Wednesday, December 30, 2009

Gerald O'Malley, DO: Dreams from the 'hood, part 1

In my emergency room, I recently treated a 14-year-old girl that had been pregnant twice and was now on Depo-Provera birth control. While talking to this young lady about her sore throat, I became increasingly distracted by the small tattoo on the side of her face, by her right eye. Who would allow their 14-year-old girl to get a tattoo on her face? My 11-year-old still watches SpongeBob Squarepants. What happened to this 14-year-old?

I became curious as to what plans this girl and the other adolescents in my ED have for their future. Do they think about the future? What are their hopes and dreams?

Every summer we have medical students spend time in our ED to do research. I put them to work. We developed a series of five questions to ask people between the ages of 13 to 18. The questions were:

1. What are you doing right now? Are you in school or are you working or are you doing something else?
2. Where do you see yourself in 5 years?
3. Where do you see yourself in 10 years?
4. With whom do you live?
5. Do you have any children?

The results of our little survey were astounding.
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Almost all the teenagers — whether they were in school or not, working or not, had children or not — had some plans or goals. Some wanted to be doctors. Others wanted to be nurses or other healthcare workers. One kid wanted to be an astronaut. Of the two dozen teenagers that we spoke to, only one or two had no dream for their future. Only one teenage boy said that he expected to be in jail.

I must say, I was thrilled. Maybe things weren’t so bad. Maybe the girl with the tattoo was the exception.

The medical students were also excited. They wanted to know more. During a meeting, the idea came up to try to identify potential obstacles to the goals so the survey questions were amended. The results were slightly less reassuring.

Many of the teenagers in our survey had children. Several of the boys had no idea how many children they had fathered. Some 15- and 16-year-olds laughed as they tried to remember all the girls they had slept with and count up all their children; others didn’t want to talk about it and seemed almost embarrassed that they fathered children that they subsequently ignored.

The teenage single moms all seemed to be doing well. Many of them were in school learning some trade. Four of them lived alone, in their own apartments and had no contact with their families. Three of those four were enrolled in school to become nurses.

“How can a 17-year-old girl support an infant, have her own apartment, not work a job, and go to school and not have any financial or child-care support from their families?” I asked.

“State tuition assistance, city-supported child care, a housing subsidy grant, and WIC,” the students said. “From a financial or childcare standpoint, there really aren’t any obstacles for teenage moms to pursue their goals.”

This isn’t the case, of course. Our subsequent surveys (more on those later) demonstrated that even with enormous amounts of financial assistance, educational and career targets are frequently derailed by unplanned pregnancies.

I mentioned to a colleague that it seemed a shame that these girls had no contact with their families, and he said, “Family interaction is a two-way street. If the family isn’t willing to work through problems, then you can’t expect the teenage mom to do it.” That seemed like excuse-making to me. Why bother working through family problems when the alternative is to just move out and get your own place?

When I mentioned that it seemed remarkable to me that the city of Philadelphia is broke, shutting down libraries and fire stations and laying off cops and teachers, yet there is money to give to teenage single moms to pursue nursing degrees, one colleague actually said, “Well, I rather see my money go to support single moms than for other things – like supporting war.”

I could be wrong, but I don’t think that the city of Philadelphia has ever declared war on anyone.

Gerald O'Malley, DO, is the director of research in the largest, busiest emergency department in Philadelphia and an associate professor of emergency medicine at Thomas Jefferson University Hospital. He’s also the son of a NYC cop, die-hard Yankees fan, and a regular contributor to Practice Notes.

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