Letter 2.

Dear Mr. Beenburned, 

You walked into the cold stale exam room with your head down wearing the wrinkled blue inmate uniform and the rubber shower shoes that everyone gets at booking.  You plopped yourself into the chair in front of my old desk that I wipe down with bleach before I start each shift.  Despite being an adult doctor, after several months working in the jail, the shock of having patients that looked like teenagers had worn away.  When I asked you about the details of your health, you didn’t have much to say.  I expected that, because you were just 20 years old, and not many people your age have medical problems let alone see a provider.  When I got up from my desk to do your exam, as I always do, I scanned your face and bare skin as I listened to your heartbeat.  I noticed over 50 circular dime-sized scars across both of your arms and red flags went off as I heard the lub-dub through my stethoscope.  I slowly took my stethoscope out of my ears, touched your forearm and softly asked, “what happened here?” 

My instinct to ask you came from my training which taught me to notice every detail about my patients so that I can help them to prevent harm.  I was expecting you to tell me that you harmed yourself in the past but that was not it.  In a matter of fact tone, you told me how your uncle used to burn you with cigarettes when you were a child.  As you spoke I imagined the sound of the cigarette burning your flesh over and over again.  Then you told me how those scars resulted in you being raised in foster care.  I couldn’t imagine the pain you had endured so I sat back to just listen but, you didn’t want to share any more.  So I continued to ask questions.  It was like pulling teeth getting answers out of you and I hope to God that I made you feel like I was asking so I could figure out a way to help.  I think you knew that and that’s why you shared that as soon as you turned 20, your foster home kicked you out, and that’s why you lived on the streets ever since.  You ended the story by saying, “DCFS ruined my life.”  I didn’t understand how the Department of Children and Family Services could be responsible because to me those old burns on your arms seemed to be the cause.

I asked you if you had a job and high school diploma only to learn what skills you had so we could talk about ways to find you to work to earn a way off of the streets.  You went on to explain how in foster care your “paperwork” had been lost and with no record of you ever going to school, no school would let you start.  You grew up in the DCFS system that never fixed this problem and you eventually aged out of the system with no education, no place to live, and forced to figure it out all alone.  Now you sat in front of me in jail.  I felt stuck; there was no resource I could give you.  Knowing that I felt stuck, I can’t even begin to imagine how you felt.  I apologized to you, not because I felt sorry for you but because I felt like I had to apologize for the systems that failed you. 

You responded to my inability to help you with genuine sincerity in your eyes, “Don’t worry, I’m gonna be alright.”  The questions that I wish I bombarded you with were:  What lives inside of you that makes you so resilient?  Literally and figuratively, you had been burned so many times by a number of people and systems.  How did you know you would be ok? 

When you left, out of curiosity, I searched the database to find out the reason for your arrest (as I sometimes do only after I see a patient).  It said theft.  Who knows if you actually did it.  Intuitively it isn’t right to steal but so much has been stolen from you that it just didn’t seem right that you were the one in jail.  I am sure you were eventually released, but I wondered how it was that you were “gonna be alright“.  

Wishing for this broken system to be shattered and rebuilt better for you,

Dr. A