Ask Me Why I Hurt (14 page)

“What do you use for cooking?”

An embarrassed look crossed her shiny face. “We just eat down the street. Plaid Pantry. There ain’t no grocery around here.”

“What do you eat there?”

“Doritos, you know, Subway if we have money.” She smiled. “We buy those top ramens and eat them out of the bag.”

“Do you ever get fresh fruit or vegetables?”

“Sometimes, at school. They got canned pears. When I was a little kid, we used to live in this place with a stove. My mama made
the best dinners.” She yawned and then self-consciously covered her teeth. She looked as if she needed dental care. “I’m tired all the time. It’s two buses to get to school.”

“What grade are you in?”

“Freshman.”

This child, I thought, was one of the hidden homeless. She was not sleeping in doorways, and if you saw her at a bus stop, you would think she was just another girl, a little heavy and probably poor. You wouldn’t know she had no real home. She had no one to supervise her homework, no one to make sure she studied or applied for college, no one to take her to a doctor when she was sick. She also had no income and no parent at home and was relying on the strained generosity of strangers. At the most vulnerable age for any child—her adolescence—she was without guidance. If she were lucky, her mom would call with good news and a bus ticket to Texas within the week. If she were unlucky, she would find herself without any place to stay or would attract the interest of a pimp. I thought of these kids as one couch away from disaster.

“Do you have any extended family around?” I asked.

She bit her lip. “My dad passed away. He had sickle cell. My grandma, she lives in Detroit, but she’s real sick. She’s got diabetes and lost her foot. I got these cousins, but they all out of work.”

By midafternoon I had seen a long line of kids just like her. It was depressing, as if I had stepped into a lake of poverty with ripples spreading around me. As with all new locations, once the word got out a van was parked nearby and offering medical care, there was almost a stampede: toddlers held in the arms of big sisters, cousins holding the hands of cousins, sheepish parents holding crying babies in their arms, hoping for help for medical problems they could not afford to have treated. Wendy did intakes until rings of sweat ruined her yellow Crews’n shirt.

Finally around 7:00 P.M. the onslaught slowed. I didn’t want to check my cell phone to see if Amy had called. If she had, I would feel bad for running late again; I still had my work at the hospital to check. Wendy and I wearily cleaned up the van, wiping the counters with disinfectant, tossing dirty gowns into the waste bags.

Just then a girl swinging her arms came up the steps. She had a head of curly blond ringlets and a huge, sunny, childlike smile. She wore dirty jeans with frayed bell-bottoms and a pink shirt with a picture of the Care Bears on the front. Her body was plump, with a layer of what my mom used to call puppy fat. It made her look endearingly young. Her tanned skin had a gleam. She looked surprisingly healthy. I opened my mouth to tell her I really needed to close for the day.

“Hey there, doctor man. I think I’ve got the clap,” she announced.

I was startled. “Gonorrhea?”

“Yeah, guess so.”

“How did that happen?” I held my stethoscope.

“How do you think it happened?” She giggled.

I was momentarily flustered. “I mean—”

“I got it from a john. At least I don’t
think
it came from a toilet seat.” She gave a streetwise laugh and winked at Wendy, who had enough experience at HomeBase that she didn’t even blink. Instead she just looked at the girl sympathetically. “But hey, you’re the doctor. Maybe you ought to tell me.”

I ushered her to a room. “Call me Sugar,” she said, and hopped onto the table.

“How old are you, Sugar?” I asked.

“Oh, I’m eighteen. We’re always eighteen,” she said with a brazen smile. “Unless you want me to be twelve. A lot of the johns do.”

“No.” I made my face calm, though inwardly I was sickened by what she suggested. “I’m a doctor. I’m here to help you. Do you have identification?” She shook her curls no. I began asking about her history. I knew that as a sexually active adolescent, she needed a comprehensive exam, including a full reproductive exam. She needed her blood drawn, so she could be screened for anemia and HIV. She needed a mental health screening and vaccinations. I explained all those things.

