Ask Me Why I Hurt (8 page)

Jan came in to take the blood. She took one look at Mary and figured it right out. “Can I talk to her?” Jan asked. I left the room. Jan told me later she gave Mary a girl talk about periods and using sanitary napkins. “She was using wadded-up paper towels from the public restrooms,” Jan said when Mary went outside. She lowered her voice. “She’s so out of touch with her body. She doesn’t even know why she has periods. I tried to tell her, but she shut down.”

We both looked to where Mary was now sitting outside, her exam over. She still wore her bracelet. “Ask Me,” it said, and I hadn’t yet. I was afraid I didn’t know how to ask. How many weeks had passed since she had first started coming to the van? Too many. What if I just scared her more? What if she left and never came back? I realized that I was better at helping the kids with their medical needs. It was everything else they needed that I didn’t know how to handle.

She sat outside in the heat, sipping water and watching the other kids play. Jan had given her a white bag with extra sanitary napkins, and she held this in her lap like a prize. This made me ache inside. I thought about her going back to her hole once again. I made phone call after phone call in between patients, trying to find help for her. I was shocked at the lack of resources for kids like Mary. I wanted to argue with the people on the phone. “She’s living in a hole,” I wanted to yell. “We’re sorry,” they said, and behind their voices I heard budget cuts and high caseloads and people sick with stress themselves over all the help they wished they could give but could not. I said I understood. I did understand. None of these people was making it rich by denying homeless kids. All of our hands were tied by lack of money and other resources.

I put my phone in my pocket and looked out the door, and Mary was gone. I stepped outside and looked around. Once again she was gone. “Mary,” I wanted to yell. “Come back.” I went home feeling sick with worry. I can’t keep doing this, I thought. I felt like a failure. Someone else would have saved her by now. A better
doctor would have helped her. I waved good-bye to Jan that night, knowing that she too carried that weight home on her shoulders. When I curled up next to Amy that night, I thought about Mary, living in her hole. I had a dream in which I went and rescued her, and when I carried her out, she was as small as a kitten. I woke in the night with longing. If only it was that easy, I thought. If only.

The following Monday I gave Mary a set of brand-new clothes, including socks and shoes. The jeans were dark blue Wranglers, stiff with newness, and the shirt had a pop star on the front. It was a nice, fashionable outfit, the kind a teenage girl could wear without shame. Afterward she sat on the paper-covered exam table, pressing her new jeans with her hands and giggling. I had never seen her act so much like the child she was. She seemed all of twelve. I imagined her having sleepovers and talking about boys and eating junk food. She had missed so much from life. Was it possible to give any of her childhood back to her? Or was it more important to help her find her way as an independent adult?

“Look at you, with those nice clothes. Now you’re ready for a new life,” I told her. She blinked, as if this idea had never occurred to her.

I thought about what to say. I needed her to talk to me. I had been taught not to get too involved, not to care too much, to keep a professional shield between the patient and me. “You don’t want to get too close” was the mantra of the medical field. I remembered that, encouraged by my friend Danny, I took the special medical program in high school. I soon found myself going to actual surgeries and teaching rounds. I was able to shadow heart surgeon Dr. Jack Copeland. I was very lucky; Dr. Copeland and his team were often in the national news. I couldn’t believe I was sitting in on their meetings. During one, Dr. Copeland turned to me and asked, “Randy, can you research this technique?” I stayed up all night writing the report.

Most of Dr. Copeland’s patients were older, but there was one teenage girl, who was sick with a failing heart. She needed a transplant. She was on the waiting list but grew sicker day by day. Her name never seemed to move up the list. It upset me that a girl my own age would be so close to dying. I sat by her bed, feeling gawky and adolescent and all arms in the new striped shirt my mom had bought just for my new job. My wrists seemed too long, my neck was too thin, and at that age I never seemed to gain weight no matter how much I ate. My voice kept cracking. Still, she seemed to like my company. We talked about the average stuff: music, bands she liked, how she wanted to learn ballroom dancing even though it was kind of nerdy.

