Chapter 32: Lord Have Mercy

August 3, 1989, McKinley, Ohio

At lunch on Thursday, I met Chancellor Evans from Taft at the diner across the street, hoping not to be paged but knowing there were no guarantees.

"I'm sorry I've been remiss about having lunch with you," I said.

"It's understandable with your medical training, marriage, and family. How does it feel to be a doctor?"

"Fulfilled. Becoming a doctor was my goal since age ten."

"I'm happy we could do our small part in helping you achieve your goal! And that you're mentoring Antonne Jefferson."

"I haven't seen him over the Summer, but we'll resume the mentoring sessions once school starts at the end of the month."

"I know your schedule is crazy, but would you be willing to meet prospective students in November and February? If so, we'd like to put together a 'pre-med' weekend. We'd invite Clarissa Saunders and Sophia Jackson as well."

"A lot will depend on our schedules, but I suspect we'll be able to make the time."

"If the hospital is amenable, we could have the students and their families come there and perhaps observe."

"You'll need to take that up with Doctor Rhodes," I said. "I'm not sure what his position would be on observation by High School students."

"You're OK with it, though?"

"Yes, so long as you receive permission from the Medical Director. And obviously you'll need to ask Clarissa and Sophia. I should warn you that Sophia is seeking to match in the San Francisco Bay Area, and Robby is going to be at Stanford."

"That's not until next June, right?"

"Correct. Clarissa will be here as long as I am."

"I was reasonably certain that would be the case. If I may change subjects, how is your friend with schizophrenia?"

"Not good," I replied. "I'll be testifying before the Ohio Medical Licensing Board in two weeks, hoping to have her former psychiatrist suspended, though I feel his license ought to be revoked."

"What happened?"

"It's a long story, but the bottom line is that in my opinion, and the opinion of two mental health professionals, he committed gross malpractice in his treatment of Angie, which made her condition worse."

"I'm sorry to hear that."

"It's a bad situation, and the hearing can't fix it, but it can ensure the psychiatrist understands how badly he screwed up."

Chancellor Evans nodded, "On a happier note, I'm looking forward to your concert at the end of the month."

"I enjoy those concerts very much."

We finished our lunches, agreed to meet sometime in September, and I headed across the street to the hospital.

The first task after lunch was to join Doctor Gibbs for evaluations for Bob and Len, both of whom received grades of 4, which were the norm for very good candidates, with scores of 5 being reserved only for the best candidates. After that, it was a busy, albeit routine, afternoon, and I met Clarissa for dinner. I let her know about Chancellor Evans' request, and she agreed she'd participate and thought the hospital was the correct venue.

The evening was quiet until just before 10:00pm when there were three EMS runs and five walk-ins within a fifteen-minute period, portending a night when I wouldn't get any sleep. Two admissions, five quickly streeted, and three being monitored took us to midnight. I was just about to sack out when Doctor Gabriel asked me to handle a walk-in — a young girl who appeared to have been struck in the face multiple times.

"Hi, Amelia," I said, looking at the chart. "I'm Doctor Mike. Will you come with me, please?"

I escorted her to Exam 3, and we were joined by Mary, Tom, and Wendy.

"What happened?"

"I got into a fight," she replied.

"Who brought you in?"

"A friend."

"I'd like to do a quick exam — listen to your heart and your breathing, and look in your ears, eyes, nose, and mouth, then check your stomach, OK?"

"Yes."

I performed the exam, observing only glassy eyes, facial contusions, and a swollen lip. I appreciated no guarding or tenderness in her abdomen. I had two suspicions — the first was that she had taken some kind of drug, and the second was that her development did not match her claimed age of nineteen. If she was a day over fifteen, then I was Mikhail I, Tsar of All the Russias!

"Amelia, when is your birthday?" I asked.

"October 12th."

"What year?"

She hesitated just briefly before saying, "1970."

I decided on a gambit.

"Do you have your ID so we can put your address on the chart?"

She pulled her billfold from her purse and showed me what even I, as a layman, could tell wasn't her driver's license, as the facial bone structure of the girl in the picture didn't even come close to Amelia's. I ignored that for the moment and wrote down her address, noting her birthdate.

