Waiting Rooms

at 10:43 PM

I have become a connoisseur of waiting rooms. But walking into foster care clinic, the mood is different. Mothers and daughters sit slightly further apart, and skin colors often don't quite match.

The day's first patient is Tyrone, perched in his diaper on step-mom's knee. His medical chart has a special tab for the police report that led child protective services to take custody. A police officer found Tyrone in the backseat of a car while his Mom was a mile away in the park, high and barely conscious. Tyrone, meanwhile, is at the 2nd percentile for weight.

As I make an airplane gesture and zoom my stethoscope onto his chest, Tyrone giggles and grabs his stepsister's hand. He has been starting to eat more, talk more, and he copies his new sister's antics. I ask the doctor the chances that Tyrone returns to his birth mom. "Probably 50-50,” he says.

That afternoon, I continue my pediatrics shift a few blocks away at juvenile hall. The mood in this waiting room is diametrically less subtle. Double-locking security doors open to concrete halls, winding through blocks of cells. Physical exams here are mandatory, and as such it's the first clinic I've experienced with a zero percent cancellation rate.

Shuffling into our concrete exam room in his brown sweatpants and orange T-shirt uniform, 16 year-old Miguel explains his burglary strategy. "Old Asian people always hide money in their house,” he says. I ask if he worries about hurting people. "Not really, I just like money and smoking and stuff, “ he says. We discuss the pros and cons of his decisions, I administer immunizations, and we walk back to his cell.

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I think back to Tyrone, the toddler I saw in the morning. I worry our clinic is only a detour in the "school to prison pipeline."  In medicine, we have a philosophy that to cure a disease we treat the source, not the symptoms. Today I worry I've only treated symptoms. So that Tyrone doesn't sit on the same exam table where I saw Miguel today, we have to look upstream, to our prisons, schools, communities, and most importantly, our homes.

With a Perspective, I’m Jake Rosenberg.

Jake Rosenberg is an MD/Phd student at the Stanford School of Medicine.

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