Ask Me Why I Hurt (15 page)

“Puppy breath,” she said with a grimace, and the kids laughed.

Amy and I took Ginger home. She was so tired she fell asleep in Amy’s lap on the drive, almost as if she had known she was finally in a safe place. It was similar to the homeless kids like Mary and Donald, I thought. Once they were in a safe place they blossomed. Once we got home I let Ginger on the bed. “She’s so tired. Just this once,” I told Amy.

“Oh, boy,” she replied. “I can already tell you are going to spoil your own kids.”

“Randy, is this a good time?” Jan asked in our offices at HomeBase a few days later. We were still teaming on the van when we could, while other times we took separate times out. Jan often took the van out with volunteers and interns while I was caught up in administrative duties like grant writing or my hospital work. I tried
to do much of my paperwork in my hospital office, since our quarters at HomeBase were less hospitable.

“Sure, what’s up?” I asked, hanging my stethoscope over my chair. I studied a new water stain on the ceiling that was ominously above my desk. I hoped the ceiling wasn’t going to fall on my computer.

“Did you hear? A young man in Phoenix died the other day from tuberculous meningitis.” Her face was sober.

“I heard,” I said, cautiously taking my chair and giving it a test swivel. One of the arms had a way of dropping off.

I felt bad for the young man. Drug-resistant tuberculosis was becoming epidemic among the homeless. This antiquated-sounding disease was making a huge comeback, and it was a killer. It was sad and frustrating. The young man’s death was so unnecessary. But I wasn’t sure why Jan was bringing it up.

The sober expression remained on her face. “I’ve been taking the van out after some of your solo trips. I’ve seen a few of your patients for follow-up too. You’re not giving any of the kids their tuberculosis skin tests.”

My stomach dropped. I immediately felt defensive. For the life of me I couldn’t think of why I hadn’t given the kids this test. My mind raced through all the kids I had recently seen. Jan was right. I hadn’t tested any of them.

“If I didn’t give them the test, then they probably weren’t at risk for tuberculosis,” I heard myself say.

“Randy!” Her voice was suddenly sharp. “You mean to tell me that homeless children, living on the streets, going into shelters, and being thrown in jails are not at risk for tuberculosis? What planet do you live on? If they aren’t at risk, then exactly who is?”

I felt my cheeks color. I felt like a schoolkid caught doing something bad. Part of me thought how dare Jan talk to me like this. But at the same time I realized I was covering for my own mistake. It was a big mistake too. “Tell the truth, Randy,” I told myself. “The truth is you didn’t even think of giving kids the tuberculosis tests. The reason is you’ve had no practice giving it. You blanked it out of your mind because you didn’t feel comfortable giving the test.”
In the hospital it was something the nurses did. Giving a tuberculosis test was a lot harder than it looked. I knew inserting the needle required exact angles, and reading the test was complicated. The idea that I was capable of forgetting something because I didn’t know how to do it, instead of asking for help, disturbed me. What else had I been ignoring?

“Do you need some practice giving the skin test?”

“That might be helpful,” I replied in a low voice.

She gave me a knowing look and went off to fetch a TB syringe and some saline. “Right now?” I asked.

“Sure, right now. No time like the present.” She grinned at me. “You’re the guinea pig. Hold out your arm, and watch how I do it. Then it will be your turn.” Her voice took on a warm, educational tone. “It has to be on the forearm,” she said as she filled the syringe with saline, “and the needle has to be inserted at a ten- to fifteen-degree angle. It should be shallow enough for you to see the needle under the skin. Like this.” She wiped my arm with a swab and delicately inserted the needle under my skin. I watched. “If you go too deep, it won’t work. If you do it right, you get a bubble called a bleb. If there is no bubble, you need to try again. The angle has to be exact.” Sure enough, a little bubble had popped out on my skin. “Now it’s your turn. You can do yourself.”

An hour later my forearm looked like a sieve. I was proud to note where I had made the skin bubble, showing I had done the test successfully. And I never again forgot to give a tuberculosis test.

“Juan is back,” Michelle said, her hands full up front. “Can you get him?”

Juan was a slender Mexican boy with smooth golden skin, shiny black hair, and intense almond-shaped eyes. He had grown up traveling the migrant farmworker route with his family, living in a series of trailers and shacks on farms across the country, often in foul conditions. As a child he didn’t go to school. He labored in
the fields despite laws that are supposed to protect children from such abuses. Eventually times got tough, and he wound up on the streets. “My mom, she got the cancer,” he had told me. “My dad, he worked, but he couldn’t make enough to feed us all. I was the oldest, so I left. I was sixteen.”

Juan was now eighteen. He was a hard worker, but finding a job as an illiterate Mexican was not easy. I asked him how the search for work was going.

“I got a job house painting,” he said in Spanish.

