, shuddering breath. My hands were shaking. I held them out in front of my face. The daylight outside told me it had been a matter of minutes, not hours, since the boy had climbed our steps but it seemed like forever. The familiar metallic taste of stress was in my mouth. During an emergency I didn’t feel things too closely. I couldn’t afford to. But then afterward it all hit me. My skin tingled, and my heart lurched in my chest. Bottled-up adrenaline hit me like a wave. My skin was alive with nerves, and
my stomach tightened. I felt as if I had been in a car accident. Oh, my God, I thought, that was close.

“That was close,” I heard myself repeat out loud, as if from a faraway distance.

Jan looked dazed. “No kidding.”

It wasn’t until that evening, when we shut down the mobile unit, that Jan and I talked about what had happened. My adrenaline was still running wild. There was the dark relief of knowing I had dodged a bullet, the skin-pricked elation and disbelief that come after ushering someone safely past the point of death. I kept thinking that boy had been so close to death he’d been touching it. But instead of reassuring me, the thought unsettled me. What if I hadn’t reacted the same way? What if I had still been too late? He might be dying in the hospital right now. When seconds count, you examine each one critically. I kept replaying the events in my head. I felt uncertain. Did I get it right? Should I have done anything else? Maybe I should call the hospital and ask if I was right.

I paced the empty van, talking a mile a minute. The feelings came rushing out, and I talked in the way that doctors do when a crisis is past.

“Can you believe it, Jan? He was seconds away.”

“Yes,” she said softly.

“He could have
died.
”

Jan touched my arm. “Are you OK?”

I wiped the sweat from my brow. “Yeah, I’m OK. I guess I just keep thinking, What if he hadn’t come in at all? What if he had stayed under those bushes for just another hour or two?” Jan nodded along with me. “Or what if we’d had that flat tire today and not yesterday? What if we had parked somewhere else? Or if he’d shown up after we left? It was pure luck he didn’t die.”

“It was lucky that we were here,” she said. Her eyes were caring.

“I guess it really just hit me how alone we are out here.”

“Well, he was alone too,” said Jan.

That stopped me. It was true. I had been thinking earlier how if I had been at the children’s hospital, the boy would have come in with his parents to answer questions. They would have been able to tell us his medical history, his shot records, any allergies or surgeries or if he’d had a cough the past few weeks. What I hadn’t thought about was how those parents were also there to hold hands and comfort and take care of their children when it was all over. When this boy finally left the hospital, he would return to no one. He had come to our van alone, and if he recovered, he would do so alone. Out here on the streets, the homeless children came with nothing at all.

I was almost thirty-four when I started the mobile medical unit that became known around Arizona as Big Blue. I was a small-town boy, transplanted to Tucson, Arizona, where I played in the dry washes behind my family’s modest house. Inside, the swamp cooler constantly blew cold, wet air. I was a goofy-looking boy with a bad stutter who talked so much about wanting to be a doctor my schoolmates started to sarcastically call me Doctor or, even less nicely, Mr. Quack. But as much as I dreamed I really didn’t think it would happen. No one in my family was a doctor. Neither of my parents had a college degree, though I believed my dad had to be the smartest guy around. Both he and my mom expected me to do well in school, but exactly what my future was I wasn’t sure. As a teenager I worked after school at the Golf n’ Stuff, a miniature golf course and amusement park. After work my friend Danny and I would stop by the closest Eegee, to drink the fresh fruit slushies and eat footlongs. Somehow, when I talked with my best friend in that hard yellow booth, my childhood fancy of being a doctor started seeming as if it could become real. One day I told Danny
about a flyer I had seen posted at our high school. The local hospital was offering a special program for teenagers to learn about the medical profession. Danny encouraged me to apply, and I did. Suddenly I was going from the Golf n’ Stuff to the corridors of the hospital.

It was several years later, in medical school, that I first saw a mobile medical unit. This “hospital on wheels” amazed me. I was in a combined program at Tufts, where I was getting a doctorate in medicine and a master’s degree in public health. In one of my classes I learned about the Bridge Over Troubled Waters program, which had a special van that took health care to the homeless. I was immediately intrigued. I rode the Boston subway out to Harvard Square, where the van was parked, just to look at it. It was small and looked worn, but the homeless lined up outside looked eager for help. I was struck by the concept. How perfect, I thought. With a hospital on wheels, I could take health care to any child who needed it.