Family members had left a gift basket by her bed. It had a sign on it that said FOR AFTER YOUR OPERATION. She often looked at the basket. You could see the treats inside, under the red cellophane wrapper. It was a reminder to keep hoping and fighting. She saved it. “For when I get well,” she said.

Then one night she died. I came in the next day, self-consciously petting the sparse mustache I was trying desperately to cultivate, wondering if she would notice it and say anything, and I walked into her room and saw the bed was empty. My throat trembled. The blankets were gone. The basket was gone. She was gone.

Losing that patient taught me that there are times when you do get close to your patients. The mantra of the field was wrong for me. It seemed to me that I could get close but also maintain my objectivity. It would make me a better doctor. There would always be the risk of attachment, and with attachment came the potential for loss. I felt it sharply at that moment, looking at Mary. I cared for her. It was as if she were my child. Whatever happened to her would affect me. I didn’t want to make any mistakes. I knew people who cared deeply but had trouble maintaining their professional boundaries and critical thinking. I knew others who didn’t seem to care at all about patients. If I was going to do this work, I thought, I had to find the balance.

I cleared my throat. “You know, Mary, I really care about you.” I
was looking at her directly. “I think about you sleeping in the hole, and I worry.”

Her eyes jumped, and what passed between us was like electricity. It hit me that maybe no one had ever told her he cared about her. I saw something in her eyes that was like hope. Under that hope was a terrible black fear. It was the fear of everything that had ever happened to her. It was time. Maybe it was past time.

“Mary, please tell me: Why do you hurt?”

She didn’t respond, just stared, her eyes dark and huge. I had a sudden, deep conviction that what had happened to Mary was deeper than memory. Even acknowledging it would bring it all back. She reached down and rotated the bracelet with one hand.

She began talking. The words came out in a monotone at first. Each one was laced with acid because what she was telling me was so painful. Her voice was flat. I could sense her shame. It was almost like a physical presence. She spoke for what seemed like a long time, her hand ceaselessly circling the bracelet. The more she spoke, the larger and darker her eyes grew. She got closer to what she needed to say. Tears formed almost unwillingly, increasing until they finally slid down her cheeks. I felt dizzy with pain myself.

As she talked and cried, the daylight outside seemed to grow brighter, and I could hear each and every sound of the van around us: the clink of metal in a tray, a series of low voices, the hum of the machines, a bird singing in the distance. If Mary had looked up, she would have seen herself, reflected in my glasses, a little child alone on an exam table, a doctor standing nearby. The tears were all over her hands, like raindrops from a passing storm. And still her story kept coming, in little choked pieces and brutal bits, with a hurt that ran so deep I could see her skin crawl. She told me, and I listened.

When I walked into my house that night, I was feeling wrung out, emotional, exhausted, sick, hopeful, angry. There wasn’t a feeling I wasn’t having. I thought about what Mary had said her father had done and how unthinkable it was, how it was the worst
betrayal. Even to think about it roiled my stomach. I wanted—I needed—to talk to Amy.

People didn’t understand why Amy was so supportive of my working on the van. After all, I could have chosen a field that made better money. Instead I had a job that paid less than many of my colleagues’ salaries, and I was gone for sixty hours a week. Yet Amy always encouraged me.

I had been smitten with Amy since the first time I’d seen her. “This is your new boss,” one of the doctors had said, introducing her. I turned to see cute curly hair and a nose that wrinkled with laughter. Amy was the senior resident, and I was her new intern at the children’s hospital. I was bowled over. She was warm, with an infectious smile, but she was also vulnerable and reserved. She was as interested as I was in serving the poor. She had requested her weekly clinic to be at the Thomas J. Pappas School–based clinic for homeless children, just as I had. I got to know Amy well during our weekly rotations at Pappas. I saw how gentle she was with children, how easy to laugh and have fun, and how stoic and strong when something went badly. Amy had integrity.

