Ask Me Why I Hurt (13 page)

Over the next several weeks Donald came by the van regularly. He was still staying with Pastor Richardson, who genuinely seemed to like him. It was clear to everyone that Donald had some kind of impairment or brain damage, but we still had no idea why. We were making headway on his case, though. Pastor Richardson was taking him to HomeBase, and a staff member was working with him on getting identification. The immediate and pressing problem turned out to be his teeth. Donald was having lots of trouble eating, and his pain grew worse by the day. Like all homeless
kids, he had no dental insurance and no way to pay for any dental care, let alone the money involved with getting his shattered teeth pulled and dentures made. I called a doctor I knew who provided emergency dental care to the poor.

“We’ve got a long wait list,” he said. “But this boy sounds like he needs help now. Have someone bring him by tomorrow.”

“Tomorrow is Saturday.”

“Tomorrow.” And that was that.

Later Pastor Richardson brought Donald by the van to say hello. Donald came running up, grinning with a row of even new white teeth. “I can eat anything with these!” Donald said.

“And how,” Pastor Richardson added dryly.

I was telling him how as a teenager I could put away an entire pan of enchiladas when Jan came into the van. She was suggesting a place that gave out food boxes to the pastor that he could use to feed Donald. But Pastor Richardson shook his head. “Someone else can use that more. It doesn’t take that much to feed a boy.”

“It’s expensive, though,” I said.

“True enough. But my wife can make some good beans and rice.”

Donald grinned. “Those are good. But not with Tabasco,” he said. “Yuck. I hate Tabasco.”

I thought about Pastor Richardson often. I saw kids who were homeless because their families were fragmented, destitute, traveling from one crime-ridden apartment to another, ravaged by domestic violence and drug abuse. They lived in isolation. By the time the kids took off by themselves, they’d lost contact with anyone who cared. Pastor Richardson, on the other hand, had a home to offer and a strong community. In his house there were cupboards with food and a stove to cook it on. There were relatives around and neighbors and a whole churchful of people to help out. If the stove broke, someone would have the tools to fix it. If his wife got sick, someone would be able to bring by a few dishes. A whole broken system could fail a child, but one solid family, or even one solid person, could save him.

Amy gave her hair one final brush and adjusted her skirt. It was Halloween, and HomeBase was having a pumpkin-carving party at its shelter. It wasn’t far from the drop-in center where we had our offices and parked the van. The agency had converted a nearby house into a long-term home for homeless kids. Downstairs there was a kitchen and a dining room with cafeteria tables and a small community area for the kids to hang out in. A scuffed pool table stood off to one side, along with a bookshelf laden with well-read novels and skateboard magazines. Upstairs there were small rooms where the kids stayed. Each had a single bed and a dresser. A staff member was always on hand to act as a parent figure. To stay at HomeBase, you had to follow the rules. No drugs, alcohol, or sexual relationships were allowed.

A skinny, nervous blond boy in glasses came trotting up to me as soon as we walked in the door. “Dr. Randy! Remember me?” he asked. I almost didn’t recognize him. It was Matthew, the boy who had been cutting himself. He looked completely different in his new glasses. The trench coat and the boots were gone. No more fear in his eyes.

“I’m in the work program here,” he said. “I’m getting a job in construction. How is Jan doing? Is she still racing?” He began asking tons of excited questions. We caught up for a few minutes as the smell of food filled the air.

“Guess what’s for dessert?” he asked.

Amy laughed. “Pumpkin?”

The staff had set out several folding tables in the downstairs area and spread them with newspapers. The donated pumpkins all were off size and lumpy. But the teenagers didn’t care. They were rooting out the seeds and laughing as they pulled at the gooey insides. Soon they were behaving like five-year-olds, laughing and throwing pumpkin seeds at one another. It reminded me
of holiday times with my own family, when something as simple as a pumpkin and an old carving knife could make a memory.

Sitting at the end of one table was Donald. His blue eyes were alive. Amy and I walked over.

“Have you decided what to carve yet?” I asked.

“Dr. Randy! Pastor Richardson said you might be here.”

I introduced Amy. Donald took her hand with a blush. “She’s pretty,” he said to me in a loud stage whisper. We sat down.

“What are you doing here?” I asked.

“Making a pumpkin,” he answered innocently.

“I meant, are you staying here now? Instead of with Pastor Richardson?”

His eyes widened. “Oh, no. I’m taking classes here. They’re teaching me how to read. The pastor will be back.” He paused with uncertainty. “He promised.”

“I’m sure he will.”

Reassured, Donald relaxed again. I helped him draw the eyes and nose and mouth with a marker pen. He wanted to do the carving himself. He held the knife with surprising dexterity, and I thought he would make a fine artist or sculptor or carpenter. When he was done, he proudly showed his work to the staff.

“My first pumpkin,” he told me.

