The sad odyssey of a troubled girl

She been on the residential treatment unit much longer than I. M. was smart for a 17-year-old, and too worldly for her own good. She had a fulminant temper that was not just bad, but legendary. But she was planning to go to college. She was on the cusp of getting it together. We put old photos of kids on the nursing station wall when we updated their charts. We put current pictures in the charts for police when the kids "eloped," or ran through the fields in an attempt to find a highway. But we hated to throw away the old photos of our charges. We began to stick them discretely on the station wall. We called it the Wall of Fame. Cute, with a stylish figure from disciplined bulimia -- which was convenient for me when I had to drag her back to the unit -- M. was a Wall of Famer. She cut herself to garner attention and release her bottomless rage. Intense, unstable, repeatedly self-destructive, chronically afraid of any abandonment, her only distorted thoughts and perceptions related to her personal relationships. A teenage insult caused her to steal scissors kept in the nurses' station and hide them in a stuffed bear for days, while staff searched frantically. When the scissors were thought gone for good, she sneaked into her rival's room at night and cut off the girl's long blond hair. She was caught with the pony tail in her hand. On the drive home, I thought of F. Scott Fitzgerald and his story, "Bernice Bobs Her Hair." Zelda Fitzgerald is thought to be one of literature's flaming borderlines, as was her husband. Fitzgerald captured the pleasure of wicked, outrageous revenge. But could we get M. to see why it is a good thing not to crash and burn? I tried to sneak up on her when I could, to listen in on what she was saying. It was my job. She was capable of anything. But she would chase me, cursing, calling up the devils, while I play-shouted, "Staff! Staff!" If she saw me coming, she would say, "You get out of here while I take care of business." M. crossed over to a more secure unit after every screaming deed. I liked to find out what provoked her, which was difficult to do, oddly. She preferred to rage against the things that didn't matter. Rage was her canvas. To talk about the truth was the hardest, bravest thing she did. Her father sexually abused her for much of her life. Her mother was either to ill or too drugged to intervene. And when not drugged up, her mother preferred to look the other way to keep the father around. Abandonment was final when her mother died, leaving M. and all the siblings to her grandmother. M. was screaming on the pay phone to her grandmother. Her grandmother was trying to explain something, but M. was crying. I patted her shoulders, so frail and bird-like. Her grandmother had remanded custody of her to the state. That way, her granddaughter could continue to receive Medicaid. In desperation, her grandmother did the thing that would almost guarantee continued care for a teenager in the U.S. if you have no health insurance. She gave her away. M. began a downward spiral. Her assaults grew more dangerous. She apologized to me for being "crazy." I told her she wasn't crazy, but that her behavior was scaring me. I told her that she was going to break her addiction to mayhem, and she smiled and said, "I don't think so anymore." M. didn't go to college. She went to prison. No one was able to persuade her that her grandmother didn't abandon her, that it was a legal trick. Sometimes we expect too much of our teenagers. Instead of a patchwork of laws that vary by state for children's health insurance, a nationwide plan of health care access makes sense, with psychiatric benefits to heal our most vulnerable citizens. Maybe such a system could have gotten M. to her high school graduation. Children are not disposable commodities. Let's work to give them this truth. It is too often all they have to go on.

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