Living and Dying in Brick City (10 page)

“Dr. Davis, you’re needed in the trauma bay,” she said.

I hurried back to the room and joined the team. Debra had lost her pulse and was in traumatic cardiac arrest. I began chest compressions. She had suffered severe blunt trauma to her head, chest, and abdomen. We worked for another thirty minutes, delivering all sorts of interventions, but nothing worked. We couldn’t bring her back. I pronounced Debra dead at 11:30
A.M
.

On average, more than three women are murdered by their husband or boyfriend every day. With Debra’s death, one more woman who’d remained in an abusive relationship was gone forever. The children she’d stayed to protect were without their mother. And those of us who could have called for help are left to wonder: What if?

IF YOU ANSWERED “YES” TO EVEN ONE OF THESE QUESTIONS, YOU MAY BE IN AN ABUSIVE RELATIONSHIP
.

For support and more information, call the National Domestic Violence Hotline at:

1-800-799-SAFE (7233) or TTY 1-800-787-3224

B
y my second year of residency, I’d begun to notice a disturbing pattern on the A side: During practically every shift, I was diagnosing or treating at least one patient with a sexually transmitted infection. Gonorrhea. Syphilis. Genital warts. Chlamydia. Herpes. And more.

One day I knocked on A3 and entered to find an attractive twenty-five-year-old woman named Danielle. She looked so serene sitting on the examining room table in a bright yellow hospital gown. Her almond-colored face wore a slight smile. Her chart told me part of the story. The rest was left to her mother, Mary Rogers, a chatty, dignified woman who appeared to be in her late fifties. Mrs. Rogers was a retired fourth grade teacher who had worked thirty years in the school system before leaving the classroom to take care of her only child.

“Dr. Davis, I love children,” Mrs. Rogers said soon after our introductions. “I told Danielle to get married and have as many as possible.”

A flash of pain crossed the mother’s face. She stared longingly at her daughter, a younger version of herself, sitting a few feet away, wearing a sweet, clueless smile. Danielle no longer remembered the life she once had. She’d forgotten her job as an assistant communications
specialist in the U.S. Army. She’d forgotten her many friends, her apartment address, and her cell phone number. She’d even forgotten the love of her life, the man who’d infected her with genital herpes. When the symptoms appeared, Danielle must have been terrified—so terrified that she didn’t go to the doctor right away. That allowed the virus to progress into a rare, aggressive form called “herpes encephalitis,” which had invaded her brain and destroyed the cells responsible for behavior and memory. By the time Danielle finally sought help, the virus had already begun the destruction that would leave her with the mental capacity of a child, and the damage was irreversible. Mary Rogers had dedicated herself to serving not only as her daughter’s caretaker but as her living, breathing scrapbook.

“Danielle was an ambitious, outgoing young lady with a bright future,” Mrs. Rogers said, suddenly beaming. “She was employee of the month three separate times. She led Bible study every Saturday morning. She only missed one Saturday, and that was to come be with me after I had surgery.”

It seemed important to Mrs. Rogers that I knew her daughter had been a good girl, that she hadn’t always been sick. I nodded and smiled, trying to imagine the vibrant young woman Danielle used to be, but I could think only of what this tragedy had wrought. The nervous system, including the brain, is the body’s hard drive, and damage to it can quickly shut down primary functions, like walking, talking, or thinking. The damage is often debilitating and permanent. For Danielle, there would be no more nights out with the girls, no more job promotions, no wedding, no children. She would have to live the rest of her days trapped in childhood, without the innocence, the fun, or the hope. Unprotected sex had cost her much of her future and had altered her mother’s life as well. If only Danielle had protected herself, if only she had gone to a doctor when the first blisters and swelling appeared, but it was
too late for that now. All I could do was treat the symptoms that had brought her to the emergency room that afternoon. I glanced down at the form the triage nurse had prepared and asked Mrs. Rogers about Danielle’s fever.

