What has happened to this little girl? What could cause this kind of damage? Not a car accident; there are no other vehicles besides the ambulance and the police cars. A fall from a bike? She’s deathly still and I wonder if she’s breathing. She looks like she could have been mauled by a dog or some other large animal. A flap of skin hangs loosely from her cheek and blood bubbles from her lips.
The EMTs lift her into the ambulance and are quickly on their way and the scream of the siren once again shatters the late-night quiet. I watch as it speeds away, the tires kicking up clouds of dust, and wonder how they are going to find out who the injured girl is. I’m just getting ready to ask the cop this question when I realize that everyone else is looking back toward the railroad tracks.
Another small silhouette appears. This time on foot, emerging from the tall winter wheat that fills the field on just the other side of the tracks.
Again my heart nearly stops.
It’s Violet.
She is moving toward us as if in slow motion. Eyes unfocused, unseeing. The front of her white T-shirt blooms red. Her hands look like they’ve been steeped in blood. Something tumbles from her fingers and lands on the dirt at her feet.
“Oh, my God,” I breathe. “She’s bleeding! Call another ambulance!”
It feels like forever until I finally reach her. I sweep her up in my arms and run my eyes over her, searching for the source of all the blood. “Help her!” I cry, laying her gently on the ground. “Please,” I plead. “What happened?” I ask Violet. “Who did this?”
Suddenly I know exactly who the other girl is. Violet’s best friend, Cora Landry. I feel arms pulling me backward and hear Sam telling me to let them do their work. Violet’s lips move but I can’t quite make out what she says.
September 14, 2018
Every doctor has a case that haunts them. A patient that runs through your thoughts while you sip your morning coffee, that tags along during rounds and therapy sessions. The case that sits shoulder to shoulder with you during the quiet moments and slides between the sheets with you at night and whispers in your ear, You could have done more. You could have done better.
For me, that case is the girl in the train yard. She’s how I measure time. Before and after.
Disorder—easy enough to define, right? A state of confusion. A disturbance that affects the function of the mind or body. Obsessive compulsive disorder, anxiety, ADHD, eating disorder, autism spectrum disorder, schizophrenia, mood disorder, posttraumatic stress disorder. And hundreds more.
Every day, through a combination of talk, behavioral and pharmaceutical therapies, my primary goal was to provide an organized clinical experience to my patients in the evaluation, diagnosis and treatment of children, adolescents and their families.
In the twenty-odd years I had walked the halls of Grayling Children’s Hospital, first as a medical student and then as a psychiatrist, I’d seen it all. I’ve seen children who compulsively eat dirt or paint chips or sharp tacks, and emaciated sixteen-year-olds who refuse to eat anything at all. I’ve counseled children who have been neglected, beaten and sexually abused.
If it sounds like I say this with pride, I must admit that I do. Psychiatrists are scientists, after all. We are fascinated by the brain and all its intricacies. It’s not uncommon for us—in closed circles, of course—to refer to a patient by their diagnosis. I’ve got my mood dysregulation at nine and my trichotillomania at ten.
We talk this way, as if the disorders are our own. It’s challenging, at times, to remain detached, to always approach each case with a clinical, dispassionate eye. We work with children, after all. It’s easy to become enamored with the idea of playing God. Desperate parents at a loss in how to help their child who is in pain. Mental anguish is just as excruciating as physical pain, if not more.
The girl in the train yard. According to the referring doctor it was a simple case. I imagined meeting with the child once or twice. I would listen to her story. Certainly scary and traumatic, but not the worst I’ve encountered. I would nod my head in all the right spots and ask questions about what happened in the train yard. But not too pointed that she would shut down and not feel comfortable talking to me.
I would instruct the parents on what to look for in their daughter in the coming weeks: intrusive thoughts, avoidance, negative moods, anxiety. I would tell them to seek follow-up professional care for her if any of these symptoms persisted.
I wasn’t worried. I was intrigued. As I learned more I became more invested, more absorbed. Three twelve-year-old girls walk into a train yard and two come out unscathed. What doctor wouldn’t be fascinated?
I often wonder what would have happened if Dr. Soto had called another psychiatrist. Perhaps the end results would have been different. But I picked up the phone and I made the long walk down to the emergency room.
Excerpt from the Journal of Cora E. Landry
Sept. 9, 2017
Well, volleyball lasted all of four days. I knew I would suck but I figured some of the other girls would be just as bad as me and we’d just end up on the B team. No such luck. There is no B team and I actually am the worst player.
Of course Jordyn is also on the team and really good. I swear she kept serving the ball right at me and I couldn’t bump a single one. This happened like eight times in a row. At first the girls on my team were really encouraging and said, “It’s okay, Cora, you can do it!” and “Shake it off!” But after a while it was pretty clear I couldn’t do it, so they stopped saying anything.
I tried, I really did. I even dove for one of Jordyn’s serves and ended up twisting my ankle. It didn’t really hurt but I started crying. Why do I do that? The coach told me to go get a drink of water and sit out until my ankle started feeling better. I sat on the sidelines the rest of practice. Afterward, when we were changing our shoes, everyone told Jordyn how good she was. No one said anything to me, not even to ask me how my ankle was.
I told my mom and dad that I got hurt and didn’t think I’d be able to play anymore. Of course my dad was like, “You can’t quit! Landrys aren’t quitters. You’ll be fine!” and I had to go to practice the next day. And the next. And the next.
Then it was like I had a target on me. Jordyn wasn’t the only one serving the ball right at my head. EVERYONE started trying to serve or spike the ball at me. Even the ones who are nearly as bad as I am. It was so obvious. Even Gemma, who is normally nice, got this mean look on her face just before she served. I swear she glared right at me and aimed. At that point I didn’t even try. I just stood there and the ball hit me on the shoulder. Everyone laughed. Except the coach and I bet that’s because she’s paid not to laugh at the kids.
When I got in the car after practice my mom asked me how it went. I told her that I wasn’t going back. “You can’t quit,” she said and I started crying and I couldn’t stop. When we got home my mom tried to get me to tell her what was wrong but I couldn’t.
