I'd worked at Nationwide Children's for almost eight years already. I had a good group of patients that I ran some group therapies with, and still worked some ER shifts.
I was pretty sure I'd seen that little girl from my residency years in and out of the ER. Not usually under my department, but I'd see this young girl with the bluest eyes now and again. It still haunted me, that night she was found wandering in her neighborhood, wearing thin pyjamas and no shoes. She had just disappeared when I'd gone to get her something to eat. It had weighed on me. I never did forget her.
I didn't consider her a failure on my part. I can't control the actions of others. I can only control
How I react. And I was determined after that, that I would do my best to make sure children like that little girl were heard. And hope that I could get them out of situations like mine. Or worse.
Lots of boys at the Boys' Home had been in worse situations than me. Some had been in decent situations that went bad or they had no other family and there was no foster home able to take them, like my first time at the Boys' Home. Some got out, went home and we never saw them again. Some came back, like I did. Some never left.
I knew I was one of the lucky ones. I knew I could have had a way different outcome from my upbringing. I could have stayed with that abusive foster family that wound up getting shut down. The Fosters could have been horrible people. Or they could have just let me age out and be done. But they didn't. They made me their son, legally. They taught me I was worth caring about. Worth being loved. And I thrived with them.
Occasionally I'd see a kid in the emergency department who wound remind me of one of the kids I'd met while I was in foster care. I'd listen as best as I could. Not only to what they said, but what they didn't say.
I kept my office inviting. I wanted kids to feel in control of their space. I had a soft sofa, a bean bag chair, carpets on the floor, toys and paper and colouring stuff. I even had a chess board in case a kid wanted to play. I found kids became more open when their minds were busy with other things.
Some kids curled up in the bean bags, some on the sofa, some just sat and coloured.
I had a few patients that wouldn't talk. We sat and stared at each other for an hour. I always told them they were in a safe space and nothing they said would leave the room unless I felt theirs or someone's life was in danger. My biggest breakthrough was with a 12 year old boy named Jesse whose father had abandoned the family but kept stalking the mother. The mother was a meek and terrified woman who was not in a good situation at the best of times. Jesse fought thought of suicide because he felt he wasn't worth his mother's love because his father had left them and yet still held such sway over them.
Jesse wouldn't talk at all at first. He was angry he was referred for therapy. He felt he didn't need it and refused to talk to me. So, I would sit in a chair near him while he sat, sullenly, on my sofa, arms crossed and head down. He wouldn't acknowledge me.
But every week, I'd welcome him in, offer him his choice of places to sit and just wait.
"I want to remind you, Jesse, that this is a safe place. You can tell me anything that's on your mind, and unless it's something that puts your life or anyone else's at risk, nothing you say here will leave this room. I'm here to listen to you. Maybe help find some solutions or ways to make you feel better."
"I'm not sick and I'm not crazy," Jesse said. The first words he'd spoken to me in three months.
"No. You aren't. That's not what you're here for. You're here to help you come up with some ways to deal with everything going on in your life," I said.
"How come you let me come here and just not talk for an hour? Is it cause you get paid whether I talk or not?"
"I let you sit and not talk because it's important to me that you know that in this room, you're in charge. You want to talk? Great. I'm here to listen, offer advice if you ask. You don't want to talk, that's okay, too. I won't force you because I think that's counterproductive. I'm not here to judge you or anything you feel or say. I'm here to listen. Or not. It's always up to you."
"What's with all the toys?" He asked.
"Some of my patients are younger than you and playing with toys helps them open up. Sometimes they use the toys to show me what has been done to them."
"Oh," he said. "What about that one on your desk?"
He was referring to my ET toy.
"Well, that one, he's special," I said.
"Why?" Jesse asked.
"I got him when I was eight years old. It was a Happy Meal toy. I had spent a few days in the hospital after my mom broke my shoulder and I was taken away from her. My social worker brought me a Happy Meal. My first one ever, actually."
"You never had a Happy Meal until you were eight?!" Jesse asked, incredulous.