“She felt warm to me,” her mother said. “And when I took her temperature, it was high. Her doctor always told me to bring Danielle to the hospital if she has a fever or isn’t acting her normal self. Since her disease, she isn’t as reliable with how she feels. Most of the time, I have to guess what’s wrong with her … Danielle used to be so independent. Even as a child she wanted to find her own way. I remember she would pick out her clothes for daycare when she was three. She always wanted to wear her pink rubber boots, with any outfit at all.”

As with my pediatric cases, I had to rely fully on Mrs. Rogers’s description of Danielle’s symptoms to come up with a game plan. The fever had lasted a couple of days so far, and Danielle, who didn’t eat much on a normal day, now ate nothing at all.

I kept probing: “Anything else going on—any vomiting, diarrhea, cough, congestion?”

“Well, she has been pointing to her bladder area, saying it burns,” Mrs. Rogers said. “I’ve noticed she moans when she goes to the bathroom. There also seems to be a strange smell to her urine, which is new.”

It sounded like a bladder infection. I explained to Mrs. Rogers that I was ordering blood work and a urine sample to be sure. Usually, that would have been my signal to move on to the next patient. In emergency medicine, there’s little time to linger, because a new crisis is always waiting. But I pushed aside the hurried feeling in my gut and stood there, in awe of this mother’s dedication. I sensed, too, that she needed a sympathetic, non-judgmental ear.

Doctors had recommended an assisted living center for Danielle, Mrs. Rogers said. But no way would she put her baby girl in
some wretched place, where people might not take care of her. Mrs. Rogers reminded me a bit of my own mother, who had been protective in that way, too, when my older sister Fellease got sick.

I was in college when I figured out Fellease had AIDS. Back then, the early nineties, it was still largely viewed among African Americans as a gay white man’s disease (even though the statistics were beginning to tell another story), and there were plenty of examples in the news of victims who were ostracized and mistreated. The not-so-subtle message was: If you had AIDS or knew someone who did, you didn’t talk about it. But turning her back on anyone in a crisis has never been part of my mother’s makeup, especially not her own flesh and blood.

Once, when growing up, I counted fourteen people living under our roof, that small two-bedroom house with just one and a half bathrooms. All around me were sisters, brothers, nieces, nephews, uncles, cousins, in-laws, and close friends, all struggling in some way—either through unemployment, marital issues, drug addiction, or alcoholism—and in need of a place to stay until they could get on their feet. At night, I’d see Moms tossing pillows and bed linens into every open space in the house, even the dining room. Likewise, she ignored relatives or friends who wondered aloud whether you could catch “the AIDS” from a toilet seat or a clean spoon or fork that hadn’t been sterilized in bleach. Her baby girl was welcome, sick or not, and if people had a problem with that, they need not visit.

Fel was a crack addict who moved from place to place, but Moms cooked for her every day, in case my sister swooped in and wanted to eat. Moms also knew right away who the culprit was when things of value suddenly began disappearing from the house. Though my mother fussed and cussed about it, she never shut her doors to her child. I’d see the worry all over Moms’s face when Fel mysteriously disappeared for days at a time.

As for me, I worried about my mother almost as much as I did about my big sister. And it was Moms’s strain I saw in Mrs. Rogers’s face. The puffy, dark circles underneath her eyes announced clearly that she wasn’t getting enough rest.

“Mrs. Rogers, all this must be hard for you,” I said, acknowledging that I saw her suffering, too. She nodded, and tears pooled in her eyes.

“She was in love,” Mrs. Rogers said, as though she could still hardly believe it all. “The boyfriend left as soon as he realized what happened. I called his family, but there wasn’t much I could do.”

Her daughter had been planning to wear her mother’s wedding gown when she walked down the aisle. “If her father was alive today, I know Eddie would beat that boy’s behind,” Mrs. Rogers said. “Look at my poor baby. Never did I plan on this. What mother could plan for this?”

I absorbed her heartbreaking words, letting her talk.