A few days later I had just finished giving a tour of the van to a local magazine writer. We had gotten some media interest. Jan said this was good because if people read about the van, they might want to donate a few dollars. I agreed, though I got tongue-tied and overly emotional during the interview, trying to tell the reporter how important medical care for homeless kids was and how much they deserved help. Talking about the kids and their needs, I felt tears come to my eyes. The minute the reporter left Jan was at my side. Her face was friendly but firm.

“Randy, let’s talk.”

“OK, what’s up?” I sat down heavily in the driver’s seat. Jan remained standing, holding lightly onto the back of the passenger seat.

“I’ve asked you before not to refer to me as my ‘nurse-practitioner.’ ”

“You have?” I looked around for something to eat. I had again let the day pass without eating. I was famished. “A hamburger sounds so good,” I said. “With bacon. And cheese.” I patted my growling tummy.

“Randy, this is important. I want you to listen.”

I didn’t see what the problem was. My face probably showed it.

“My name is Jan Putnam. My name is not My Nurse-Practitioner.”

“But that’s your title.”

“All right then, the next time we have a reporter here, I’ll introduce you as My Doctor.”

“But I’m not your doctor—oh.” I saw her point. “I thought I was being respectful,” I said. “Not everyone understands what
nurse-practitioner
means and that you have a lot of responsibility. Most people think a nurse is just a nurse.”

Jan looked conciliatory. “I’d much rather have you introduce me by my name. You could say, ‘This is Jan Putnam. She is our nurse-practitioner.’ ”

I still wasn’t sure of the difference, but I appreciated her thoughtful explanation. She touched my arm. “Friends?”

“Friends. Now, you know what sounds really good, Jan Putnam, nurse-practitioner? Mexican. A huge plate of enchiladas covered with cheese. And some beans on the side. Plus some guacamole.”

“Randy, you’re always forgetting to eat and then getting hopped up about food. You’re going to make me fat just listening to you.”

I missed Jan on the days when I took the van out alone. Since there were only two of us, Jan and I had decided it would be more productive to take the van out separately as well as together. Since I still spent many days at the hospital, this freed us both up to reach more kids. We were getting more interns, and we also had the two staff members from HomeBase, Wendy and Michelle Ray, but it wasn’t the same, I told myself, on the days without Jan. I had come to depend on Jan more than she probably knew. In addition to being a nurse, she was my role model. I often looked to her to see how she handled surly or reluctant teenagers.

Because we could now have two teams, we were trying new sites. On this day I decided to park the van in a new place. It was in an area of Phoenix known for gang activity and prostitution. I had Wendy with me. Wendy was blond and strikingly pretty. She was also whip smart and good with the kids. At HomeBase she and Michelle been great at getting kids their identifications. But she wasn’t a nurse, and for the first time I found myself doing Jan’s nursing work as well as my own. It was turning out to be a lot harder than I had thought. Jan was an accomplished nurse who seemed to have the complex world of immunization schedules and blood draws memorized. Different immunizations had to be injected in different places, in different ways, and there were extremely complicated schedules that had to be followed on the order and timing of the shots. I soon felt I was floundering. I had to keep calling Jan. “Is the MMR shot intramuscular?” I asked.

She coughed in alarm. “Randy! Subcutaneous. Under the fat. Do you want me to come in?”

I told her I was fine, even though I wasn’t feeling fine. I was glad to have the phone to connect with Jan and others. Even with other staff or volunteers around, there was a feeling of isolation on the van that was unlike anything I had experienced. In a hospital every emergency decision I made was as part of a team, supervised by others, with plenty of help and advice and support. On the van I often had to play nurse, case manager, counselor, and emergency physician, all rolled into one. There was no one to ask
for advice or share the responsibilities, and only the phone and computer kept me connected with other doctors and nurses.

The new location turned out to be a good choice, as far as reaching homeless kids went. I soon had a line of kids waiting to be seen. Wendy helped the kids fill out their intake forms. “Where do you live?” I asked one African American girl, as she shyly tugged the back of her shirt over too-tight jeans. Like many of the other kids waiting, she had the obesity that comes from poverty. She had come in for an untreated urinary tract infection. She was fifteen. “I’m staying with a friend of my cousin’s,” she said. “Can I still come here? ’Cause I’m not like homeless.”

“You can come here,” I said.

“I’m not like some street bum or something. I got friends.”

“Where are your parents?”

“My mom went to Texas to see if she could get a job. She’s a good mom. She just can’t get work around here. She left me at my cousin’s so I could finish high school. But he lost his job and got evicted. So now I’m staying with his friend.”

“Where’s that?” I asked, taking chart notes.

“This hotel room.”

“How many people are staying there?”

“Um, there’s my cousin’s friend. He’s got work. He’s a food stocker at Bashes’. Then his girlfriend, her kids—she’s got one with that autism—and a few others like me that ain’t got no other place to be. So there’s like six of us. He’s worried we’re gonna get caught and get evicted. It’s just one room. It ain’t got a stove or nothing.”