Ask Me Why I Hurt (5 page)

“Amy?” She was barely awake. “Sorry that took so long.” I
crawled into bed, wearing my pajamas, my breath clean. I curled against her back. I smelled her clean damp hair, and I felt a lot better.

The next few days were a firestorm of activity. We ordered many of the supplies we had found ourselves needing, including clipboards. At home I began regularly running problems by Amy. She immediately had an answer to the laundry problem: disposable paper gowns. It was a genius thought, and I ordered them immediately.

Jan was busy creating new intake forms. She had reviewed dozens on the Internet and found none to her liking. Not one, she told me, was appropriate for a homeless child. There were intake forms for regular children, the kind that parents fill out, and there were forms for adults. But none was for an unaccompanied teenager. So she was making her own. One morning I went into our offices at HomeBase and found ten different samples waiting on my rickety swivel chair. “What do you think of this one?” Jan asked, handing me a form. At the top was a place for the kid’s name. The first question was, “Where are you currently living?” Under the answer section the choices read: “Street,” “Shelter,” “Friends,” and so on. The second question was, “How long have you been homeless?” On down the list the questions went, from abuse at home to depression and suicide attempts.

“This is great,” I said.

“Can we use them?” she asked.

I thought for a moment. “Sure. But let’s run them by administration first.”

Jan frowned a little but didn’t say anything. It occurred to me that I was used to working with bureaucracies while Jan was not. I didn’t want to upset anyone in administration by using intake forms it had not approved. The van was considered a clinic under the Phoenix Children’s Hospital; the administration was
essentially our boss, I felt, and we needed to follow its rules and regulations.

Before I knew it, we were parked again in Tempe. A week had passed since our first visit. I was hoping to see the girl with the cherub’s face, but she didn’t appear, and when I asked the other kids, no one seemed to know who she was or where she had gone. The kids came all day, in dusty waves. They came with uncontrolled asthma, injuries from fights, broken teeth and noses, tooth abscesses, old scars from beatings, and long lists of symptoms that sometimes began in early childhood. I was already learning that this would be a typical day. None of the kids came with easy solutions either. As soon as I treated one symptom, a child would nonchalantly mention another. “I’ve had this bad cough now for months,” he or she would say, or, “My tummy hurts all the time.” Under it all was a desperate need for help: for shelter, housing, a search for relatives or friends to take the child in. But at least today I felt the day was going better. Jan had the kids organized and the new intake forms made care much easier. Jan was seeing as many patients as I was, or even more. We dashed in and out of the rooms, calling names.

The day whizzed by. My last patient left, carrying a new inhaler. It had to be close to quitting time, I hoped. I stretched my back and looked at my watch. It was past eight, and I was starving. I hadn’t eaten all day, let alone taken a break. I stepped outside the van to take a breather. Dusk was falling. The heat was still a heavy mantle over my shoulders. Fresh sweat trickled down my back.

That was when I saw her. She was sitting in one of the lawn chairs outside, as if waiting for someone to notice that she was there. I hoped she hadn’t been waiting the whole day. I grabbed a bottle of water and took it to her.

She was slender and waiflike, almost ethereal. She had dark hair cut in elfin wisps around her face. She was far too pale for Arizona, a porcelain girl in the desert heat. Her jeans were stained, and the hems dragged in the dust. Thin adolescent shoulders jutted out from her T-shirt. She was just sitting there, slumped in her chair, looking exhausted. Her arms seemed immobilized from
weariness, almost dead in her lap. I noticed she wore something on one wrist, a bracelet.

I sat in the chair next to her.

“I’m Dr. Christensen,” I said. “What’s your name?”

The moment stretched out. Finally she answered. “Mary.” It was a small and unimportant voice, the voice of a girl who has learned how to be forgotten.

She took the bottle of water, reaching in slow motion. The bracelet swayed. The pockets of her jeans were pouched and grimy, and her fingernails were dirty. She obviously needed a bath and a change of clothes. She slumped back in her chair as if I weren’t there. The sun was setting, and the sky was aflame in streaks of magenta and orange, while the red stone mountains stood in sharp relief. The smell of citrus from ornamental orange bushes was heavy and florid, a thick perfume. In other places of the city people would be getting ready for dinner. They would be having meals in air-conditioned restaurants and later strolling in cool malls where fountains tinkled. Tempe was such a beautiful city, crowned with tall palm trees and rimmed with red mountains. Yet even here, like everywhere else, there were children like Mary.

I sat next to her for a moment, making conversation, trying to help her feel comfortable. I sensed a fear about her, and I worried she might bolt. She sat with her hands loosely folded in her lap. We watched as a group of kids played hacky sack outside the van against a backdrop of the setting sun. Even in one-hundred-degree heat they would play, stopping every now and then to pant. Jan came out with several water bottles and left them on a chair for the kids.

In that crystalline moment, my eyes dropped to Mary’s wrist. It was very thin and white, and I could see the tender knob of the ulna bone. The bracelet, made of large letter beads strung together into a sentence, was large and conspicuous.

I read the beads she had strung together. It took me a moment to absorb what they said:

For a moment I was so caught off guard I thought my heart had stopped. My breath caught. I wanted to ask her what painful memories had left their mark so deep that she needed to wear this naked plea around her wrist. But she suddenly turned to me with a look as if to say, “Don’t ask. Not yet.” Her eyes were dark.

I saw Jan poke her head back out of the van. She was looking at us. “You’re next, honey,” she called, smiling at Mary.

