History

“I need to ask you one more question.”

Ricky looks at me. “Okay.”

“Have you ever been stopped by the police?”

Ricky’s brow furrows for a split second, then relaxes. “No.”

“What will you do when that happens?”

Ricky looks across the room to his mom. She nods. “Go ahead,” she says.

He takes a deep breath. Slowly he says, “I’ll do whatever he tells me to do.”

“Yeah,” I say. “That’s good.” His mother nods again. I ask her, “You’ve talked about this?”

“Oh, yes, Dr. Haller. We have.”

“Good,” I say.

Ricky is 15. He’s thin, and he has a shy but generous smile. He wears glasses. His favorite subjects are math and science, and he’s getting As and Bs at school. He wants to go to college to be a civil engineer. He wants to build highways and bridges. And he’s African-American.

“I don’t know why I’d get stopped, though,” he says. “I’m not going to do anything wrong.”

He is so young, I think to myself. “I know you’re not,” I say.

I hate this conversation. I hate that I have to have this conversation and that I am going to have to keep having this conversation. But since August 2014, after Michael Brown was shot and killed in Ferguson, Missouri, a few miles from where I live and work, I have been having it more and more with my teenage patients, especially my African-American male patients.

A thorough history is crucial to delivering appropriate, compassionate patient care. This history-taking is, of course, modified based upon particulars about the patient, such as age, gender, and various other circumstances. With adolescents about age 12 and up, for example, pediatricians generally obtain from the patient a confidential “HEADS” history with the parents outside the exam room. We ask how things are at Home (H), at school/Education (E) and/or work/Employment (also E), what Activities (A) they engage in outside school and work, whether they have experienced Depression (D), what their Diet (D again) is like, whether they have tried Smoking/Drinking/other Drugs/Substances (more D/S), and whether there are times they don’t feel Safe (S).

In the past few years, that last S — Safety — has become more of a concern for me when it comes to these young people. Unlike the other letters in “HEADS,” though, I usually ask this with the parents in the room. It just seems to me to be a discussion for the entire family.

“I know you’re not,” I say again to Ricky, “but you know why I’m asking, right?”

He looks down at his feet and nods.

“Words, Ricky,” his mother says.

“Yes, sir,” Ricky says quietly, still looking at the floor.

“Ricky?” I say. He looks up. “How will it feel when the police stop you and you haven’t done anything wrong?”

He shrugs. “Bad, I guess.”

“Yeah,” I say, “I’m sure you’ll feel bad… and maybe mad?”

He nods, looking at the floor again.

“And what will you do?”

“I’ll do whatever he says,” he sighs. He’s still looking at the floor. “If he wants to see my ID, I’ll tell him where it is and keep my hands where he can see them and ask if I can get it for him.”

Ricky’s mother looks at me. Her eyes are a bit moist. And I realize, so are mine.

“That’s right,” I say. “That’s right… Now, Ricky, here’s what I want you to know.” He looks up again. “I want you to know that I know that this whole thing sucks. You should not ever have to go through anything like that. It is unjust, and it is unfair, and I am really sorry that you may have to go through this someday. When I was a kid, I would never have dreamed of having to worry about something like that because, well, I’m white.” This is, of course, obvious, but he nods and listens. “And if it makes you angry, that is really the only way a normal person could feel in that situation… But here’s the thing: I’ve known you since you were a little kid, right?” He nods. “You’ve bounced me up and down when you shook my hand.” He smiles. “I found those birds in your ears.” He smiles more broadly. “You’re a really great kid. And I know you have a destiny, a reason you’re here. I want to be driving over a bridge in about 15 years that you helped design — if they haven’t taken away my driver’s license because I’m too old!” He laughs. “But here’s the thing: You have to survive to make that happen.” Ricky is quiet again, and once more he nods. “So when that policeman tells you what he wants, you are going to have to do it. And when you get home, you can figure out how to what to do with that anger. Do something good with it. Go to the gym, run, write a blog, write to Congress, go to a protest… But you have got to survive… because I want to go over your bridge.”

He looks me in the eye, nods, and says, “Okay, I will.”

We all stand up as the visit ends. “And I’m sorry if I’ve been kind of lecture-y. At my age, I can get that way.”

“That’s fine, Dr. Haller,” Ricky’s mom says, nodding and shaking my hand vigorously. “That’s just fine.” I give her his physical forms and vaccination records for school.

“And you, sir,” I say, turning to Ricky, “I don’t need to see you again till next year. That’s when you get your meningitis vaccines. You’ll need them before you can go to college.”

“Okay,” he says, a little glum at the idea of shots in a year. He takes my hand, and I bounce up and down as he shakes it, just like the old days when I’d say, “Wow! You’re so strong! You bounced me up and down!” Today he gives me a smile/eyeroll — a smiyeroll? — that says, “I’m too old for that… but I’m glad you did it.” He actually says, “Thanks, Dr. Haller,” as he walks out of the exam room with his mom, the door closing behind them.

I am alone in the room. I sit down for a moment, then take a slow, quiet breath before I leave to see my next patient, a 17 year old African-American male.