"Thanks. How many times were you hit?" I asked.

"I don't know, maybe four."

Which matched her observable injuries.

"I'd like to get an X-ray to make sure no bones are broken," I said.

"Yes."

"Let me arrange that, please. Just relax here. Nurse Wendy will stay with you. Mary, with me, please. Tom, just wait here."

He gave me an odd look but acknowledged my instructions, and Mary and I stepped out.

"What's wrong?" she asked. "Usually, you would have Tom call radiology."

"She can't consent to the X-ray," I replied. "I either need two doctors with medical licenses to sign off with me or her parents."

"She's nineteen, right?"

I shook my head, "I think she's fourteen or possibly fifteen. The ID she showed me is not hers."

"You know, she does look awfully young, but some girls look young. We had an undercover policewoman at my High School who was twenty-three but passed as a Junior."

"Obviously not well enough if you knew!"

"I only knew after she busted the pot dealer. But then it made total sense why she never went on dates or hung out with kids after school or went to parties. So what do you do?"

"The discrepancy between her claimed age and what I observed is too great to simply ignore and pretend she's really nineteen. My thinking is to get Doctor Gabriel and Doctor Mastriano to sign off and treat her, but also see if you or I can build rapport with her and get her to admit her age."

"Then what?"

"Figure out if she's being abused or if she really was in a fight. The age mismatch suggests another possibility, too, based on something a Sheriff's Deputy said this morning."

"I wasn't here, obviously. What?"

"They're looking for a pimp and drug pusher who runs underage prostitutes."

"I'll cut his balls off if I see him!" Mary declared fiercely.

"I think that was what Deputy Sommers was thinking as well. Let's go see Doctor Gabriel and see if he'll back our play."

We went to the Attending's office, and I was happy to see both Doctor Gabriel and Doctor Mastriano there.

"What's up, Mike?"

"I have a female patient who was battered. She has facial contusions, a swollen lip, and glassy eyes, suggestive of marijuana use. She claims to be nineteen, but after my gross exam, I believe she's fourteen or fifteen. She has ID, but it's clearly not hers, given the differences in facial bone structure and offset between her eyes compared to the picture.

"I want to get X-rays, but given I'm convinced she's under sixteen, I need you and Doctor Mastriano to sign off. I'm concerned that if I confront her, she'll leave AMA, and I'd rather get the tests done so we know that she doesn't have any fractures. I'll also draw blood for a tox screen."

"And then what?" Doctor Mastriano asked.

"Then we treat her, most likely with analgesics, and attempt to get her to tell us who beat her."

"You have a suspicion, Mike."

I nodded, "Deputy Sommers this morning said the Sheriff and the McKinley PD are looking for a pimp and pusher who runs underage prostitutes. Maybe the patient really did get into a fight, but I'd say it's more likely she was beaten by an adult male, given the bruising. Whether it's a family member, boyfriend, or pimp, she needs help."

"And if it's a fight?"

"We street her. If not, either a Psych consult or a social worker. Given the hour, it'll be Psych."

"Alternatives?"

"Well, I precluded pretending she's actually over sixteen once I stated my suspicions to Mary and then to you. The other option is confrontation, with the risk she bolts."

"Who brought her in?" Doctor Mastriano asked.

"A friend."

"Is the friend still here?"

"I don't know," I replied. "Mary, go check with the admit desk, please. Don't say anything, and be surreptitious so you don't spook anyone. Just get a look at the person who brought her in."

"OK," she replied and left the office.

"You couldn't let it go?" Doctor Mastriano asked.

"Not once it became obvious she was lying about her age, and with what the Sheriff's Deputies said this morning."

Mary was back a minute after she had left.

"Scruffy-looking guy, who I'd guess, is around thirty," Mary said. "Nurse Emily identified him for me without making it obvious."

"OK," Doctor Gabriel said. "I'll sign off on the treatment. Isabella?"

"Sure."