“Let’s get you taken care of,” I said to her, and the words I had often spoken to children as a doctor now seemed to have special meaning. I stopped at the van steps and let her go first. I watched her as she entered the exam room and slowly climbed on the table. I watched her breathing rate and how she spoke, to see if she showed signs of a condition like asthma. I watched her eye movements, mouth, head, and neck to evaluate what we call the twelve cranial nerves, or the main nerves of the head. I observed her skin color, which can give clues to problems like anemia. From the way she moved it appeared she had good muscle function, but she also moved slowly, as if depressed. I wished at that moment I had a psychiatrist on board. Even in our first week we had seen kids with mental health issues. Some had been outright delusional or suicidal. I felt poorly equipped to deal with these problems.

I fell into the doctor role, smiling and calmly explaining the physical as I went. First I checked her eyes and ears and the lymph nodes of her neck and head. I listened to her heart and lungs. “Can you lie down?” I asked, and she reclined slowly and, I thought, suspiciously. I felt her abdomen for liver, spleen, and masses. She looked away, tuning me out. She kept her head turned. Her body was tense when I touched her. I couldn’t tell if it was because she had pain or because she was emotionally uncomfortable. “Does that hurt?” I asked as I gently felt her liver area. She gave a quick shake no. She doesn’t want me to touch her body, I thought, and quickly finished.

I stood back. Mary’s general physical health seemed good. She was slightly malnourished. She had a lot of scrapes and bruises.

“How old are you, Mary?”

There was a very long silence. “I don’t know,” she whispered.

I stopped when I heard that. She had spoken so softly. Instantly I felt my own voice soften.

“Don’t you remember when you were born?”

She didn’t answer. The blank quality to her face gave her a strangely ageless look, like a blurred photograph. She could have been eighteen. She could have been younger.

“What’s your last name?”

She turned her head away and looked out the exam room window, to where dusk was falling rapidly. The sunset had tinged the blinds orange and purple. It was as if a curtain had fallen over her features. She tucked her hands inside her legs. I felt a sudden, completely unexpected flood of emotion. Maybe it was the lack of animation in her face and the emptiness and despair it suggested. Maybe it was the slightness of her body and how young and vulnerable she seemed. I had come for this, but the reality was not what I had expected. It hit me in my gut. This child had no home. She would not bounce off my table and return to the loving smile of a mother or father. She would leave my van—for what? What was waiting for Mary outside on the streets?

In that moment I thought of my little sister Stephanie. I remembered one Christmas when Stephanie was about three. Wearing a Christmas red smock, she was sitting in a tiny chair under our fake white tree. I was standing by her, proud to be a big brother. The memory was as bright as a snapshot. Then another came: Stephanie, diagnosed with multiple sclerosis, rising from her hospital bed in a Christmas red nightgown, leaning on a walker. As the doctor in the family I was the one who broke the news to my sister and helped in her treatment. Mary reminded me of Stephanie in some way. Maybe it was the sense of vulnerability about her, the feeling that under this blank exterior a real girl was hiding.

“Do you have a place to sleep, Mary?”

“Sure,” she said. Her eyes slowly moved toward mine.

“Couch surfing?”

There was no answer.

“Do you have any identification, Mary?” She shook her head no and gestured toward her grimy jeans pockets, as if to turn them inside out. I had discovered in the past week, much to my shock and frustration, how much identification mattered. Identification was the key to unlocking so many services, from housing to employment to education. Yet very few of the kids had identification. Why would they? I thought. Not many homeless children are going to have driver’s licenses. It was a major stumbling block for getting help.

Mary got up as if to leave. I wanted to talk her into staying, but I felt if I pressured her, she would bolt for good. Outside the exam room I heard voices. Jan was dealing with a new group of freshly arrived kids, telling them we needed to close down the van for the night. She was telling them we would be back at this site next week, that tomorrow we would be in Phoenix. There was a chorus of complaints.

I looked again at the intake form Jan had filed out. Mary had answered few of her questions. “Says she has a headache,” Jan had written, with a question mark after it. That was our new code for suggesting that maybe the kid was using one complaint to get help for another problem.

I gave her some Tylenol. She smiled at me for the first time, a shy smile that she almost immediately hid behind her lips.

“Can I make some calls for you, Mary? Is there anyone in your family—”

She looked alarmed, shook her head rapidly, and began edging toward the door. For the first time I saw panic on her face.

“Hold on,” I told Mary.

I got her a pair of fresh socks and a hygiene kit, which contained a toothbrush and soap, as well as bus tickets and brochures for help. I handed this to her up front.

“Come back please,” I told her.

For a moment she stood there, and in the final vestiges of sunset I again thought of my sister. Could Stephanie have survived on the streets? I knew the answer: of course not.

Jan and I watched Mary walk off toward Mill Avenue. She was small and slender under the large dark sky. She looked no bigger than a child and walked quickly, as if afraid of the coming night. She carried the bag with supplies under one arm. I didn’t want to think of what awaited her on those streets.

“She’s just a baby,” Jan murmured.

I nodded.

“What’s her name again?”

“She said it was Mary.”

“That’s right. She didn’t really have a headache, did she?”

I shook my head, “I don’t think so. I think what is wrong with Mary is much worse,” I said. “But I can’t say what it is. She wouldn’t talk to me.”

Jan nodded. “If only headaches were the only problem these kids had.”

Night was falling, driving a final sweep of colors across the sky. Soon the stars would come: bright desert stars. The streets had fallen into that peculiar desert silence, permeated with clicks and buzzes and insect sounds, yet seeming utterly still. Mary’s figure retreated until it was just a small shape, and then she turned a corner and was gone. From down Mill Avenue came the faint hoot of music from a bar, and in the distance there was a sudden blast of a car horn. I felt a tremendous guilt. If I could, I thought, I would lock her up to keep her safe. I looked at the stars and made a fervent wish that Mary would travel safely into the next day.