Ask Me Why I Hurt (28 page)

I took Nicole inside to an exam room. I didn’t get far in questioning her. She simply stared off in the distance. She sat on the edge of the table. Her long arms were limp. There was something yellow, dried mustard perhaps, smeared around her mouth.

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

She didn’t respond. I was not a psychiatrist, but I thought I was looking at psychosis. Then all of a sudden a light flashed in her eyes. She smiled and giggled behind a dirty closed fist. “My name’s Rebecca.”

“Rebecca. Pleased to meet you.”

She held her hand out briefly and then snapped it back. The giggle came again. She looked coyly up from under her lashes. She pulled a lock of her hair.

“My stepdaddy calls me Becca.” There was another twirl of hair.

“That’s nice.”

“Sometimes he calls me Cupcake.”

She made a quick, girlish gesture by folding her legs up, so her feet were almost tucked under her. I was about to ask her what had brought her to the van when the gesture caught my eye. I knew what I wanted to ask first, her age. She smiled a smile that almost made me believe she was gap-toothed and in second grade, though I knew she had adult teeth.

“I’m eight,” she said proudly. “I just had my birthday too.”

“What can I do for you, Becca?”

“I got an owie.” She showed me a tiny mark on her wrist.

“Would you like a Band-Aid?”

She gave the same little-girl smile. There was dried food on her chin and mats in her hair. I pulled out a box of Band-Aids. We kept Disney ones for the little babies we saw at the domestic violence shelter. She looked delighted. She patted the Band-Aid on her wrist.

“Do you have any medicine?” she asked.

“Like aspirin?”

“I’m too young for aspirin, silly.”

“How about some Tylenol?” The conversation was surreal. The longer I talked, the more convinced I became that Nicole was eight. If it was an act, it was pitch perfect.

I got out a sample of Tylenol pills. She shook her head, her eyes wide. “I don’t like pills.” Without saying anything I put it away and found some liquid baby Tylenol. Now her face split into a smile. I poured the red liquid in the measuring cup for her. She drank it
daintily. When she was done, I gently cleaned the dried food off her chin with a wet wipe.

“Where are you from, Becca?”

Suddenly the blank look returned. I waited for a long time. She just looked vacant.

“How did you get to Phoenix? Do you live around here?”

Then she smiled at me, again a little girl.

“I’d like to give you an exam,” I said. She shook her head rapidly. The little girl was back.

“Oh, no. My mommy told me not to take my clothes off for strangers.”

“She honestly seemed to believe she is eight years old,” I told the team at our next-morning meeting at our HomeBase offices. We were now regularly meeting to go over our patients, and budget and other issues, though we all still dashed out to the van as soon as the meetings were over. Wendy and Michelle said the smell of the offices made them sick, and I knew the air aggravated Michelle’s asthma.

“What happened when you asked for her history?” Wendy asked.

“All of a sudden she lapsed back into that nearly catatonic character,” I said. “I wasn’t able to get any information from her at all.”

“Do you think she is really multiple personality?” Jan interrupted.

“I don’t know enough to say,” I replied slowly. I tapped my hand on her file. “Only a psychiatrist can tell us that. Which is why we really could use one on board.”

Jan pointed out that we’d never be able to afford it.

“I know. But the longer we do this, the more I think it’s what we really need. We see so many kids with depression, bipolar, or the onset of schizophrenia. We are not equipped to diagnose or treat them. Heck, we can’t even afford to keep medications for
them on board.” Jan nodded in understanding. We had realized early on that we simply could not afford to stock medications for the mentally ill youth. A month’s supply of a common medication for schizophrenia could cost nine hundred dollars. Often teens came to us with empty bottles, pleading for their psychiatric meds. We had none, and if they had no insurance, there was no way they could get their prescriptions filled. It was a situation that made me angry every time we dealt with it, which was sometimes several times a day. We had a few pills for emergency use only, and that was for kids with existing diagnoses.

“Can we even get her to a psychiatrist for an evaluation?” Jan asked.

“You can try,” I said hopefully.

“I’m on it,” Wendy said.

“In the meantime what do we call her?”

Wendy spoke up. “The other kids called her Nicole.”

“Good enough for now,” I said.

The next morning I stopped again at the HomeBase offices. My own desk was a mess. Jan’s desk was surrounded by a huge collection of training manuals and medical documents. I swore she kept every training manual from every conference she had ever attended. Michelle’s desk was quiet and orderly just like her. Wendy’s desk was surrounded by empty water bottles. Wendy was the queen of recycling and would even scout our trashcans for water bottles. I was sometimes tempted to leave some in my trash with notes just to tease her.

I could hear Wendy on the phone. “How do I get her to see a psychiatrist?” There was a silence. “No, I understand you won’t do that. I just want to understand how it works.… OK.” There was a scratch of a pen. “So you’re saying first we have to get her on the state Medicaid insurance.… I know she needs valid identification.” There was another scratch of the pen. “I understand. But here’s the problem. This girl is too delusional to even tell us her name. Obviously I need to get her evaluated and medicated. But I can’t get her evaluated without identification. You see the catch-22.”