"Nope. In fact hospital chicken fingers, macaroni and cheese and pizza were the first time I tried any of those foods. I was lucky if I got a sandwich at home before I went into foster care."
One thing I believed in was being open and honest with my patients. That way they wound know that I do understand some of what they're going through.
"You were in foster care?" Jesse asked. Actually looking at me for once.
"Yep. From the time I was eight until my sixteenth birthday when I was lucky enough to be adopted."
"What about your real mom? Or your dad?"
"My birth mom died when I was fifteen and my dad was never in the picture. I don't know anything about him."
"Why were you in foster care?" Jesse asked.
"My mom was abusive. So were her boyfriends. And most of their friends. When she broke my shoulder, my social worker finally got me out."
Jesse frowned.
"Sometimes I wish I could go into foster care. Or just die," he said.
"Foster care isn't always the best. You have to be lucky to land with a family that actually cares. Your mom loves you, you know."
"No she doesn't. She's too busy being weak to love anyone."
"Not true. Your mom is in a tough situation. And I think it's put you in a tough situation. You feel like you have to protect your mom because she doesn't seem able to protect herself from your dad's influence. He may have left you and your mom, but he's sure holding something over your mom. Jesse, it's not your job to protect your mom."
"Then who will?" He asked.
"You could call the police the next time your dad shows up or does something. Go to a neighbour's if it's safer. You don't have to take this all on yourself."
Tears filled his eyes and I'd never seen any emotion besides anger from him.
"But he scares her so much," Jesse said. "And he scares me. He's threatened to kill her to scare me and me to scare her."
"Jesse? Is your mom seeing anyone?"
"No! She's too scared to date."
I smiled.
"No. I meant a therapist of her own."
"Oh. No."
"I see. That's something she may want to consider. But that's not something I can tell her. You're my patient. Not her."
"Dr. Freud?" Jesse said.
"Yes?"
"Do you think my mom could get stronger if she had someone to help her?"
"I do. I can give you some information to give to your mom, but obviously, I can't tell her to use any of it."
At the end of our session, Jesse thanked me for the information and left.
Six months later he came in for his appointment and was smiling.
"My mom was going to talk to you after my appointment but today's my last appointment with you," he said.
"Oh? How come? I mean, you're doing great and you've made some fantastic gains and we've had quite a few breakthroughs. I can't force you to come here, but I don't think you're ready to be discharged," I said.
"I know. Can you recommend anyone in Chicago?" He asked.
"You're moving to Chicago?"
"My mom started seeing a counsellor a few months ago and they helped her realize that my dad's problems are just that. His problems. So my mom thought that maybe one way for us to get away from him is to move. So she got a job in Chicago. We're leaving on Saturday."
"Well, I'm sorry to see you go, honestly, Jesse. I've enjoyed our sessions since you started talking. But I'm happy to hear that you're hopefully moving on to better things. Good luck. What would you like to do with this last hour?"
"Can we play chess?" He asked. I smiled. No one ever wanted to play chess.
Over the game, Jesse told me about the house in Chicago they were moving into, and how he'd met the kid next door who was his age and seemed cool. He talked about the school they found in the neighborhood and he seemed happy and excited.
At the end of the hour, his mom came in to pick him up and I could see the change in her, too. She looked more confident.
"Thank you, so much, Dr. Freud," she said. "I don't know why it took me so long to get counselling on my own, but thank you."
"I told Jesse as sorry as I am to see him go, to see you both go, I'm happy you're both making some positive changes."
"I think Chicago will be good for us. Good for Jesse. My sister lives there and her kids. Jesse will have cousins to hang out with and we're in a good neighborhood with good people and good schools. It'll be a fresh start for both of us. I think we need it."
"Agreed. Good luck to the both of you. Once you're settled, I can send over some recommendations for therapists if you want for both of you."
"We will be in touch," she said.
And they were. Two months later I got a thank you note from Jesse and a request for my records on him from a psychologist at Cook County Hospital.
I'd helped him. I'd done what I'd set out to do.