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Volume 1, Issue 4
Winter 2005:

Throwaways

Brian T. Maurer

Cell 2 Soul. 2005 Winter; 1(4):a2

Tangier Bicycle
Photographer: Barry Penchansky
[Larger Image]

She's only fifteen, here for a school entrance physical examination.

She sits on the exam table clothed in a hospital gown, waiting. I haven't seen her for quite some time. She tells me she's been down south, living with her father and grandmother for the past eight months. Now she's come back to New England, hoping to start over again.

I ask her what grade she's going into this year. She smiles shyly, and tells me ninth. "I didn't like to get up and go to school," she says, "so I stayed back. I should be a junior this year."

I nod my head. "Maybe this will be a better year for you."

She shrugs her shoulders and smiles briefly.

"Any medical problems today?" I ask.

"My back's been bothering me; can't sleep at night. And I've had diarrhea, too."

"How long has your back been hurting?"

"Since last fall, when I had the car accident."

"You were in an accident?"

"Actually I was in two accidents. Last November. That was right before I left to go down south."

I look at her chart. The last entry of care is over 18 months ago.

"Where did you go to get checked out?"

She shakes her head. "Didn't go nowhere. Didn't have insurance then, and besides, I had to leave."

I pause, waiting for her to continue.

"My mom was into drugs, so I went down south to live with my dad and grandma."

"And you came back because . . ."

"Because my dad's into drugs, too. And my grandma couldn't take care of me."

"So where are you living now?"

"I came back up here to live with a friend, but the state found out about me. They put me in a shelter downtown last week, but I near went crazy there. That's when I got the diarrhea. My stomach's been upset. I'm hoping to move in with my step-grandma this week so I can start school again."

"Your step-grandma?"

"Yeah. She's known me since I was three. She's my step-dad's mom. I haven't seen my step-dad for years since he and my mom split up."

"Where's your mother now?"

"In a half-way house."

The only medicine she's taking is birth control pills. I ask her if she's having sex. Sheepishly she says yes, she's got a steady boyfriend. He graduated from high school last year and plays in a rock band. "But," she assures me, "he's looking for a steady job. Playing gigs is a hard way to live."

As I proceed methodically through the examination, I remember this child when she was a little girl, blonde-haired and blue-eyed. I can still recall her mother's face.

"You'll need a TB test today," I explain. "The school nurse can look at it in two days. I'd like you to come back to see me in two weeks. We can look into doing something about your back pain then."

"OK," she smiles again, and then looks at the floor.

We used to call them throwaways, those medical journals that mysteriously appeared every month in the mail. As a young student I learned quite a bit by reading the articles in them.

I remember an early mentor telling me that he learned a lot from his patients over the years. A lifetime of practice provides the best medical education.

After twenty-six years of practice, I find that many times it's still the throwaway patients, the ones no one else seems to care about, the ones who scratch their way through life learning to survive with brief smiles and unknown resources, who teach me the most — about medicine, about life, and about myself.

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