Franciscan Hospital for Children, Inc.
Brighton, MA

Written by Mark Alexakos, M.D., Project Director

Who Will Help Carlos?

"Dr. Mark, please come to the office.”
"Dr. Mark, please come to the office.”

Schools still overhead page, I feel like a doctor in the 50’s. On my way down to the principal’s office, I briefly wonder what I did to get into trouble but realize I graduated elementary school thirty years ago.

As I entered the office, a tearful young brown-haired boy sat looking down at his feet, next to the school nurse and principal. The principal had sweat on his brow. The nurse takes me aside and tells me, “Carlos wants to kill himself. The MACAS test was too much pressure.” Tears streaming down his cheeks, he says, “I can’t think anymore,” and mostly shrugs his shoulders to questions.

In these situations, my first step is to take a deep breath and call his parents. Carlos’s mother and father run into school and hug Carlos, who starts to cry again. Because they speak Spanish, Dr. Santos our Spanish-speaking psychologist joins us. Mr. Hernandez is anxious and talking rapidly. Mrs. Hernandez, who is pregnant, has a demeanor like her son: quiet, looking down at her feet. With eyes welling up she softly says, “He put a rope around his neck last night.”

It is not often that an eight-year-old boy puts a rope around his neck. Our plan: have Carlos go to the ER. This is what any rational mental health provider would do. I explained to Mr. and Mrs. Hernandez that he needed to get help in a safe place so he wouldn’t hurt himself. The next day, a familiar page came early in the morning: “Dr. Mark, Dr. Santos, please come to the office.”

To our surprise, Carlos and his mother sat in the principal’s office with bags under their eyes. Carlos and his family spent half the night in the ER. They were sent home with a list of web sites to find an outpatient provider. Ms. Hernandez has no computer and the list was in English.

Carlos had no insurance. He is a victim of what my senior residents in medical school cynically referred to as a “wallet biopsy.” His care was dictated by insurance, not need. The hospital would not accept him because of his free-care status so he was discharged. The principal really had no idea what to do now.

Dr. Santos and I quickly got to work. Dr. Santos, a petite woman from the Dominican Republic, spent that morning with Carlos’s mother. We learned that Mrs. Hernandez was born and raised in a “dusty” rural area of Guatemala. She was one of nine children; their family struggled to get by. She toiled in the fields. Life was hard. Looking for a better life, she and her brother paid to be transported across the United States-Mexico border.

She met Carlos’s biological father in Los Angeles. He was going to love her and take care of her. Soon after Carlos was born things changed. He stayed out a lot and would come home late reeking of alcohol and would scream and hit her. After he broke her ribs, he was arrested and she left Los Angeles. Carlos was four years old.

Carlos never really adjusted well to moving to Boston. Mrs. Hernandez said he is always cold and nervous. He doesn’t do much since she has become pregnant. He stays in his room a lot. Carlos’s stepfather took an evening job, anticipating needing more income to support the baby. He has had less time to play ball, which Carlos loved.

To help Carlos, Dr. Santos and I needed to work with him, his family, and his school. Dr. Santos started to meet with Carlos individually for psychotherapy. They often played nerph basketball in the office. Carlos was a sports nut and talked on and on about anything to do with a ball. He also started to tell his own stories like hiding under the table when his father beat his mother. Dr. Santos taught him how to manage the fear that those awful memories brought.

But that wasn’t enough; he barely spoke in the classroom and wouldn’t look others in the eye. Dr. Santos and I helped the school help Carlos. We worked with them to help reduce his stress and put off the standardized state test. We got Ms. Smith, his teacher, to pair him with another boy who also loves sports. Ms. Smith started sending him on special errands to the office. The principal would take that opportunity to talk to him about the Red Sox, and we got Carlos a big brother who loved sports.

But this still wasn’t enough. Mrs. Hernandez would not come back to the school to meet with us, even though she lived three blocks away. Dr. Santos tried to visit her at her house but she wouldn’t let the psychologist in. At one point Dr. Santos caught her looking out the window so she waved. Mrs. Hernandez sheepishly opened the door. She apologized but was embarrassed, she rented her apartment to two other families and lived in the basement and didn’t want them to know her business. She agreed to let Dr. Santos come at specific times when the other families weren’t there.

Dr. Santos soon became alarmed. Mrs. Hernandez was so depressed that she mostly sat in the basement all day. “I remember my first visit to her house: it was dark, all the windows were covered up, and it was hot, a chicken was boiling in a pot on the stove. I talked with her about how bad she felt. She just didn’t want to do anything.” With time, she agreed to take an antidepressant medicine.

This was the tipping point. Mrs. Hernandez had a great response to medication. She came out of her shell, smiling and talking again. Carlos began to participate in class and even started to high five me in the hallway at school.

We all worked together to help Carlos: mental health professionals, the school staff and his family. Carlos is no longer using our services and is doing well at the middle school; and he still high fives me when I see him in the hallway.

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