On Tuesday afternoon, Sarah climbed into the cab of the converted truck that had become the mobile clinic. She usually drove separately and met up with Hank Bryson, the clinic nurse and expert driver, once he'd parked the truck, but today she'd hitched a ride so they could have a meeting. A mobile meeting to discuss the mobile clinic.
One of the best decisions Sarah had made was hiring Hank Bryson. He was a full head shorter than her, but what he lacked in height, he made up for in breadth. He could stop people with a steely stare, something he'd perfected while working as a bouncer through his nursing degree. He was also gentle and compassionate and just as readily flashed a wide grin. That's what the teenagers related to. He remembered their names and drew them into the clinic. Most impressive, he could manoeuvre their honking-big truck into the tightest of spaces.
Clarington had a whole population of teenagers who had trouble accessing medical care. Some lived on the street, some on their own, and some raised siblings while a parent tried to make ends meet. With all of that, there were escalating numbers of teenage pregnancy, malnutrition, and mental health issues.
Sarah had decided to do something about it: she took the clinic to them. She'd raised funds, applied for government grants, and bought and renovated an oversized cube van. On Tuesday and Thursday afternoons and evenings, the clinic rotated between three different locations in town. The furniture and space in the truck was minimal, bright, and efficient, and the examining room was fully equipped with the latest technology.
"Hey, some of the kids got wind of the rumour that the clinic might be closing unless we find some money," Hank said, drumming on the steering wheel. He only did that when he was really worried. "I told them you were talking to the Comcor people, and they asked what they could do to help. They wanted to put together a video. I could help them with it, but I wanted to run it by you first."
"That's very sweet, but I don't want them to worry. They have enough on their plates."
"We have to do something. The kids need this clinic." He made a tight turn onto a quiet street.
"I know. I've had meetings with both the accountant and the lawyer. We're okay for another eight months or so, but after that, it doesn't look good. It's such a shame that the government money is so fickle."
"Yeah, especially with an election on the horizon. Street youth aren't exactly a priority."
"No, unfortunately not. I'm meeting with Comcor on Thursday. I'd be happy to include a video, but that doesn't give you much time."
Hank glanced over at her with a nod. "I'll make time. I'll see what they have in mind and email you." He pulled to a stop, flipped on the blinker, and prepared to parallel park into their reserved space.
"Thanks, Hank. Every little bit helps."
As Hank manoeuvred the truck into place, Sarah sifted through and signed off lab results and consult letters. Later they'd be scanned into the medical records.
Within minutes of parking, Hank had removed the safety covers in the clinic, unlocked the storage cabinets, and set up chairs in the waiting room. By the time he finished, patients were waiting.
Sarah booted up the laptop, shrugged into her lab coat, and ushered in the first patient.
"Hey, Dr. Jain, how's it goin'?" a young man asked with a grin. He leaned a skateboard against his chair. With his freckles and spiked jet-black hair, Juan Rodrigo looked closer to twelve than his actual seventeen years. He wore slouchy black jeans low on his waist and a bulky hoodie two sizes too big for his lean frame. He had a wide smile and was one of the few teenage males she dealt with who made easy eye contact.
"Hi, Juan. How're things with you?"
"Chillin'. Chillin'," he said, nodding. "Just came in for a check. Was whack'n Willy Wonka into Wonderland, you know." He winked, smiling broadly. "And found the golden ticket."
"Uh-huh" she said dryly. "I hope there was a wrapper involved." She raised an eyebrow at him.
He looked sheepish. "Ya man. I hear ya. Wrap your willy, don't be silly. I got it here." He tapped his head. "But it doesn't always happen here." He pointed to his groin.
"It's important, Juan. Every time you have sex, you should use a condom to protect yourself and your partner. Do you have any concerns about a sexually transmitted infection? Any bumps or sores? Any discharge?"
"Nope, lookin' good, good-lookin'." He grinned at her. "Just checkin'."
Hard to be insulted with such open cheerfulness. "Well, if you'd like it tested, leave a urine sample and we'll send it to the lab. Let's keep it clean. Here, these should get you started." She gave him a handful of condom samples. "Come back for more if you need them."
"'K. I'll be back tomorrow," he said, tongue-in-cheek.
She laughed as he left.
Mid-way through the afternoon, Sarah received a text from Mike.
The new heist movie, Firefox, is playing at the drive-in. Does that interest you?
A drive-in? Sounded intimate. Who was she kidding? He could suggest a polar ice swim and she'd agree. Yes. Sounds great. Maybe his truck would have bucket seats with a console separating them.
Perfect. See you tomorrow.
Sarah put away her phone and ushered in the next patient, a young woman who was new to the clinic. A well-worn black winter coat hung loosely on her shoulders, and her pale skin accentuated the dark circles under her eyes.
"Hi, Crystal, I'm Dr. Jain," Sarah said with a smile. "I see you came in today because you're feeling tired?"
Crystal looked up briefly and then hung her head. Her straight, long brown hair fell forward and covered half of her face. "I feel like I don't have any energy during the day. Since the summer, I've been tired all the time."
Sarah had to lean forward to catch the quiet words. Fatigue for two months. Anemia? Hypothyroidism? Mono? Maybe just poor sleep habits. "Have you been unwell, with a sore throat or fever?"
"No." Crystal picked at a loose button on her coat.
"Do you have any history of anemia or low iron?"
"Not that I know of."
"Are your periods heavy?"
"Umm...two days are heavy and then three or four days are lighter."
Sounds normal. "How's your diet? Do you eat a wide variety of foods?"
"Yeah, I guess. I don't always eat breakfast, but I eat lunch and supper. I don't have a lot of meat, but I have sandwiches or KD. I'll grab an apple if I'm hungry."
Not ideal, but not completely out of the ordinary for a teenager. More unusual was the lack of eye contact and the missing spark. "How has your mood been?"
"I dunno. Not great." Crystal smoothed the hem of her coat. "I've felt pretty down for a while now, but it hasn't changed in the past year or so. I've always been able to get out of it, you know. This is the first time it's lasted so long."
"That's not good. When you're feeling down, sometimes it can be hard to look after yourself. Have you lost weight? Are your clothes feeling loose?"
"Maybe some of them."
"Are you getting enough sleep?"
Crystal shrugged. "I can't fall asleep. Then I end up sleeping through my morning classes."
"That must be difficult, and when you're tired, things look bleaker. How's school going?"
"It's okay. Grade twelve is harder. I've bombed the last couple of tests, but I'd been doing okay before that. Nothing sticks. I feel like I have to read everything three or four times, and I still can't remember any of it."
Low mood, poor appetite, weight loss, insomnia, and trouble concentrating. Depression moved to the top of the list. "Did anything happen when this started?"
Crystal looked up with watery eyes. "My mom died. It was awful."
Ahh. She handed Crystal a tissue. "Can you tell me about it?"
Crystal took the tissue and wiped her eyes. "Mom was diagnosed with breast cancer. She had surgery and chemo, went through all that, and died nine months later. We were really close." Her breath hitched. "My dad fell apart. I don't think he could stand looking at my sister and me, so we moved out, got an apartment together, and found part-time jobs to cover the rent. We did okay, but then Jen went off to university in September. She's only three hours away, but she's really busy and can't afford the trips home."
"So you're living on your own?"
Crystal nodded. "I talked to my dad, but nothing's really changed, so I kept the apartment and picked up a few more hours to cover the rent."
"You've done a good job in a tough situation. It's a lot to handle." She spoke slowly. "Crystal, sometimes when people are feeling down, they start to have thoughts about suicide or harming themselves. Has that happened to you?"
There was a long silence. "Yeah." Crystal looked up and then off in the distance. "I'm so tired of dealing with it all. It would be so much easier if I wasn't around. My dad wouldn't have to look at me, my sister wouldn't have to worry about me, and I think I'd be better off, too."
That was not good. "Do you have a plan?"
"Not really, but it kinda scared me."
"Crystal." She waited until Crystal looked at her. "You've had a lot to cope with. A lot has happened in the past year. We should do a blood test to rule out some of the possible causes of your fatigue, but I think how you feel is related to your mood, and that may be related to your mom's death. There are things we can do to make it easier for you. Counselling would be a good place to start. I could also write a letter to the school, and maybe they could make some accommodations for you with your timetable or assignments. If you need social assistance or help with the food bank, we can arrange that.
"This can get better. Suicide is not the answer. It sounds like your dad is grieving and having a hard time with it, but he cares about you. You seem to have a special bond with your sister. Although things seem pretty tough right now, there is hope that it will get better." She paused. "I'd like you to make a contract with me. If the thought of suicide get worse or seems overwhelming, I want you to call my office or go to the nearest emergency department. Would you do that?"
Crystal wiped away tears with the back of her hand. "Yeah, I will. I didn't know I could go to the hospital."
"Yes, you can. It's open twenty-four hours a day." Sarah took a business card out of a drawer. "This is the phone number for the crisis helpline. You can call them anytime, day or night, if you need to talk to someone."
"Thanks." Crystal took the information and a requisition for blood work, and agreed to make a follow-up appointment in two days' time. "Thanks, Dr. Jain. I feel better talking to you about it."
"I'm glad you came in. You don't have to walk through this alone. We'll get some help for you."
Crystal nodded, holding back tears. "Thanks."
After Crystal left, Sarah took a moment to complete the chart and settle the sadness stirring inside. It was tricky – caring enough, but not caring too much and not dragging her emotion into the next patient's visit. Patients were anxious enough without worrying about how she was feeling.
Normally she could find that balance, but today it was layered with all the emotion swirling around Mike. It was going to take a minute.
She glanced at a magazine someone had left on a chair in the office. "Dating – fun and flirting in new relationships" was splashed across the cover. She shook her head. She should flip through and look for the other article, the one called, "Dating – stress and angst: why do we bother?" Then she thought of Mike's sexy body. And sighed. That's why we bother.