Ask Me Why I Hurt (9 page)

W
hen Mary told me her story, she disclosed her real name. I called Child Protective Services the next day. Mary, it turned out, was seventeen. Her father had been sent to prison for sexually abusing her. The original charge was rape, but he had pleaded guilty to the lesser charge of sexual abuse instead. During the years he molested Mary he had kept her secluded from her other family members. He threatened to kill her if she told anyone what was going on. Mary was terrified. After his arrest Child Protective Services had found Mary a home with an aunt who lived in Chandler, right outside Phoenix. But when the aunt went to school to pick Mary up, she had already run away. “Mary was sixteen at the time,” the social worker said. “She’s been missing ever since.” She paused and then asked curiously, “Do you know where she was hiding?” I thought of the hole in the desert. I wondered how long Mary would have kept living there if she had not come to our van.

There was a storm of phone calls. By the time we were back in Tempe the following week the aunt was coming to get Mary once again. The social worker assured me that the aunt was nothing like her brother: “The two haven’t talked for years. He never
let her meet Mary.” As remarkable as this story sounded, I wasn’t surprised. In my work as a pediatrician I had often been struck by the fragmentation of the American family. I asked what the aunt was like. “She works in a nursing home. She’s a nice single lady, a bit of an old maid, to use an old-fashioned term. No criminal history, not even a traffic ticket. Apparently her hobby is needlepoint. She’s never had any kids of her own but said she’d be happy to take Mary.”

Mary was waiting outside in one of the folding lawn chairs, biting her lips. “I didn’t even know I had an aunt,” she mumbled. “Maybe she won’t like me.”

“She’ll like you just fine,” Jan said. “What’s not to like?”

I felt just as nervous as Mary. Her aunt drove up in an old Datsun. When she got out of her car, she was crying. She hugged me, tears wetting my shirt. She was crying so hard she could barely speak. “I almost gave up,” she said.

Mary stood off to the side. Her aunt approached slowly. She touched Mary’s hair and then gently brought her close. “I know we’ve never met,” I heard her whisper into Mary’s hair, “but we’re still going to be family.”

We hugged Mary good-bye. I gave her a little stuffed bear I had found. It had a heart sewn on the chest. “Friends Forever,” it said. Hokey, I thought, but I wanted her to know she could always come back.

“If you need medical care for her, or for any reason, bring her back,” I told her aunt, whose name was Diane. “We’d love to see our Mary.”

Once inside the car, Mary waved a little. She held the bear up, bending its arm as if it were waving good-bye. I was shocked at the changes in her life. It was as if Mary had been a piece of luggage sent here or there. I knew it was wonderful she had a place to live. But I had mixed feelings. I wanted Mary to be safe. I wanted her to be successful. I wondered if this was possible after what she had been through. Could a girl who had lived in a hole make the transition to a normal life? Would she be able to go to high school? How would other teenagers treat her? Could she fit in? Could she
recover? Or did her past mean she was damaged forever? Still, I knew she had to try. And we all had to help. There was no alternative.

Monsoon season struck a month later. Dark and gray, the dust storms came over downtown Phoenix. We called them Arizona dusters; they were great black and gray roiling clouds that came in solid walls over the city. It was like watching something from a natural disaster movie. The man on the radio had warned drivers to pull over, far off the road, and turn off their lights. If you were driving and got caught in those storms, it was like being immersed in black soup. When the monsoon season came, I worried for the homeless kids. Arizona storms are nothing to ignore. Homeless people have drowned after falling asleep in the washes and getting caught in a flash flood.

When the rush of patients subsided, we stood for a moment in the van door way. The distinctive smell of the creosote bushes drifted from the desert, and the hum of the cicadas was so loud it sounded like the buzzing of hundreds of rattlesnakes. It brought back old memories of monsoons, time spent as a kid playing board games with Stephanie inside our house and listening to the rain roar down the washes, or sitting in a café while the rain poured in sheets outside. After, I knew, the air would smell fresh. The streets would be washed, and all of Arizona would seem clean. But for the homeless kids it was different. The storms left them soaked, miserable, and sick. Their socks and shoes and sleeping bags became sodden. Infections and illnesses quickly set in.

We watched as the sky turned the thick, menacing dark color of dust clouds. A boy came running ahead of the storm toward us, the sheet of black dust behind him. He was coughing as he ran—asthma, I thought. “Hurry!” Jan called.

She interviewed the boy with the new intake forms she had created. He said his name was Matthew and he was seventeen. He
had been sleeping under an overpass since his stepdad had kicked him out of his home. He had been mugged repeatedly. “He’s lost count of how many times he has been assaulted,” Jan had written. I took a deep breath and went into the exam room.

He was small and thin, with thick blond hair. He wore a dusty long trench coat over black clothes. My heart knitted a little bit at seeing the outfit. It looked like the sad posturing of a boy trying to look tough. But he didn’t look tough at all, not with thick glasses mended with Scotch tape and rubber bands. One lens was shattered inside the frame, and he kept turning his head to look at me through the good lens. I could see from their thickness that he had very poor eyesight. I thought he looked like a walking target, a boy so demoralized he was open to attack.

“What happened to your glasses?” I asked in a friendly voice.

“I got jumped. I was trying to fight them off.”

I examined his teeth. The ones up front were OK, but there were huge gaping holes in his back molars, the result of years of untreated cavities. He would need intensive dental work.

“What can I help you with?” I asked.

“My feet. They hurt.”

I looked down. He was wearing heavy boots.

“OK, how about we take them off for a look?”

He hesitated. “It’s OK,” I told him.