"Mike, get the X-ray and lab work and see if you can get her to admit what's going on. If it's what you suspect, I'll call the Sheriff. Isabella, you go with them, please, given we're treating an underage patient without parental consent."

Doctor Mastriano, Mary, and I returned to Exam 3.

"Amelia, this is Doctor Mastriano, one of my supervisors. We'd like to get some X-rays and draw some blood, and also get a urine sample to check, among other things, for blood. That's standard when someone's been in a fight."

"How long will it take?"

"It depends on Radiology," I replied, then turned to Tom, "Call for a facial series, please. Wendy, if you'd draw blood for a trauma panel, hCG, tox, and get a urine sample. Tom and I will step out as soon as he finishes the call. Amelia, do you want us to tell your friend what's going on?"

"Uhm, er, I guess."

"What's her name?" I asked, using subterfuge to not make her suspicious.

"It's a guy. Gary. He's wearing jeans and a black T-shirt."

Tom finished the call and let us know Radiology could take Amelia as soon as we were ready, so I asked him to step out with me.

"What's going on?" he asked once we were out of the room.

"We're pretty sure she's only fourteen or fifteen, and the guy she's with is around thirty. Come with me, and we'll see if we can get any clues without making him suspicious."

"You think he's abusing her?"

"I don't know, but a guy of thirty isn't usually 'friends' with a girl who's fourteen or fifteen."

Which I knew from experience, though Paul hadn't been that old when he'd been with my sister.

"Statutory rape," Tom said. "Well, I guess it's Criminal Sexual Assault now."

We went to the waiting room, and I saw Gary, who was dressed as Amelia had said, though I realized that probably was not her name, given the phony ID.

"Gary?" I said.

"Yeah?"

"Doctor Mike Loucks. Amelia seems fine, except for the obvious bruises and fat lip, but we're going to take X-rays of her face to make sure no bones are broken. That will take about an hour."

"Can I see her?"

"Once the X-rays are completed, I'll ask if she wants you to come back, but it's up to her."

"She'll say 'yes'."

"Do you know what happened?"

"Some guy beat her up. She came to me, and I brought her here."

"OK," I replied.

I didn't ask about calling the police because the last thing I wanted to do was make him suspicious. Tom and I went back into the ED and waited outside the exam room.

"He looks like a pusher," Tom said quietly.

"And possibly a pimp," I replied. "The Sheriff is looking for a guy running underage girls as prostitutes."

"Guys like that should be strung up."

"Mary suggested she'd perform an orchiectomy."

"Sounds about right."

Mary came out of the exam room with blood vials and a urine sample.

"Doctor Mastriano signed the order," Mary said.

"Tom, take everything to the lab, please. We need the results of the hCG before we run an X-ray."

"You think she might be pregnant?"

"A standard trauma panel for any female who is of childbearing years includes a pregnancy test."

"Got it."

"Mary, I'll leave you in the room and have you try to build rapport. Be very careful."

"You're sure I should do it?"

"Positive. I think she'll be more willing to open up to you as a medical student, but don't push too hard."

"What did the guy say?"

"That 'some guy' beat up Amelia, and she came to him for help."

"Consistent with him being her pimp."

"Or pusher," I replied. "Or both."

We went into Exam 3 where I had Wendy draw the blood and had Tom take them and the order to the lab.

"Amelia, Mary is going to stay with you until the lab results come back."

"OK," she said.

Wendy, Doctor Mastriano, and I stepped out of the room.

"She's not nineteen," Wendy said quietly. "Fifteen at most, but I'd bet fourteen."

"We're all in agreement on that," I replied. "And the 'friend' is a guy around thirty.

"Everything lines up except one thing that makes no sense," Doctor Mastriano said. "Why does the guy bring her and stay with her? In my experience in Los Angeles, the pimps and pushers never hung around, and with injuries like this, they never showed up in the first place."

"What's your theory, Doctor Mastriano?" I asked.

"I don't have one," she said. "I just pointed out something that didn't line up. That's not to say he's not her pimp or pusher."

"A girl my parents are fostering was involved with a guy in his forties at age fourteen and got pregnant," I replied. "She had a fight with her mom, and her response was to go next door and screw her best friend's dad. He was arrested the day her baby was born. She'd concealed the pregnancy."

