The Question

Hers was the first stomach I ever pumped. I stood by the semiconscious teenager’s head and chanted under my breath “In with the good, out with the bad.” The unrelenting light in the Emergency Department hid nothing. With an experienced doctor walking me through it, I had inserted the tube. I snaked it through her nose and ran it all the way down into her stomach. The stomach full of a mishmash of capsules and tablets. Now I was pouring a black slurry of charcoal into the tubing, letting it rest a minute, then drawing her stomach contents out. As I look back, the interaction reminds me of a later patient. The man roused himself during what docs call a “procedure” and asked, “Who convened this satanic coven?” Who, indeed?

Outside the Emergency Department, through the wide doors, other girls gossiped and flirted in the San Francisco dusk. They were enjoying life and looking forward to the future. Not this one. Like most females, she opted for pills in her quest to flee this world, but it was our job that night to thwart her efforts. We were successful. The next day, at morning rounds, tiny pin point red spots dotted her pale brown face, reminders of her violent retching from the night before. But the young woman was alive.

I saw her the following week in the clinic, and she became one of my assigned patients. We were as congenial as possible for a 15-year-old poor city girl and a white lady doc from the corn belt. She was seeing a psychiatrist for her mental health challenges and doing well.

A few weeks after the stomach pumping episode, I was again on call for the Emergency Department. Friday nights always brought a surge in business. Anyone under eighteen was my bailiwick. Teenage mothers, at their wits’ end and frustrated, brought their babies in with rashes, upset stomachs, fevers. At least one or two aimed for the respite hospitalizing their child might offer them. I empathized. Rearing another human is daunting at any age, but for a thirteen-year-old it can be overwhelming. Other youngsters trailed in as the night evolved. Soccer injuries, sore throats, worries and concerns. Finally I had a moment to myself and retreated to the call room.

Rapunzel’s tower room must have been nicer than the call room. Six floors up from the Emergency Department, the cell-like room teetered over the old brick hospital. It dated back to the early 1900s and had the atmosphere of a tenement. My resident’s father had used it forty years earlier when he was an intern. I hoped the sheets had been changed on the narrow bed since then. Beside the cot-like bed, a small sink protruded from the wall, set off by a cracked mirror. Seven years of bad luck. A window with no screens gave wispy bugs entry along with the sound of foghorns. Still, I sought the solitude. I could read a journal article. I could air out my mind.

Within minutes, I was paged again to the Emergency Room. There was a fifteen-year-old female ready to be seen. I grabbed the chart and realized it was her, my clinic patient. The complaint written on the chart was common. “Girl problems.” Her dark eyes studied me like a hawk. I wondered what she was trying to say. So, we moved on to a detailed back and forth talk followed by an examination plus lab tests as “girl problems” cover a wide territory. I was stumped. Her “girl problems” were vague; I could not find anything wrong. What was the real story? What would bring her in when she could be doing something else, something fun? Few were eager to go through a complete examination unless they were sick or worried or needed something, like birth control or an excuse note to get out of school. What did she need?

I returned to the exam room after a final look at her lab results. “Everything appears good. I’m not sure what’s going on. Do you think you could come back for a short check up in a day or two to make sure everything’s going the way it should? I’m glad you came to see us and let us know you were worried. I think you’ll be fine.” I waited a beat or two to give her time to digest my message. “What questions do you have for me?”

“Ain’t you going to tell me happy birthday, Doc?”

I glanced down at the chart. Oh, nuts! I had missed it. The Date of Birth on the chart matched today’s date. The teen had had to take a bus, come to the Emergency Department with a bogus problem, and go through an examination and blood tests just to find someone she thought would care about her birthday. I may be smart, but I am not always wise.