But Sugar just wanted her clap treated. “Just give me the pills, doctor man.”

“I’ll need to examine you before I give out medication. Why do you think you have an STD?”

“You know, it hurts. When I do it.” I made a note in her chart. Dyspareunia, I wrote: pain during sex.

“Would you like a female nurse to do your exam? She’s not here today, but we can schedule you for when she comes back.”

“Naw. You can do it.” To my amazement she hopped off the table and started to take off her pants before I was even out of the room.

“Stop,” I told her firmly. “Wait till I leave, and then put on the gown.” Outside the room I took a deep breath. I felt deeply unnerved. This smiling curly-haired girl made me feel off center. She had such a childlike innocence about her, yet she was forced to prostitute for a living. I went to get Wendy. I asked her to be present as a witness and in case Sugar needed support. “I’m sorry this is such a late day,” I told her.

Wendy just smiled sadly. “I think about what that poor child does to survive,” she said. “I don’t mind.”

In a few moments we knocked. Sugar was waiting impatiently, her rounded feet and calves dangling over the side. She had little feet and tawny skin. The health of her skin surprised me again. Usually, with the homeless, it was stressed and aged. The minute we came in she lay down and stared at the ceiling. She put her feet in the stirrups, and it was as if she had just disappeared, psychically and personally. She was physically there but not emotionally present at all. I remembered what I had read about sexual abuse victims and how they learned to disassociate from their bodies. Reading about it was different from actually dealing with a real child on my exam table, a child who lay there like a defenseless puppet. When I asked her a question, the answer came as if delivered from a distant planet.

I worked carefully and quickly. I wanted to convey only respect and caring for her. Inside I felt a wrenching sadness for the life she led. She had symptoms of common STDs. I excused myself so she could change. When I came back in, she was dressed again. It
was as if her personality had returned with her clothes. The huge friendly smile was back. “Do I have the clap or not, doctor man?” she asked.

“We’ll have the results in about a week,” I told her. She looked disappointed, as if she had wanted me to pull them out of a hat right then and there. “I’d like to get you caught up on your immunizations,” I said, looking at her information. “I also want to give you a vaccination against hepatitis B.” I began to explain that this immunization would help prevent a serious disease. But she cut me short.

“Whatever,” she said. She looked impatient. She’d had her exam. “I’ve got to go,” she said, putting her shoes on over old and dirty socks.

I tried to discuss safe sex. “The johns pay more for bareback,” she said. “A lot more.” My face must have shown my feelings. “It’s good money,” she said defensively.

“It’s death,” I said.

She shrugged as if to say, “That’s life for you, buddy.”

“It’s your health I’m concerned about.”

I tried to give her referrals to shelters. She pushed them away. “I got a place to sleep, most of the time,” she said.

“If you are prostituting for a place to stay, then you are homeless.”

“I’m fine,” she said tersely, as if I were a street-corner preacher ranting about some religion that she was far too wise to believe.

“Why not try a shelter?” I asked. “How can it hurt? I heard there is an adult shelter not far from here.”

“I went to one of those places once.” She shrugged. “It wasn’t good.”

“Tell me about it,” I said, trying to engage her. She shrugged again. “Stay and we will get you services,” I said more forcefully.

But tough love got me precisely nowhere. “Just give me the meds,” she said.

Now I saw flight in her eyes. She was going to dash whether I wanted it or not. I prescribed a one-gram dose of azithromycin
and a two-hundred-fifty-milligram dose of Rocephin for her symptoms of chlamydia and gonorrhea. They were the common STDs afflicting both child and adult prostitutes. A few minutes later she was gone. I went to the van door and watched her cross the street. Fall in Phoenix means the weather can grow cool at night. She had no jacket, no purse, nothing but the bag with her medicine. At the corner she seemed to sense me watching. She turned and waved good-bye, smiling. Wendy had stepped behind me. Her long blond hair moved in a welcome breeze. “Poor girl,” she said.