I was graduated from Tufts University in 1995 and began a combined program in internal medicine and pediatrics at both Good Samaritan Hospital and the Phoenix Children’s Hospital. Over the next few years I saw many homeless adults and children. As part of the residency we were assigned to a weekly medical clinic where we would practice “real world” medicine. For my pediatric clinic I chose the Thomas J. Pappas School, a school in a decrepit area of downtown Phoenix for children whose families were homeless, living in shelters, cheap motels, and cars or on the streets. The school allowed them to get not only educations but also social services. It had a clinic, staffed by local pediatricians like me, that opened once per week. For the first time I got to practice medicine in the community I wanted to help.

After graduation, I was hired on at the Phoenix Children’s Hospital as a faculty physician. I got married, bought a house, and fell into a busy life with a lot of work, extended family, and friends. With a full-time demanding schedule and the continuing work of the Pappas school clinic, my dream of the medical van seemed out of reach.

But in 1999 all that changed. Phoenix Children’s had teamed
up with a program called HomeBase Youth Services, an agency serving homeless youth in the Phoenix area. It had a drop-in center and a separate long-term shelter. The
Arizona Republic
newspaper ran an article drawing attention to homeless kids needing medical attention The article got the attention of the hospital administration, and soon the idea of a mobile medical unit was proposed. A grant was written and funded. Dr. Irwin Redlener of the Children’s Health Fund came to town to give a talk. He and singer Paul Simon had founded the Children’s Health Fund to help bring health care to America’s most vulnerable children. When he heard about the idea of a mobile medical unit to serve homeless kids in Arizona, he eagerly got on board and offered to help.

As soon as I heard about the plan, I ran into the office of my boss at the hospital, Jeff Weiss. I wanted to run the van, I told him. I
needed
to run the van. But he wasn’t so convinced. I was young, he said. I had barely started my career as a doctor. It was the kind of position that called for a doctor with tons of experience who possessed more than a little street smarts. Besides, funding was iffy. There probably wouldn’t be enough money for a director for the van, he warned me. But I insisted. Finally, after weeks of my constant lobbying, he relented. I suspect he thought I’d never give up. There was still no money for my position, but I was confident it would all work out.

When I called my wife, Amy, to tell her I had been offered the position, my childhood stutter had returned, as it often did when I was excited. I had to take a few deep breaths and avoid the problem words that sometimes tripped me. Finally I got it out. “I got the job,” I said.

It felt more like a question than a statement because I needed Amy’s support. I felt the world stop until she answered.

“Go for it,” she said. So I said yes, with neither a moment’s hesitation nor the faintest idea of what I was getting into.

“OK, what do we do next?” I asked the folks who had gathered to help plan the launch of Phoenix’s newest mobile medical unit. It was our first meeting. I was bubbling over with enthusiasm and so excited I could barely sit still. Silence greeted my question. Embarrassed, we all looked around the table. How
did
one start a mobile medical unit?

“Are there any books on the subject?” someone asked after a long pause.

Someone else opened up a laptop to do a search. More silence. “Apparently not.”

“Well, one thing is clear,” a colleague said. “We have no idea what we are doing … yet.”

“We can at least start with a name,” I said.

“How about something after Jim Crews?” a HomeBase staff member asked. Jim Crews was the CEO of Good Samaritan Hospital and a big supporter of the van. “Something like the Crews’n Healthmobile.”

“Perfect,” I said.

It turned out that making a hospital on wheels was incredibly complicated and expensive. The first step—getting an RV to remodel—was probably the easiest. Jim Crews arranged for the donation of a 1991 Winnebago. When the van arrived, I ran out behind the hospital to take a look. It was an old Winnebago, sure enough, but to me it was beautiful. The hard part was going to be turning it into a functioning hospital. Months of meetings were spent finding out the regulations on everything from which oxygen tanks we could use to what medical equipment would fit. We wanted a van that could offer high-quality hospital-level medical care, which meant having the right equipment that met hospital-level standards. The Children’s Health Fund donated thousands of dollars, the Phoenix Children’s Hospital and HomeBase chipped in, and the Flinn Foundation contributed huge amounts in a seed grant. The donations and grants were a godsend, yet the costs were staggering.