Not to mention the situation with my sister, but I wasn't going to say anything about that, given everything else that had happened. Tom returned then and joined us in the corridor.

"So, are we taking bets?" Wendy asked. "Boyfriend? Pusher? Pimp? Trick? Friend?"

"Any or all of the above," I replied. "I do think Doctor Mastriano has a point about how a pimp or pusher would behave, but what's with the bogus ID and lying about her age?"

"If she claimed to be twenty-one, I'd say for bars," Tom said. "What does nineteen get you?"

"R-rated movies?" Wendy suggested. "Driving? And some clubs let you in at eighteen but won't serve you booze."

"If Doctor Mike identified the license as phony, wouldn't a cop or bouncer?" Tom asked.

"It doesn't add up," I observed. "Let's see if Mary has anything for us when she comes out."

We waited about ten minutes, and Mary came out, and Wendy went in to stay with Amelia,

"She says Gary is her friend and that her boyfriend hit her."

"Did she admit how old she is?" Doctor Mastriano asked.

"Fifteen, and the ID is her older sister's. Her name is actually Amber. She doesn't want anyone to call the cops, so she pretended to be her sister."

"There are holes in the story," Doctor Mastriano said. "I think we need to call Social Services."

I nodded, "This certainly isn't our area of expertise."

"I'm going to discuss it with Doctor Gabriel," Doctor Mastriano said.

"OK. Tom, go see what the lab has for us so far. I'm particularly interested in the tox screen and pregnancy test."

He left and was back five minutes later.

"Positive for THC, and she's pregnant," he said.

"We need to tell Doctor Gabriel," I said. "Let's go."

The three of us went to the Attending's office, and I shut the door.

"Tom?" I prompted.

"Positive for THC and a positive pregnancy test."

"Mary?" I prompted.

"She admitted she's fifteen, says the guy who brought her in is a friend, and that it was her boyfriend who hit her."

"We can't X-ray her because of her pregnancy," Doctor Gabriel said. "Mike, do you actually suspect broken bones, or was it simply a precaution?"

"Precaution."

"OK. We need to call Social Services," Doctor Gabriel said. "The problem is, they won't see her until 7:00am tomorrow. We can't release her to an adult male who isn't her guardian, given she's under sixteen. There's no medical reason to keep her, so the only way we could do that is a Psych hold, which would obviously be a pretext or call law enforcement."

"What about calling her parents?" I suggested. "We at least have an address for the sister. We could check the White Pages for surname and address match."

"Tom, do that," Doctor Gabriel said.

"Amelia DeJong," I said. "That's a Dutch name and isn't common in Ohio. 15 Custer Drive."

"Be right back," Tom said.

He left the office and came back a minute later.

"Charles DeJong, 15 Custer Drive," he said, "555-9898."

Doctor Gabriel pressed the speaker button on his phone and dialed the number. It rang five times before it was answered.

"DeJong residence," a man's voice said.

"Mr. DeJong, this is Doctor Peter Gabriel from Moore Memorial Hospital. Do you have a fifteen-year-old daughter named Amber?"

"She's fourteen. Is she OK?"

"Someone hit her several times, but we don't believe she has any broken bones or other injuries besides bruises. Do you know a man named Gary?"

"He lives next door. Why?"

"He brought your daughter here. We'd like you to come to the hospital so we can release her to you."

"My wife and I will be there in ten minutes!"

"Thank you, Mr. DeJong."

He pressed the button to disconnect the call.

"Do we tell her she's pregnant?" Mary asked.

"Yes," Doctor Gabriel said. "But before her parents arrive. We do not tell them. I'll put that on the chart."

Fourteen was iffy, but it was Doctor Gabriel's decision, and I felt, given the unknowns, it was better to handle it the way he'd said.

"Mary should tell her," I suggested. "She developed a rapport. Refer her to the Free Clinic?"

"Yes."

"Mary, let's go. Tom, go to triage and wait for her parents, then bring them to the consultation room and let us know."