When he unlaced his boots and pulled them off, the smell was profound, putrid. I struggled to keep my face even. I carefully lifted one foot. Humiliated, he put his head down. His once-white socks were stuck to the soles of his feet. I could see damp blood and pus through the thin fabric. Parts of the socks were embedded in the rotten flesh. He probably hadn’t changed the socks in weeks. Months even. How could he change them? He was homeless. He didn’t have access to a bath. The lack of shelters meant the kids had no way to get clean.

He began slowly peeling one of the socks off his foot. A layer of skin and pus came with it. I could tell immediately his feet had a bacterial superinfection from an untreated fungus. I examined the soles. Along with raw infected flesh there were deep holes that
looked to be a good quarter inch deep. Of more concern were his toes. The tips of two were black and spongy. It had to be incredibly painful just to walk. He kept his head turned down, his eyes at his knees. The smell filled the room. He was embarrassed. How hard this must be on him, I thought. He was at a time in his life that he should be feeling ready to take on the world. Instead he was at rock bottom.

“I can take care of this,” I said, trying to reassure him, to take away the humiliation.

“Really?”

“Sure. These kinds of foot infections go crazy in the heat, especially in monsoon weather like this. First I’m going to get rid of these socks,” I said, picking them up with my gloved hands and dropping them in the trash. “I’m going to get you some new socks and shoes. We’ve got extras up front. But before that I am going to treat your feet. I need to spray them with medicine. Then we’ll get some clotrimazole cream. I’m also going to put you on Keflex, since the infection is bad. It’s an oral antibiotic. You’re going to get the triple whammy.”

After I had treated his feet, I finished the rest of his exam. What I’d thought was asthma turned out to be a mild case of bronchitis. On his arms I noticed a series of unusual symmetric scars. They were neat, almost orderly, as if his forearms had been caught in some form of machinery. I turned his arm gently and examined the scars further. They weren’t identical. They had a hand-hewn look, something I had seen as a pediatrician, though usually in girls.

“Do you cut yourself sometimes?” I asked.

“Yeah.”

“What with?”

He took out a folding knife from his back pocket. “With this.”

I took the blood-flecked knife. “It’s hard to hurt so much, isn’t it?” I asked him. “You must hurt an awful lot to do this to yourself.”

He nodded, his eyes watering behind the broken glasses.

“When kids hurt this much, there is usually a reason,” I said. “You know, this is a clinic just like any other doctor’s office. We are
real doctors and nurses. That means we maintain confidentiality. But I’m also what they call a mandated reporter. That means if you tell me you are going to hurt someone or hurt yourself, I have to report that.”

“What if someone hurt me?” he asked.

“That depends on when it happened.”

He nodded.

I touched his arm very briefly. “Why don’t you tell me, and we will figure it out together?”

“I’m scared a lot.”

“Why?”

“I don’t have anyplace to go. I keep getting beat up.”

“How about your home? Your mom?”

“My stepdad kicked me out. He was always beating on me anyhow. You can call him. I don’t care. He’s just going to tell you he doesn’t want me around.” He willingly gave me the number.

“OK. We’re going to get you help. In the meantime I want you to sign a contract with me not to cut yourself. If you feel like cutting yourself, I want you to call us. I’m going to give you our phone numbers.”

He wiped his eyes. “How about that nurse?”

I smiled. “Jan would love to see you. Did you know she’s one of the top BMX racers in the country? You should ask her about that sometime. She’ll love it.”

“Really?” He looked surprised. “I used to motocross … a long time ago.”

“Ask her about it. She’s got medals and the whole nine yards.”

Before he left, Jan had set him up with an appointment with an optometrist for new glasses and another appointment at a dental clinic for the homeless that primarily handled emergency cases. I had taken a full set of labs, testing for everything from HIV to hepatitis, and given him a ten-day supply of Keflex, the antibiotic. He had three new pairs of socks, new running shoes, and a pair of flip-flops to wear while the foot infection healed. He opened up his backpack to put in the extra shoes and medications. The backpack was almost empty. There was a crumpled shirt in the bottom.
He carefully took out an old and creased photograph. “This was my dad.” I saw a bigger version of the boy, a ruddy-faced blond-haired man sitting on a couch. “He died when I was five. He got killed by a drunk driver.” He carefully slid the photograph into the now-bulging backpack. For a moment his face was transformed by anger. “Then my mom marries a drunk. Go figure.”

“You’re not out of here yet,” I said. “I’m calling a shelter program I know about called HomeBase. They serve young adults and teenagers. It’s a great program.”

“You mean I can go there today?”

“Yes, I hope today.”

I glanced at my watch. Almost two hours had passed since the boy had shown up. For once I felt I had done it almost right. The boy was relaxed, happy. I watched him joke with Jan up front as we finished. It was instructive for me to watch how she handled the teenagers. Instead of reacting negatively to her firm and take-charge tone they seemed to eat it up. I can learn something here, I thought, watching Jan. She was very authoritative, and the teenagers seemed to bend over backward to please her. The two of them went off, chatting like crazy about motocross racing. When he was gone, I called the number he had given me for his home. A gruff voice answered the phone: “Yeah?” I identified myself and told the man why I was calling. His stepson was a minor and had seen me for medical care. I wanted to know about the possibility of his returning home. “Oh, yeah?” the stepfather said. “Tell that little asshole not to bother coming back.”

I recoiled. “Why?”

“Little shit called the cops on me.”

I listened to the man rage drunkenly for several minutes, threatening to do worse than he had done, he said. I was unable to get a word in edgewise. Finally I hung up. I decided to try again, later, to reach the boy’s mother. As much as I believed in keeping families together, I realized there were times when it wasn’t going to happen. Some of these kids were never going home. What future they had depended on what they discovered, or didn’t discover, on the streets.