“Muy bueno,”
I said, wishing my Spanish were stronger. I could speak the language well enough from my Mexican mother, but I lacked nuance. And unfortunately, medical terminology often escaped me. My parents had decided not to teach us Spanish when Stephanie and I were little. It was in the days before we knew that learning two languages had many developmental advantages for a young child. At the time parents were actively discouraged from teaching more than one language. My own parents worried I would just be confused and do poorly in school. But because I didn’t learn Spanish until I was older, I was not as fluent as I could have been.

“But that job ended,” Juan continued in Spanish. “The economy, it is hard to find any work.”

“Where are you sleeping?” I asked.

“In this old house. No one lives there. It is cold at night.”

“Juan, how come you don’t stay at one of the adult shelters? You’re eighteen. You could stay at one of the shelters downtown.”

“Dr. Christensen, those are bad places.”

“What do you mean?”

His dark eyes were grave. “Bad things happen there at night.”

“What kinds of things?” I asked, curious. He was the second young person to tell me that some of the adult shelters were bad.

“Bad things, period.” I could tell he didn’t want to tell me more.

“How are your meds?” I asked. Juan handed me an empty bottle. He had been born with a seizure disorder but never had insurance to pay for his phenytoin. I worried. He could easily die from a seizure. “Have you been having seizures?” I asked.

He nodded, looking as if he were somehow at fault. “Even with that medicine,” he said.

I checked his charts. Juan hadn’t been evaluated in years. His dosage probably needed to be adjusted. That was not something I could do. He needed to be seen by a neurologist. Once again I felt slammed against the wall of access to health care. Juan didn’t have identification, and without identification he could never get state insurance and a referral for a neurologist.

“Juan, I’m going to make a call for you, OK?”

I stepped outside the exam room to the front of the van. Michelle was doing an intake with a heavyset girl with short dark hair. The girl had the frightened look of the newly homeless, her eyes huge in her face.

“Dr. Hendin?” I said on my cell. “I have a favor to ask.”

Dr. Barry Hendin was a respected neurologist in the community. He was also my sister’s doctor. Setting Stephanie up with him after her diagnosis was probably the best thing I had done to deal with the disease that had taken my sister from being an active mom to being a woman who couldn’t get up a four-inch curb without help. Dr. Hendin was a warm, Marcus Welby–style doctor who exuded caring and confidence. He was a healer.

“The problem is he doesn’t have any insurance,” I told Dr. Hendin after apologizing for taking up his time. “Our program can help out with costs, I think. He desperately needs an evaluation.”

He interrupted good-naturedly. “Don’t worry. I’ll have my receptionist schedule him next week.”

I felt a surge of gratitude. A lot of people wanted to help homeless kids; they often just weren’t asked. “Thanks. I’ll let you go. I know you’re busy.”

“It’s fine. How’s your sister? I haven’t seen her for a bit.”

“She just got back from Mexico. She was feeling good enough to take our mother. I haven’t seen Stephanie so happy in a long time.”

“Did she take those boys of hers?”

“Yes, and my mom had the time of her life with them. She had wanted to go to Mexico for ages.”

“And your sister’s husband? Curtis, right?”

“He went too.” Curtis had been a rock for Stephanie. He was always there for her and endlessly patient with her MS.

I thanked Dr. Hendin and told him I’d make an appointment for Juan.

A few weeks later Juan dropped by the van. It was early December but as warm as always in Phoenix. Dr. Hendin had evaluated him and adjusted his meds appropriately. His seizures were back under control. Even better, he had found work. “It is roofing. It will be hot under the sun. But I’m used to that.” The dark muscles of his shoulders were a stark contrast to his white tank top. I noticed the tank was white and clean. His clothes looked freshly laundered.

“Did you find a place to live, Juan?”

“One of the guys on the crew, he asked me to stay at his place. He’s a good buddy. Now that I make a little, I can help with rent.” He gave a shier smile. “I met this nice girl too. Her family is from the same part of Michoacán as my family. Her name is Gabriella. She’s going to school and is teaching me English.” I could picture Juan as a husband and father, a good provider, and a contributing member of society.

I congratulated him in Spanish. “It sounds like your life is looking up.”

“No kidding. I still don’t have insurance,” he said apologetically, handing me another empty bottle.

“One step at a time,” I said, examining the dosage that Dr. Hendin had written.

When I saw the pastor leading Donald up to the van, I thought, Now he’s going to ask us to find him a shelter bed. So far the efforts to get Donald identification had been fruitless, so he still couldn’t qualify for any evaluations or services. Without identification he couldn’t even get food stamps. His delays were more
apparent over time; he was taking remedial classes at HomeBase but struggled with reading. As charming as Donald could be, I was sure there were times he was frustrated. I wouldn’t have blamed Pastor Richardson if he had come to a time when he decided he no longer could care for this large, brain-damaged boy.

But to my delight that wasn’t the case. Pastor Richardson spoke. “We dropped by to tell you that the HomeBase shelter is having a little Christmas dinner. Going to be tomorrow, if you can make it.”

“Can you come?” Donald was excited.

“Sure. Amy and I will be there,” I said.