Two Different Worlds

   I glanced at the chart to see who it was before going into the examination room. It was Bonnie, an overweight teenager I had seen once or twice before. Bonnie's mother had a determined look in her eye, and she sat with her arms folded across her massive chest.

   She glared at me from the other side of the examining table, where Bonnie lay like a beached whale staring up at the ceiling.

   Bonnie was a large, coarse-featured 13-year-old with doughy white skin and facial acne. Her hair was closely cropped about her head, and she wore a set of menacing, stainless steel orthodontic braces like a villain out of a James Bond movie. Her formless grey sweat suit engulfed her body, and she sullenly ignored my greeting.

   Her mother spoke first. "Doctor, is there any way you can tell if she's pregnant?"

   I was momentarily surprised, not by the question of teenage pregnancy, but by the thought this large, dull creature might be active at all, let alone sexually active. She seemed light years removed from the seductive adolescent temptresses who usually asked me that question themselves. I thought the idea was ridiculous, but felt obligated to answer.

   "Yes, we can do a pregnancy test," I said, "but it may not be accurate until several days after a missed period. How long has it been, Bonnie, since you had your last one?"

   Bonnie thought for a moment, and then, wthout looking at me, said in a very low voice, "about six months."

   I tried to reassure them. "Sometimes a girl doesn't have regular periods the whole first year after she starts, Bonnie -- but let's have a look and find out."

   I pulled up her sweat shirt and stared in amazement at her abdomen.

   It bulged upward in a gentle curve from below her sweat pants to just beneath her rib cage. Her belly button was stretched so tight that only a small dimple remained. I held a stethoscope to her abdomen just next to her navel and listened. There was a heart beat, faster than and not in time with the one I could feel over her chest. And then I felt a firm round object, about the size and shape of a grapefruit, down in her lower abdomen just above her pelvis. Finally, I did a pelvic examination, and her cervix felt soft, like the lips of a mouth, instead of firm, like the cartilege of a nose.

   "I'm sorry," I said, "but you're right. Bonnie, you're pregnant."

   And then Bonnie told us what had happened. Her 15-year-old brother's best friend used to live in their neighborhood, but the boy and his family moved to Florida last year. The boys missed each other, and so her family invited the boy up to spend a week last summer at their house. The boys slept in her brother's room, just down the hall from Bonnie's, and almost every night the boy from Florida would go into her room and have sex with her.

   I went home that afternoon feeling very depressed, and for once the sight of my own four daughters didn't make me feel any better. Eight-year-old Erin and her friend were playing dolls on the front porch. Eleven-year-old Noelle was riding her bicycle up and down our driveway.

   Sixteen-year-old Caroline was upstairs talking on the phone with a girl friend. And Laura, my own 13-year-old, was playing the piano in our living room. I sat down and listened to the music and tried to sort out the thoughts racing through my mind.

   Just last month Gloria, one of my 15-year-old patients, came to see me for fever and a backache that turned out to be a urinary tract infection. She had been having sex with her boyfriend every afternoon in her own bedroom. He had been coming home with her after school to study and do homework, and had asked her for sex the fourth time he was there. Three days later she agreed, and they didn't even know each other's favorite foods, music, vacation places, or anything else about each other.

   After dinner that evening, I told my wife Moira about Bonnie and Gloria, and how worried I was that something like that could happen to our girls. What happened to Bonnie wouldn't have happened if her parents hadn't invited a 15-year-old boy to spend an entire week at their house.

   And if someone had been at home with Gloria when she came home from school, maybe she and her boyfriend wouldn't have had sex and she wouldn't have had a urinary infection. We needed to be very careful nothing like that ever happened to us.

   Moira said, "Oh, our girls are not like that. Things like that don't happen in our neighborhood.

   We're not at all like those people and besides, our girls are different. Things like that happen to people on the other side of town -- they don't happen here. We have nothing to worry about at all."