Wendy was quiet for a moment, listening. I heard her lower her voice. “I know you didn’t invent the system.… OK. But what if the child is too delusional or psychotic to cooperate?” There was a pause. “I understand you can’t help until she has identification. Once she gets the identification she still has to sign up in person. Then what happens? She has to request the provider? … OK. Which one offers mental health services?” Another scratch. “So you are saying that none of the providers offers mental health. So even if she gets on the insurance, how can she see a psychiatrist then?”

The pen scratched. “OK. So you’re saying that
after
she gets on the insurance, she needs to enroll in the mental health program. Then she needs an intake assessment. Then can she see someone? … Oh. She has to find a psychiatrist who will accept the insurance. Can you give me an idea of how many do? … Oh, my. No, I understand. So from start to finish, how long will it honestly take before she sees a psychiatrist, provided we can get her identification?” The pen wrote and then paused. “Wow. No, I understand.… OK.” I heard the phone go back in its cradle. Wendy sighed. “Six months to a year.” I heard her whisper to herself. There was the sound of phone keys being punched. “On hold,” I heard her mutter to herself. Twenty minutes later she was still on hold. I heard her tapping her pen.

I left for a meeting and returned an hour later. I walked by Wendy’s cubicle to check in. She was still on the phone. Her face was a tight, frustrated mask. She had a notepad filled with angry doodles. I left to take the van out for a quick visit to the domestic violence shelter. When I came back that night, I found a note on my computer. “Sorry, Randy, still working on it.”

Driving home that night, I decided to call my sister. The truck had turned into my de facto time to make calls. With the kids at home to take care of, it was becoming harder to keep on top of
Stephanie’s medical issues. I felt guilty because I knew she was having more trouble with her MS. It had been flaring up. “I’m using a walker now,” she said. “But no way am I going to be in a wheelchair. I’ve got two crazy boys to keep up with.” Stephanie and Curtis had two beautiful boys named Matthew and Trevor, both blond-haired, bright-eyed, and full of happy intelligence.

“That’s the spirit,” I said. It was hard to think of her limited mobility when I remembered how carefree and energetic she had been as a child.

“Have you talked to Mom lately?” she asked.

“Yesterday. I was planning on calling her tonight.”

“Dad says she’s not feeling very good.” I opened the front door to the sound of shouting and crying. Amy had one crying child, Charlotte, in her arms, and the twins were wrestling on the living room floor. Charlotte was now eighteen months old, and the twins were four years old and in preschool. Amy turned to me and saw I was on the phone. She looked tired.

“I know,” I said. Both Stephanie and I were in close touch with our parents, often speaking to them daily.

“Her pains are getting worse.”

My mother had started having symptoms of colon cancer when I was in the third year of my residency. Then, two weeks before my wedding, I got a call from her doctor. He told me that Mom had colon cancer. I was floored when her doctor asked me to be the one to give her the news; his request was incredibly unprofessional. If he is this inept, I thought, I
should
be the one to tell Mom. The news was devastating. I knew as a doctor that her prognosis was not good. She needed surgery and chemotherapy if she was going to have a shot at remission. I vowed to keep this knowledge to myself. The first thing my mom said was, “I don’t want to miss your wedding.” She insisted on waiting until the wedding was over for her surgery and treatment.

A few weeks later Amy and I went on our honeymoon. We kept telling each other how wonderful it was not to hear anything about the surgery, because no news was good news. I even expressed the
naive hope that my mom would be one of the “lucky ones.” It didn’t occur to me that my dad and she would wait with the news. For the first time my parents hid information from me. The cancer had metastasized. For six months she did chemotherapy and eventually seemed to be in remission. But there were complications wrought by the radiation. Mom was often weak and in severe pain. We all had learned to live with her illness as a family, just as we were learning to cope with Stephanie’s MS. But it was never easy.

“Dad says her intestines are having trouble absorbing nutrients,” Stephanie said.

“She had a lot of chemo,” I said. I had been hoping this alone was the cause of the increased pain. “That can lead to scarring and kidney damage.”

“Are you going for Sunday supper?”

“We’re planning on it. When is your next doctor visit?”

When I finally got off the phone, I glanced at my watch. I was surprised to see it was past ten. I checked on the kids. Charlotte was conked out in her little bed, but Reed and Janie were still awake in their beds. I quietly encouraged them to go to sleep. I walked back out, and Amy was at the counter, making a shopping list. I reminded myself she was putting in her own long hours, as well as doing most of the child rearing, and we had three children under age five.

“Do you mind going to visit my parents this Sunday?” I asked.

“No. That’s what we usually do,” she said, crossing out “pot roast” and writing “chicken” with a question mark after it.

“My mom’s stomach pain is getting worse.”

“I don’t want your mom to feel she has to cook. We’ll make a casserole.”

That Sunday Mom looked drawn. I didn’t want her to think I was worried, but in truth I was. Maybe the cancer was back. Her face had the tight look of someone in pain, and she walked slowly. Dad spoke to me quietly. “We’ll have to just keep trying to figure out why the pain is getting worse. We’ve got another appointment in a few weeks.”