Juvenile Hall

Well not everybody, but I did, as I spent the past week in the Santa Clara County Juvenile Hall. I have to admit, at first I was more than a bit apprehensive. Growing up in the mean streets of Sugar Land, Texas I never met anybody that was in a gang, and the closest run-in I ever had with the law was the one time in high school that I got pulled over for running a red light because I was in a rush to get my tennis rackets strung for a tournament that weekend. Not the sexiest rap sheet I know.

Entering Juvenile Hall, I went through two locked doors and followed a yellow line to the control desk where they pointed me to the medical clinic. I couldn't help but feel a bit like Dorothy, or more aptly, the Cowardly Lion on the way to meet the Wizard of Oz. In this case, the Wizard of Oz turned out to be Dr. Jerry Klein, who definitely showed no penchant for smoke and mirrors and arriving and departing via hot air balloon. Immediately, he set me to work.

As part of the medical care at Juvenile Hall, each kid that comes in undergoes a full physical. The first patient I interviewed was in because he was riding in his cousins car, and when they were pulled over for a routine traffic violation, the police discovered drug paraphernalia (mushrooms and scales) in the car. An important part of the adolescent physical exam is the HEADS assessment (Home, Education, Activity, Drugs, Sex). After hearing his story, Dr. Klein came in and I presented the patient to him, and then I had the enviable job of checking for inguinal hernias. Cough, cough.

This past week has been an amazingly enlightening experience. I never for once felt unsafe at juvenile hall, and all my apprehensions quickly dissipated each day as I was greeted by the friendly nurses, medical assistants, and clerks each morning. Speaking with the patients, my eyes were opened to life in its grittiest details. At the end of the day, I realized that despite whatever crime that these kids were accused of, they were just that--kids. The toughest gang member would suddenly become the 14 year-old kid that he was when we took out a needle for a TDap vaccination.

Some of the kids were from average families who just were at the wrong place at the wrong time, but a significant majority of the kids came from group homes, children shelters, or foster homes. One young 12 year-old boy had bounced from group home to group home for months. Many were suspended from public schools and had to go to alternative independent or remedial schools, and while, most of my kids answered that PE was their favorite class, I was delighted when the rare kid would answer history (I was a history major in college) or chemistry.

Of course, often times I felt I had trouble connecting with my patients. I had never been in a gang, never heard of a group home until this week, but what I had been was a kid. And remembering what it was like to be an awkward 14 year-old (some might say I'm still awkward, but I beg to differ), scared, and away from home helped me gain at least some measure of understanding of what my patients were going through.

Most importantly, I was there to listen and learn. The beauty of providing medical care at Juvenile Hall is that the kids have no place to go. Your patients in an outpatient private practice may have soccer practice to go to or a date that night, but my kids had no other place to go but sit there and bear with my (I'm sure) boring and seemingly irrelevant questions.

I also learned quite a deal about gangs in the San Jose area. Bloods, crypts, Nortenos (Northerners), and Surenos (Southerners). One of my patients even suggested that if I were in a gang I would most likely be a Crypt--apparently its the Asian gang.

I wasn't alone in all of this. Along the way Dr. Klein encouraged me to explore these social issues, and he always made sure to call me over when he saw some pathology in a patient that he was examining in the other room.

One patient stood out for me. Joe (I changed his name) had run away from his group home, and in the process of jumping over a dry creek bed, ended up dislocating his knee. The knee joint is a fairly strong joint, and you need incredible force to completely dislocate it, tearing the ACL, PCL, MCL, LCL. When I first met Joe he was in the back of the infirmary of the clinic, a small quiet room away from the hustle and bustle of the clinic. I felt I was entering a solitary confinement room. Joe had all sorts of orthopedic hardware sticking out of his leg, a rather dramatic sight for the uninitiated like myself.

Over the course of the week, I got to know Joe. He had been in Juvie previously for hitting his father with a tequila bottle, and ran away from the group home because another kid and him would get into arguments over who got to use the phone. He also told me of his history of what sounded to me like schizophrenia. When I had down time, I would sit down next to him in his bed (inevitably waking him up from a nap), and just shoot the breeze. He told me about his faith and pointed out his favorite passages in the Book of Mormon. He told me about his desire to get back to his unit and be with his friends. And he got up excitedly and smiled each time he heard me entering his room. He asked how tall I was, and asked me to guess how tall he was. We talked about basketball. And each time as I left he would shake my hand, and I felt that for a split second I wasn't a medical student seeing a patient, but a friend visiting someone at the hospital.

That feeling raised an ambivalence within me. Could I be friends with somebody charged with assault and battery? Unfortunately, I don't know what happened with most of the kids I saw this past week, whether their cases were thrown out or they were sentenced for longer stays at Juvenile Hall or the California Youth Authority. Some were in for minor crimes, some were in for armed robbery or grand theft auto, but not once did I consider them criminals. I am not in the legal profession with their black and whites, right and wrongs. Luckily, I am in medicine, where we have the luxury of not having to view people as good or bad, but only as sick or healthy. For all they did, didn't do, or were accused of doing, the kids at Juvie were just kids, my kids, my patients, for one inspiring week.