Content warning: child abuse, self harm, suicidal ideation, substance abuse, gun violence
Eight years of med school, and a bachelor's, master's, and doctorate to show for it all. Although none of it could have prepared me for this case. This seventeen-year-old female was brought to me today with a long history of suicidal ideation, self-harm, depression, and PTSD. Currently, the patient has poor impulse control and unhealthy coping mechanisms. Patient has a family history of depression. The chief complaint today is poor coping, increased thought of suicide with a plan, and poor impulse control. Patient has had three prior unsuccessful suicide attempts including overdose and cutting. Patient speech is rapid, she has poor eye contact, stressed, and rambling, Patient appears disheveled.
When I saw the girl myself, my heart broke for Kelly Tristan. She was a pretty girl. Her long auburn hair hung loosely around her face. Her clothes, grey sweatpants, and a rumpled pink sweatshirt that looked like it hadn't been washed in a few days. The clothes hung off her frame. She was way too skinny for her age. Malnourishment, perhaps?
Her eyes darted everywhere. I glimpsed her face. Her nose was splattered with freckles, her eyes a dark shade of green. Put the pain and fear in those eyes I will never forget. She looked like she wanted to run away from everything.
I walked her into my office and asked her to take a seat. She fidgeted and squirmed. "Kelly," I said as gently as I could, "Can you tell me why you are here?"
Kelly shuddered. She said nothing. "Kelly, I am here to help you. You don't have to end everything just to end the pain. That's why I am here. I am here for you. This place is safe and I am your friend. I can't help you unless you tell me how." Kelly looked down, and breathed, and began.
"I have been never been happy. My parents did meth, cocaine, heroin, opium, and alcohol. They were the drug dealers for the local gangs, that was their income. I was beaten until I dropped to the floor unconscious. My brother too. I got shoved through doors, slammed on tile, beaten with a blow drier, whipped with an electoral cord, punched, kicked, had my hair ripped out, been clawed at, and bitten. I still have the scars from when I was a toddler."
Kelly rolled up her sleeves and related a long white scar on her right arm. "My mom took scissors and started slashing at me. She rolled up her left pants leg, "My dad threw a bottle at me and cut open my leg and he refused to give me bandages so I had to use my shirt. I can't hear right out of my left ear because my mom ruptured my eardrum. There were other things as well. James, my brother, and I were starved. We weren't allowed to open the fridge or even go in the kitchen. In total, we each had about three sets of clothes. There was no running water, not for us at least. We were constantly screamed at. I was nine when I began to steal for James and me. I was good at it. The beatings taught you to be sneaky. If you didn't get caught you wouldn't get beaten. Not always, but there was about a 2% chance that we wouldn't get whopped whether we had been "bad" or not. I stole clothes, food, money, medicine for the two of us. I lied about my age and got a job at a McDonald's to get more money to support us. When I was fourteen everything changed. James and I had been planning to run away. We had a route planned out, our bags packed and we were going to leave that very night. Little did we know that our parents had ratted out one of the most famous gangs, The Red Hand Mafia. They killed anyone, and it was not a quick death. Later I learned my parents had called the police on them hoping to get their money. They came to our house in the dead of night. James and I had been planning to leave at 1am when everyone was dead asleep. They raided our house. I was the only survivor. I had insisted that James crawl out the window to save himself. One member saw him and shot him. He died instantly. He was only eight. It was all my fault. I should have gone out first I should have known."
She shivered, and one tear slid down her young face, and when that tear fell the silence was deafening. I did not say anything, Kelly said nothing. It felt like the silence would never end. Until Kelly raised her head looked me in the eye for the first time and continued.
"I knew my parents were dead. I knew James was dead. There was this tree near my window, I slipped into it, climbed down, and ran for my life. I continued with the plan James and I had made. I had just enough money in my pocket to ride the bus as far as it could go. I was homeless for a year. What the streets do to you?" Kelly shook her head.
I decided to go into a shelter and that's when I started to hurt myself. They had dinner knives. So I did it. I didn't want to die, not yet. Until I started thinking of James and fifteen years of fear, hatred, pain, and suffering. They had asprin at the shelter. A blood thinner. I knew if I took enough I would die. I tried that two times. No luck. I took that as a sign that James didn't want me dead too. I stopped TRYING, but I still get the thoughts. "Hey, that bridge is nice and high. Go jump! Go jump in front of that car!" I started to collect myself. But all my fears didn't help. I am afraid of most people. I hate being all alone, but I hate human interaction. I never feel safe."
I looked at the girl, and she looked at me right back. I got up from my seat and hugged her. Slowly, the girl melted into my arms. I whispered in her ear. "You are safe. I will help you. It is not your fault, it has never been your fault."