I surprised myself by asking her out after only a few weeks. Usually I would have been too shy. She gave me that huge smile. “Nope,” she announced. I was taken aback. She saw my hurt look. “Look, I don’t want a relationship. I’m a senior resident. Next year I’ll be out of here. I could get hired in Minnesota for all I know. Or Guam,” she said, with a teasing look that I came to know well. So we became fast friends instead. She invited me to go house hunting with her. For months we went to look at little houses in the Willo and Encanto districts of Phoenix, older houses with few modern conveniences. I watched as Amy made plans to buy a house that would contain only her. “I don’t have a lot of clothes,” she once said, excusing the fact that a little cottage had no closets.

I cleared my throat. “What if you get married?”

Amy looked as if that were way off in a foggy distance. I began to suspect her reservations about a serious relationship ran much deeper than just job choices.

Amy was there for me when my sister, Stephanie, began having
troubling symptoms of MS, including numb feelings below the waist and difficulty walking. She listened when I told her that Stephanie’s doctors had told her it was all in her head. They wanted her to see a psychiatrist. In the meantime they ran an MRI. I was doing a rotation at the hospital when the neurologist called. He sounded humbled. “We think your sister has multiple sclerosis,” he said. I immediately went to my boss and asked to leave early, so I could talk to my sister.

It was Amy I turned to later for support. We sat on the back porch of the house she rented with her roommate, Angel, a southern girl from North Carolina, drinking Diet Cokes. “Look,” Amy said, and pointed to a shooting star. “What do you wish for, Randy?”

I looked at her profile. “I wish my sister’s MS would go away,” I told her. She turned and looked at me abruptly. Maybe, I hoped, she was seeing something new in me.

But after months of friendship I was starting to feel Amy would never develop romantic feelings for me. I wondered if the loss of her mother when she was young had made her fearful to grow attached again. Her father lived in California. Amy was alone. Maybe she wanted it that way. I reflected on my life so far. Each time I had fallen in love, it had been hard and with a woman who never felt the same way. These infatuations had lasted for years. When it finally became clear that a relationship would not happen, I fell into a deep depression. Now I worried I was falling into the same trap again.

In April 1997, when I was ready to give up, we both were invited to the wedding of her roommate. It was in Las Vegas and two months before the end of Amy’s residency. We were coming out of the parking garage elevator, talking about nothing, it seemed, just the comfortable everyday stuff we always discussed. Amy suddenly stopped. Her eyes were large and bright. We stared at each other, and she stepped forward and kissed me. The kiss seemed to last forever. When it was done, Amy tucked her face against my pounding chest. “What are we going to do now?” she asked. It was a telling sign of our relationship that after we returned to Phoenix, we started the process of buying a house together. We had
been looking for weeks before one day Amy turned to me in my truck and said teasingly, “We love each other, and yet we’ve never even said it.”

I turned around, took a deep, delighted breath, and responded, “I completely and totally love you.”

I was thinking of that magical moment when I came through the door and unloaded the contents of my pockets onto the side table. I jerked them out in a hurry: phone, keys, codebooks. I opened my mouth to call Amy. But there was something about the atmosphere in the house. The air felt different. There was a palpable tension. I walked into the kitchen. Amy was sitting where I expected her to be, an ignored magazine in front of her.

“Honey?” I asked, coming in.

She turned to me, her face bright, incandescent, and beautiful.

“I’m pregnant,” she said.

I felt all my worries about the van fall away. I stepped forward and gave her a huge hug. Amy was ecstatic. I felt that together we were seeing the same vistas, embarking on the same journey. My heart raced with excitement. I’m going to be a father, I thought, I will have a son or daughter. I realized that along with my joy came brand-new concerns. Suddenly I had worries I had never had. Was our budget enough? Did I need to plan for college? I remembered all the times as a doctor I had seen new fathers, and they had told me about the pressures of fatherhood. Now I understood. Along with those worries were some that came from my experiences on the van. My world was full of kids who had diseases and problems. I wanted desperately not to have these worries for my own children. I held my wife and kissed her, rocking back and forth in our joy.