labor nurse has been reborn and shares her experiences as a new nurse-midwife, woman, and blogger

Tuesday, November 6, 2007

Polly (the fast version)

I've been finding that I have a soft spot for the young girls who come in with a laundry list of problems. My first real introduction to this type of girl was in my primary care rotation; an 18 year old who was essentially homeless and couldn't even scrape up enough money for tampons and had soiled every last pair of underwear she owned with her period. Most would look at their history and cast them off as losers, possibly junkies (whether or not they did drugs), without second thought. But how can a young person go so astray? Where was the positive adult influences in their lives?

Take, for instance, Polly. She's only 14 years old. She has been sexually active since she was a mere 11 years old. She said she has had up to 20 partners so far. Her first pap smear was significant for low grade lesion. A colposcopy was negative, and two repeat pap smears were still showing some atypical cells.

Remember, she's only 14.

When I walked into her exam room, Polly's eyes revealed how quickly she would retreat if things made her not feel right. I made sure to make eye contact with her, and hoped that I conveyed openness. I asked her all the usual questions, you know... all the fun gyn stuff, and then asked if she was having sex with anyone now.

"No," she said. "But I have a boyfriend." Who is 18. She'd been with him several months and he was "cool" with not having any sex with her. Polly said she was trying not to have sex and make her relationships "real". I told her I thought that was really a good decision.

As we continued to talk, I noticed that she was trying to cover her arms. It soon became obvious why: she's a cutter.

Now, I have never understood the desire to hurt oneself. I do know that the cutting itself releases endorphins, helping the person feel better. But still, I've always found crying and moping a much better way to releasing my emotions. each his own....

I put a hand on her arm and asked about her cuts. Polly didn't say anything at first, likely because she was trying to come up with something. She must have realized that it would be hard to explain symmetrical cut marks that were equal distance to each other in an orderly fashion down her forearm.

She gave the typical teenage shrug, and the "I don't know". But soon she was talking about living in a group home for kids with behavioral problems, and how her father put her there because he didn't know what else to do. Her mother was a distant memory of her toddler years. It was her father, she said, who also decided she needed gynecological care, and from what she was saying he sounded like he was very much involved. He was the one to make sure she kept her follow up appointments, and hammered in how sometimes abnormal pap smears can lead to cancer if not treated properly. Polly's dad also came in to discuss with the doctor in an earlier appointment what would be the best birth control for her, because he didn't want to be the parent with "his head in the sand". And of course, he kept up on when she was due for her Depo-Provera shots.

I asked Polly if she was ok with all this, and how her dad knew about her gynecological business. She said she loved her dad, but couldn't live with him. She was glad that he didn't just "dump her off" at the group home like the other kids were. She was one of a few that had a parent who visited them regularly.

I could go on and on about all of her problems. I've barely scratched the surface here. But my fundamental question here is, what the frig happened to her? Why would this girl be making such bad decisions at such a young age? What could make such a young girl get off to such a bad start?


Anonymous said...

My first thought is abuse. Girls who become sexually active so young have often been exposed to sexual behavior earlier. With all his interest in her gynocological business, my money's on the dad.

Labor Nurse said...

Ya, my thoughts leaned in that direction, too. But I'm not sure. Something is telling me that it wasn't the dad, but someone close. Perhaps a friend of her dad's? I'll likely never see her again, so I won't be able to ask her about sexual abuse.

AtYourCervix said...

That's so incredibly sad.

My first thought was sexual abuse as well.

Melissa said...

Stumbled onto your blog...

I'd wager that dating older boys/men plays a role in the self-destructive behavior. Expectations of sexual availability from older boys/men not meshing well with ones own comfort level can lead to all sorts of internal conflict. But breaking up is not an option -- the boy or man loves you, protects you, gives you some measure of freedom (he probably has a car and financial resources, however limited).

I think Dad is good in that he's not "sticking his head in the sand." But by the same token, he's consenting to some serious behavior. Behavior that probably isn't the best for the 14 yr. old girl. I'm not one to go all "abstinence is the only way" on anyone but I can't think that Dad's approval -- however unspoken -- is helping.