Ask Me Why I Hurt

Dear Reader,

For many years now I have wanted to tell the stories in this book,
needed
to tell them. But having done so with similar stories in the past, I know the potential consequences. Years ago I introduced a reporter to a young street kid. She was eighteen years old and happily consented to an interview. Her story hit the papers and she was immediately and violently persecuted by some on the street. To this day I am still unsure what grave secret she disclosed. But to some people she knew, her disclosures mattered. I committed myself then to ensuring that such a situation would never arise again.

The stories here are true. The successes and the tragedies are all true. If anything I worry that I have not shed enough light on those dark places where we are all afraid to tread. In order to protect the kids involved, I have changed identifying characteristics such as their names, physical attributes, and identifying diagnoses. These children have already lost so much—the last thing I want is for them to lose their privacy as well. Instead I hope that this book will bring attention to their plight and in some way help to give them a chance at the good life they deserve.

—Randy Christensen

W
hen I first saw him, I could tell he was sick. His face was pale. The look in his eyes was vacant and confused. He held the side of the van wall, looking as if he were on the verge of collapse. His short brown hair was sweat stained. His wide mouth was rimmed in white, and his broad forehead was beaded with sweat.

He was wearing khaki trousers and a blue shirt that had the name of a tool company on the front. His arms were tanned; his face was broad with sun-bleached eyebrows and blue eyes. If I’d walked past him on the street, I would never have known he was homeless. He looked like your typical teenage boy, with an athletic build and a friendly smile, the kind of boy who could have been an all-star athlete or a gifted student or the editor of the school newspaper, if only he hadn’t been sick and homeless. But he was homeless. And the day he came to the van, one late afternoon on a day blistering with heat, he was ready to die.

“Randy.” It was my nurse-practitioner, Jan Putnam.

I had been in one of the van exam rooms, stocking supplies, and at the alarm in her voice I stuck my head out. I could tell immediately he was very ill.

I took three long steps to grab him. He fell limply against my shirt. My heart lurched, and I felt galvanized into action.

“Jan, let’s get him in the back room. We need vitals right away.” But she was already pulling out the equipment. She could always anticipate my thoughts.

The van was a mobile medical unit, as close to a real hospital as possible, if a hospital can be crammed into a Winnebago. The exam room was only feet away, down a tiny hallway. Everything was sparkling clean. I laid him down. He moaned, the paper cover on the exam table crackling under him. The white lights above were bright.

He looked defenseless in his blue shirt, baggy tan pants, and tennis shoes. It seemed like a lot of clothes to be wearing in an Arizona heat wave that was topping 108 degrees. “Tell me how you are feeling,” I said, pulling on gloves.

“Sick, dude.” He opened his bleary blue eyes at me. “Man, I’m tired. I’ve been sleeping now for … days.” His voice trailed off. His skin was flushed, and I could feel the heat coming off him. It was probably from the sun. There was an underlying sweet smell of sickness on him. Sweat rolled down his cheeks, the tops of which were stained bright by fever.

“Sleeping where?” Jan asked, bustling around the exam room.

“Uh, under some bushes. Not far.” He closed his eyes as if dizzy. “I can’t even remember how I got here. Guess I walked.” He made a small choking cough. “Dizzy.”

“Just hang tight,” I said soothingly. “We’re going to take your vitals.”

I started with his temperature. It was a 101—elevated. Maybe it’s heatstroke, I thought. I took his heart rate. It was 112, also only slightly elevated. His blood pressure was next. It was perfectly normal, 110/75.

Confused, I removed the cuff. These were the vitals of a healthy person. This boy was presenting as extremely ill, yet his vitals were almost normal. I leaned over to look into his eyes. The pupils were dilated, outlined with a clear sky blue. His breathing was labored.
His chest rose and fell with effort. What was wrong with him? A hundred thoughts ran through my mind. Maybe it was drugs. Maybe it was the flu. Maybe it was food poisoning. Maybe it was an allergic reaction. No, that didn’t fit.

Back at Phoenix Children’s, the hospital where I worked, there would have been other doctors and nurses and lines of equipment for tests. We would have tackled this boy’s sickness with all the power of an army. I’d have asked his parents everything I needed to know: How long has he been sick? Has he had any other symptoms? What has he eaten lately? Is there a chance he could be on drugs? Does he have any medical conditions?

But I wasn’t in the hospital. I was in a mobile medical unit surrounded by empty lots in the middle of a rough area on the outskirts of town. The only things out here were sandy wastes, boarded-up houses, homeless kids, and the criminals who preyed on them. I was out here in a medical van with a patient I knew nothing about: no history, no known allergies, nothing.

He muttered something. His cheeks were starting to sink. I was watching him decline in front of me in a matter of seconds. His eyes flashed at me. I had seen this look before. It signaled profound distress, crisis. A wave of panic passed through me, and my mind raced. My experience as a doctor told me something was terribly wrong, even if his vital signs were not that abnormal.

I looked over at Jan. She was my BMX-riding, fiery red-haired nurse-practioner who tolerated no cussing, no guff, and certainly no back talk. We had only just started our operation with the van, but already the homeless kids we treated loved her. She was watching the boy with concern and attention.

It came to me. “Let’s do an orthostatic.”

An orthostatic is a different kind of blood pressure test. Because young bodies are so strong, often they can mask the worst illnesses. Their blood vessels are elastic and will adapt and hide even bad infections. A child in the midst of shock can have perfectly normal vitals, which, in medical terms, is called compensated shock. It is something usually encountered only by pediatricians.
The problem is it can last until it is too late. By the time the victim crashes he or she is close to dying. By moving the boy from lying down to sitting up and then to standing up, I could break through his body’s coping mechanisms.

I let him rest a moment. Then Jan helped me lift him to a sitting position. Up close he smelled of unwashed clothes, sweat, and hair that needed a shampoo. His carefully maintained appearance melted away up close, and it was clear now that he was homeless. To me it was the vulnerable smell of despair. He leaned against me in his weakness. When his head rolled against my arms, he felt like a large child in my arms. I helped him to a standing position. He wobbled on his feet.

Then I took his blood pressure again.

It had plummeted within moments.

“Oh, my,” I said.

I took his pulse.

It had suddenly climbed to 150. I could almost see his heart racing in his chest.

“He’s in shock. It’s sepsis,” I said quietly.

My voice was low, but I could hear the stress. The storm was taking place, and I was in the middle of it. Jan knew what those numbers meant. They were the vitals of a patient in severe crisis, a patient whose system was crashing. I could have just as easily said, “He’s dying.”

“Why?” Jan asked softly. The traces of silver in her red hair caught the light.

“Bacteremia, I’m guessing,” I said. A huge blood infection.

I grabbed the stethoscope hanging around my neck and listened to his lungs. I had broken into a sudden sweat, and it was only the years of ingrained training that helped me stay calm. There it was, over the lung fields: a faint crackling like Rice Krispies. I held his wrist. His heart rate was climbing by the second. His body was done compensating. He was crashing. The boy who had weakly stepped into my van just minutes before was now moments from collapse and coma. If I didn’t do something soon, he would die.