   Well, Bonnie and Gloria are both white. Gloria's mother is an attorney for a Fortune 500 company and her father's a division manager for another. They have a house in Dunwoody with a swimming pool and a three-car garage. Gloria's boyfriend is only 16 and has his own car. Bonnie's mother sings in her church choir and her father sells water sprinklers to shopping centers and country clubs. Things like this don't just happen to other people:

   They can and do happen to people like us.

   The next Sunday afternoon was the student recital Laura's piano teacher presented every year, and this year it was to be at our house. Outside it was winter and the rain was coming down in buckets, and I told Moira I was going to take up the oriental rug in the foyer so it wouldn't get muddy from people coming in out of the rain.

   "Don't be silly," she said. "Nothing can hurt an oriental rug; they wear like iron, they're indestructible." I wondered where she might wear an oriental rug, but didn't say anything.

   She's wrong, of course. Nothing's indestructible, not even an oriental rug. This one in the hallway was from my bedroom when I was a boy, and it cost my father a lot of money to repair it after our dog chewed up one end of it. And now Moira's standing there telling me an oriental's indestructible!

   The doorbell rang and it was the Masseys, all four of them, and absolutely drenched. Each one of them wiped their feet outside on the doormat before coming in. 

   "Oh, Moira!" Olivia Massey said. "What a beautiful rug! But aren't you afraid it will get all muddy on a day like this?" "Oh, not at all," Moira said. "If it does, it will just wash right out, and besides," she said, looking at me, "you know what people say -- if you don't own your things, they will own you."

   The Dunbars were next, with Erick and Derrick, their nine-year-old twins. They walked right in, with Georgia red clay mud streaming like rivers off of their shoes and soaking into the carpet. Everyone was struggling out of their raincoats and handing their umbrellas to Moira and me, and if anyone noticed the mud, nobody said anything.

   While Moira showed the Dunbars into the living room, I rolled up the carpet and carried it downstairs into the basement. When I came back up the stairs Moira was greeting yet another wet family. Our eyes met briefly before she showed the new arrivals into the living room and I turned to answer the doorbell.

   The next day the answering service called to say there was a newborn baby for me to see at the hospital. The baby was fine and so was the mother -- except she was only 14. Only 14 years old, and what kind of future was left for her now? A high school diploma? A college degree? A good job? A decent husband? A nice house? Her children on the honor roll at school?

   No -- she probably will quit school, if she hasn't already. The best job she's likely to get will be flipping hamburgers at a fast food chain or pushing the buttons on a discount store cash register.

   She probably will be on food stamps and live in an apartment or housing project forever -- and her baby's as doomed as she is.

   Gloria's boyfriend had the sexual thrill, but she's the one who had the fever and the backache and who hurt when she had to urinate. Bonnie's boyfriend had sex for a whole week, but she's the one who got pregnant, gained weight, and has swollen feet, backache, and fatigue. She's the one who will go into labor and have the baby. She's the one who will drop out of school and have a dismal future in front of her. She's the one who will suffer.

   When the boy who was the friend of Bonnie's brother found out she was pregnant, he cried and offered to marry her. His family offered to pay for her to have an abortion or for the costs of her maternity care -- but Bonnie decided she didn't want to get married, and she didn't want an abortion.

   She and her family weren't sure if they would keep the baby or put it up for adoption, so they decided to wait until "later" to make a decision. The baby was born on her parents' wedding anniversary -- and I still don't know what they decided to do about the baby.

Sometimes I think all of us live in different worlds from each other-- male and female, parent and child, and husband and wife -- and it's not just a matter of different principles or ethics or zipcodes. It's a matter of knowing something bad can happen if we just sit back and let nature take its own course.

   When a chicken comes home to roost, it soils its own nest.

E. Noel Preston, M.D. is a pediatrician in solo practice in Peachtree Corners. 6063 Peachtree Parkway, Suite 202-A, Norcross. (770) 448-1553. More information can be found at www.PeachtreeCornersPediatrics.com

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