Danielle had been a military brat. The family had traveled the world with Eddie, who’d been a soldier in the U.S. Army. “She wanted to be just like her daddy. That’s all she talked about,” Mrs. Rogers said.

Danielle loved the uniforms, the stripes, the decorum of the army, and as early as high school, she began mapping out a plan for her military future. She enlisted right after her high school graduation, determined to make a career in the U.S. Army, and was well on her way. Sadness and resignation seemed to settle on the mother’s face when she got to this part of the story. It wasn’t supposed to end there. Mrs. Rogers grew quiet.

“I’m so sorry about what happened to your daughter,” I said.

She thanked me. I handed her the urine cup and pointed the way to the bathroom. “The nurse will be in when you get back.”

Within an hour, I had the test results and returned to the room to talk to Mrs. Rogers. Danielle indeed had a bladder infection, I
told her. I explained that I was prescribing a regimen of antibiotics that Danielle would have to take twice a day for seven days, but that the two of them should follow up with Danielle’s doctor. The mother seemed relieved by the diagnosis; at least her daughter would soon be out of this particular misery. I wished I could have done more than just treat the bladder infection, but the damage had already been done.

No way should Mrs. Rogers have been taking care of her daughter a second time around. While herpes encephalitis is extremely rare, it can be devastating to those it attacks. I wished in that moment that I could show Danielle’s face and share her story with every young lady out there making bad decisions about sex, often in an empty quest for love and validation—especially African Americans. They’re not the only ones having unprotected sex, of course, or the only ones contracting sexually transmitted infections. But the prevalence of these diseases among black women has been disproportionately high.

Educators report that sexual activity, from oral sex to intercourse, is beginning as early as middle school. My guess is that African American females are no more promiscuous than their peers of other races, but they do, unfortunately, have less access to good healthcare—nearly one-fifth of African Americans have no health insurance, statistics show—sex education, and reliable information, and thus are suffering more.

A study conducted by Dr. Sami Gottlieb, M.D., at the University of Colorado in Denver, showed in the mid-1990s that African American women were at a higher risk than any other group for infection with herpes simplex virus type 2, the most common type of herpes. It was one of the largest studies of its kind, involving questionnaires and blood tests from more than 4,000 people who visited STI clinics in five cities, including Newark, between July 1993 and September 1996.

Most times, when I asked the young women I treated why they didn’t insist on a condom, they said they thought they could trust their partner. It never seemed to occur to them that their partner might not have known he was infected—or worse, just didn’t care. I’ve seen that, too, like the two teenage boys who showed up in the E.R. together one evening for treatment. Both were experiencing penile discharge, and they laughed when I told them they had contracted an STI from their sexual encounter—presumably, from their banter, the same girl. There seemed to be a weird man-code thing going on, because they asked to be treated together. Then, as if it was some kind of honor, they smacked each other high fives when the nurse appeared with a needle and syringe to administer the antibiotic. I told them their partner needed to be notified so she could be treated, too, but they shrugged it off. Their response angered me.

“What if this was your mother or sister?” I asked, hoping that might get through to them.

Smirking, one of the teens responded: “Please, Doc. That ain’t my problem.”

I thought of my own sister and felt a strong urge to smack both of them. I left the room wanting to run to the hospital rooftop with a megaphone, yelling to the young women in my community: “Take control of your own sexuality! Protect yourselves! You’re suffering, dying needlessly!”

Surveillance reports from the Centers for Disease Control and Prevention show significant racial disparities in the rates of sexually transmitted infections. It is worth noting that the source of the CDC’s data is local and state health departments, which tend to base their reports on information from public health clinics. Since such clinics are used more often by minorities than whites, the differences in rates may be skewed. But other population-based surveys also confirm striking racial disparities. The point is, there’s
much work to do in convincing young men and women of color that this is a crisis that doesn’t have to be, that they have the power to protect themselves and their partners. Here are the facts: