Tell No One

Eight Years Later Another girl was about to break my heart. She had brown eyes and kinky hair and a toothy smile. She also had braces and was fourteen years old and-- "Are you pregnant?" I asked. "Yeah, Dr. Beck." I managed not to close my eyes. This was not the first time I'd seen a pregnant teen. Not even the first time today. I've been a pediatrician at this Washington Heights clinic since I finished my residency at nearby Columbia-Presbyterian Medical Center five years ago. We serve a Medicaid (read: poor) population with general family health care, including obstetrics, internal medicine, and, of course, pediatrics. Many people believe this makes me a bleeding-heart do-gooder. It doesn't. I like being a pediatrician. I don't particularly like doing it out in the suburbs with soccer moms and manicured dads and, well, people like me. "What do you plan on doing?" I asked. "Me and Terrell. We're real happy, Dr. Beck." "How old is Terrell?" "Sixteen." She looked up at me, happy and smiling. Again I managed not to close my eyes. The thing that always surprises me -- always -- is that most of these pregnancies are not accidental. These babies want to have babies. No one gets that. They talk about birth control and abstinence and that's all fine and good, but the truth is, their cool friends are having babies and their friends are getting all kinds of attention and so, hey, Terrell, why not us? "He loves me," this fourteen-year-old told me. "Have you told your mother?" "Not yet." She squirmed and looked almost all her fourteen years. "I was hoping you could tell her with me." I nodded. "Sure." I've learned not to judge. I listen. I empathize. When I was a resident, I would lecture. I would look down from on high and bestow upon patients the knowledge of how self-destructive their behavior was. But on a cold Manhattan afternoon, a weary seventeen-year-old girl who was having her third kid with a third father looked me straight in the eye and spoke an indisputable truth: "You don't know my life." It shut me up. So I listen now. I stopped playing Benevolent White Man and became a better doctor. I will give this fourteen-year-old and her baby the absolute best care possible. I won't tell her that Terrell will never stay, that she's just cut her future off at the pass, that if she is like most of the patients here, she'll be in a similar state with at least two more men before she turns twenty. Think about it too much and you'll go nuts. We spoke for a while -- or, at least, she spoke and I listened. The examining room, which doubled as my office, was about the size of a prison cell (not that I know this from firsthand experience) and painted an institutional green, like the color of a bathroom in an elementary school. An eye chart, the one where you point in the directions the Es are facing, hung on the back of the door. Faded Disney decals spotted one wall while another was covered with a giant food pyramid poster. My fourteen-year-old patient sat on an examining table with a roll of sanitary paper we pulled down fresh for each kid. For some reason, the way the paper rolled out reminded me of wrapping a sandwich at the Carnegie Deli. The radiator heat was beyond stifling, but you needed that in a place where kids were frequently getting undressed. I wore my customary pediatrician garb: blue jeans, Chuck Taylor Cons, a button-down oxford, and a bright Save the Children tie that screamed 1994. I didn't wear the white coat. I think it scares the kids. My fourteen-year-old -- yes, I couldn't get past her age -- was a really good kid. Funny thing is, they all are. I referred her to an obstetrician I liked. Then I spoke to her mother. Nothing new or surprising. As I saiCoben, Harlan is the author of 'Tell No One' with ISBN 9780385335553 and ISBN 0385335555.