What If…?

During my first two years of medical school, the service-learning program I most enjoyed was Sickle Cell Superheroes. This program matches medical students with teenagers (or “kiddos,” as I like to call them) who are transitioning from pediatric to adult hematology for management of their sickle-cell disease.

My kiddo was Harry, and I absolutely adored him.

Harry was forty minutes late for our first appointment. Sitting in the clinic’s waiting room, I thought, What if something happened?

“He often misses appointments,” a staff member shrugged. “I’d just get on with my day, if I were you.” But I couldn’t shake my concern, so I waited.

When Harry arrived, he was all smiles. His vibrant brown face was freckled, and his eyes held a mischievous twinkle. His hair cloaked his shoulders in a gorgeous Afrocentric twist-out. His mother, a medical assistant, accompanied him. As we chatted, I felt my worries wash away.

Harry and I hit it off immediately. He’d been diagnosed with sickle-cell as a baby; he and his mother knew the clinic inside-out. Together, they reminisced about Harry’s childhood appointments in the “dinosaur room,” with its toddler-sized dino bed and jungle-themed walls.

“It was a sad day when I outgrew that bed,” he said with a chuckle.

I learned, though, that beneath his smiles, Harry was in constant pain. The oral narcotics he took barely enabled enable him to function, and every month or so, excruciating hip pain brought him to the ER. He visited the hospital so frequently that his doctors had placed a port beneath his skin to allow them to draw blood and administer medications more easily.

Harry’s mom managed his medications and hospitalizations, seeking to give him a normal childhood. But Harry had grown so dependent on her that he didn’t know the names of his medications, their doses or how to order refills.

Over time, I learned more. Harry and his mother lived about an hour from the clinic. She was the only parent in the picture. Harry loved her boundlessly. I came to believe that his smiles were for her—a protective shell shielding her from his deeper pain and sadness.

One day, I received an email from Nurse May, who kept tabs on the program’s kiddos. “Harry was admitted to the hospital today. Why don’t you say hello?”

When I found Harry’s room, he was alone, and in so much pain that he could barely keep his eyes open. Their whites had turned yellow—a sign that his sickled blood cells were breaking apart in his veins. Watching tears pool in Harry’s eyes, I felt certain that there was no smile wide enough to conceal his pain.

“What’s your pain, on a scale of one to ten?” the nurse asked.

“Nine,” he replied. I imagined that he was saving the top number for a level of pain he hadn’t yet felt—but if we’d traded bodies, I’d be screaming, “Ten!”

“Nine?” the nurse said.”We just gave you morphine. Are you sure you’re not just emotional?” Protectively, I stepped closer to the bed.

“Harry is in pain,” I asserted. Knowing how often Black pain is not taken seriously, I prayed that she would at least hear mine. She nodded and left, and I sat with Harry, holding his hand until he fell asleep.

That evening he received an exchange transfusion, in which his sickled blood was removed through one port and non-sickled blood brought in through another.

The next morning, I skipped my classes and went to visit him. His mother was there, completing a paint-by-numbers picture, and they were smiling.

“Ma, you’re acting like a little kid with that paint-by-numbers, while I’m out here, a whole-ass adult, taking care of myself,” Harry joked.

“It’s so good to see you,” I said, relieved.

“It’s good to feel like myself again,” he replied.

Over the next three days, I spent hours curled up in the big armchair beside Harry’s bed, determined to break through his shell.

What if this were me? I thought. I would want a friend, even if I couldn’t say it.

One day we played Assassin’s Creed III for six hours, and I learned more about Harry.

For as long as he could remember, he’d been in and out of the hospital. He loved to play basketball, read books and play video games. He hated cold weather and wished that he could live in the Caribbean, where most of his family still lived. He’d never done well in school; every time he started to get the hang of things, he’d end up back in the hospital. None of his family had gone to college, and he wasn’t sure he could make it, either.

He’d started working when he was seventeen, first in retail, then at a fast-food chain, but he didn’t enjoy customer service. He wanted to be a radiology tech: Going for imaging was the only hospital experience he enjoyed. He didn’t like working with little kids, but he loved to play.

His favorite holiday was Christmas.

Harry was my hero. We couldn’t have been more different, but I admired his resilience in adversity and his devotion to his mother. He brought me laughter, a smattering of rap lyrics, and scenes from his favorite scary movies. I aspire to be like him someday—spreading positivity wherever I go and bringing light and humor to the darkest corners of illness.

When Harry was discharged, I felt an emptiness: I was saying goodbye to a friend.

We kept in touch by text. Sometimes he kept his appointments; when he didn’t, I figured he was busy with work or school, or that his mom couldn’t bring him. But I worried about his mood, too. He’d been missing appointments with his counselor as well.

After one missed appointment, I texted him, “Hey, kiddo. Missed you today. Hope you’re okay.”

A few days later he replied, “Hey. Sorry, just seeing this. I went out the night before. Some guy pulled a gun, and everyone had to leave.”

I responded, “Holy shit, are you okay???” No reply.

A few months later, he called. He said that he’d enrolled in community college, and that it was hard. He was feeling depressed.

Harry stopped coming to his appointments. Then he stopped responding to my messages. I was crushed. I missed him.

What if something happened? I kept wondering.

One day, walking through the hospital, I got an email from Nurse May: “Hey. I just wanted to let you know. Harry overdosed last night.”

I froze. The classmate walking beside me asked what was wrong. I told him. He shrugged.

“Par for the course,” he said. “What did you expect?”

What did I expect? That’s all my beloved Harry was to him, a statistic. What did I expect? I expected empathy for my friend. I had no words; I took a deep breath and walked away.

When I got home, I cried tears of anguish for Harry: Have I lost him forever? Tears of doubt, for myself: Should I have reached out more? Told him that I loved him more? Tears of anger at my classmate: How could he say that?

To my immense relief, Harry was resuscitated. He’s now in rehab. He still doesn’t answer my texts. I wonder if he’s embarrassed, sad or scared that I might judge him. I wonder if he has anyone to confide in, or if his feelings remain hidden beneath new smiles.

But now, every time a sickle-cell patient is late to an appointment, my thought is different, more definite:

Something has happened.