It was a sunny September afternoon. You were sad you had to miss school to come to the doctor, especially because you were feeling fine. You may have been coughing every other sentence, wheezing a little too, but it didn’t stop you from exploring every corner of the office and exam room, or from helping your younger sister, who kept misplacing her doll.
When I walked in to introduce myself, you pushed yourself off the big, uncomfy table to meet me at the doorway. Very solemnly, you said, “Mister, you have a very pretty unicorn,” and your big brown eyes shifted from the clip on my lanyard up to my eyes. Then, you smiled, and my heart melted.
What followed, however, was an all too common conversation with your mother. She pulled out meticulously kept records of your asthma hospitalizations and regimen changes. Your triggers. How you were one of several living in that old apartment, last inspected who-knows-when, who had these “fits” – sweating, panting, crying. So many visits. So many medications on back-order. Would you have to go to the emergency room again today? Who would pick your older brother up from school or take care of him when he got home? Dad wasn’t around. Grandma couldn’t drive anymore.
You’d had a happy but not carefree life, and it was reflected in how you participated in this conversation. Though you were only five, and not breathing any better after the inhalers and steroids we gave you when you arrived in the office, you comforted your mother. Your attention switched occasionally to your little sister, who wanted to play, and you entertained her. Your mother told me you were a leader at your school, showed all the kids how to read during playtime. I wanted to joke with you about smart cookies like yourself going on SMART therapy. You used big words with me, like “responsibility” and “maturity.” You had them in spades.
I wondered if a referral to our community asthma program would make a difference. They could come to your home and make recommendations about carpets, bedsheets, pets, and pests. But could you afford those changes? Would your landlord be responsive? Your mom had said you were trying to move because he wasn’t the nicest man. So I didn’t know, yet I referred you anyway. As I talked with you and your mom about it, did I see understanding in your eyes? Did you share my doubts? Or was it anticipation? Tempered maybe by having been let down before.
Ultimately, you did go to the ER. I often wonder what’s become of you since, or what will. I haven’t seen anything in the medical record. Given where you live, are you at the same school system as my next patient? She’s in high school, and her mother is worried about pregnancy and STIs, drugs, bullying, gangs, and guns. Would you continue to be a light for your sister and mom, and for your classmates and teachers, if you stayed?
Art by Jennifer Guo, MS1