Later that night, at home, as Amy made last-minute changes to her Thanksgiving menu, I pictured Sugar waiting on a cold curb. I saw the men pulling up. It was a dirty secret of our society. The life of a young prostitute: Sugar, on my table with her soul checked out.

I wanted to talk to Amy about Sugar the way I had wanted to talk about Mary, but once again I hesitated. We had been through so much lately. I felt I was always burdening Amy with sad information and on top of all her own stresses at work. Just the other day she had told me about a child she saw in her practice. His school had kicked him out because he had lice. His parents were too poor to buy the expensive treatment needed, so the boy had missed almost a month of school before Amy managed to get his lice problem fixed. She had been enraged that a child would miss so much school over a fixable problem like lice.

I hesitated, opening my mouth to say something and then closing it. I worried Amy would think I had made a wrong choice. I worried she would get tired of hearing all these sad stories or overwhelmed by the tragedy I dealt with on a daily or even hourly basis. Before I met Amy, I had dated women who seemed intimidated by the life of a doctor. Some had even seemed to frown on my work with the homeless students at Pappas. If those women had known what I dealt with now, they would have run for the hills.

I knew in my heart Amy didn’t feel the same way, but part of me worried that if she knew the scope of the kids’ problems, she might change her mind. Nothing in my life was more important
to me than Amy. If I lost her because of the van, I would never forgive myself.

“What do you think about a ham to go with the turkey this year? We’re having over twenty people,” she said.

“A ham would be good,” I said, bringing her close.

It was the week after Thanksgiving, and Amy was doing her hospital rounds at the Phoenix Children’s Hospital. I dropped by to see her and give her some nice news to brighten her day. “Someone at the HomeBase shelter found a puppy in the Dumpster down the street. They want to know if we want it.”

Amy and I had been looking for a puppy for some time. I wanted a German shepherd. I’d had a white one for a time when I was a kid. Amy said she didn’t care what breed it was, as long as the dog would be good with babies. Amy was too excited to wait. She finished her rounds, and we drove over to the shelter. It wasn’t far. The kids who lived there were crowded around on the front porch. As we walked up, I saw the little thing, lying on a torn-up old towel. Matthew, the skinny blond boy I had treated for the bacterial superinfection on his feet, was on his knees, petting the puppy. The puppy was ginger-colored and shivering, with either fear or exhaustion. “Hey, Dr. Randy,” Matthew said as we came up the steps. “Isn’t this a pretty puppy?”

“The kids were trying to talk us into keeping it,” a staff person said, coming out onto the porch. Some of the kids turned hopefully toward her. “I was telling them the shelter doesn’t have the room or the time or probably even the insurance for a dog.” There was a chorus of protests. “It wouldn’t be best for the puppy,” she added firmly. “She needs a real home,” she said to the kids. They nodded, understanding. Just like all of you, I thought.

“I can keep her,” a tall older boy said. He had a leather jacket adorned with punk rock symbols.

The skinny blond boy frowned at him. “You can’t raise a dog on the streets,” he said.

“Lots of people do,” the tall boy said defensively.

“It wouldn’t be fair to the dog,” the skinny blond boy said. “She deserves better.” He picked the puppy up and held her protectively. “I want her to go to Dr. Randy. And his wife here. They can take better care of her.” He handed the shivering puppy to Amy.

“Thank you,” Amy said, holding the bundle of reddish fur. The puppy licked her face. The kids looked sad for a moment.

“You’ll take good care of her, won’t you?” Matthew asked.

“We will,” Amy said. “Does she have a name yet?”

“We were calling her Ginger,” the brown-haired girl said.

“Well, we already have a cat called Gilligan, and a beta fish named the Professor,” I said. “Maybe we should get a goldfish and call it Mary Ann. Then we can have the whole television show.” Amy rolled her eyes at my dumb humor. The puppy licked her face again.