By Sarah Teasdale, MD, EdM pediatric hospitalist at Children’s Hospital Boston
It was near midnight about a year ago when I noticed a gaunt young man in his early twenties walking toward me in the Emergency Department. It was a young man who, about a decade earlier, had threatened to kill me.
For nearly ten years prior to becoming a physician I was a high school teacher. That particular July, I was teaching English in summer school for students who had failed the class during the regular school year. It was a group of 15 surly teenagers ages 14 to 19, beaten down by a system in which they could not—or chose not—to succeed.
The young man—I’ll call him Andre—was my student that summer. He was a gangly, thin 15-year-old who often wore the same ill-fitting clothes day after day, rarely made eye contact and showed a level of fatigue in the early morning that was extreme, even for a teenager. Whenever I tried to talk to him, he would simply say he was “a’right.” He meant: Stop asking.
So I stopped asking. In doing so, I lost a chance to help him.The morning he threatened to kill me, Andre sat directly across from me in the center of the back row, his head planted face down on his backpack. I walked to the edge of his desk and asked him to sit up.
“I’m tired,” he hissed from below his hood.
I stood over him with my arms crossed. “Andre, please get up.”
He didn’t move.
“Andre! I said get up now.”
He stood up with slow, deliberate motion. He stretched his arms in front of him and leaned forward over the desk so our faces were very close.
“Missus, you have no idea what I been doing last night. You better stop bugging me.” He looked directly at me. His eyes were bloodshot and he squinted in the bright morning sunlight from the facing window.
He directed his gaze to the ceiling. “I’m ‘bout to kill someone.”
We aren’t doing our job as a supportive adult if we don’t push past the “a’right” and find out what’s really going on.
He looked back at me briefly but definitively then sat down as slowly and purposefully as he had risen. He pulled his hood over his eyes, and nestled his head back onto his bag.
“Don’t push me, missus,” he said from below his hood.
I called for the principal. He escorted Andre out of the room. Andre didn’t resist. He gave a little snort as he picked up his bag and rolled his eyes, as if to suggest anything was preferable to sitting through class that morning. The rest of the kids in the room watched in silence.
Soon a police car pulled up outside. Andre, hands cuffed behind his back, looked resigned and allowed the officers to drag him across the lawn the squad car.
Later I learned what he had been doing at night. He was working as a prostitute. Andre had been shuffled between multiple foster homes as a young child. He had a long history of abuse and neglect. He started working the streets at age 12 and already had a police record by the time I met him. As far as the principal knew, he wasn’t living anywhere consistently. No family claimed him.
The tough part for us as potentially helpful adults is that when teens have a lot going on, they often hide behaviors that are downright off-putting. But those are the very behaviors we have to see as warning signs of impending disaster. That’s when we have to step up the questions, and not accept the simple answers.
Anyone who has spent time with a troubled teenager knows this is no easy task. Adolescents are tough to talk to in general, and that challenge is far greater when kids have a lot going on. But we aren’t doing our job as teachers or doctors—or just as a supportive adult—if we don’t push past the “a’right” and find out what’s really going on. When we expect things of them without considering what might be gnawing them apart below the surface, we risk confrontation that can be explosive. Usually, it’s the teen that pays the price. Andre did.
Andre isn’t a kid anymore. Another doctor saw him that night in the Emergency Department, but I watched him as he left. He didn’t recognize me. He was unnaturally thin, his face was drawn, with sharp cheekbones offset by the same distant gaze he had when he was fifteen. When the nurse said, “You take care of yourself, Honey!” he flashed an easy, warm smile I had never seen.
I asked the nurse about Andre once he had gone. She told me that he’s no longer a prostitute, but he has severe chronic illness and is still intermittently homeless. When she had asked him if he had family, he said no.
I suspect, given all that she knew, the nurse had asked him a lot of questions and didn’t accept simple answers. If so, then she’s a lot closer to helping Andre than I ever was.