Sweet 16

I like to think I can relate to my teen patients. Yes I have 15 years on them, and yes, my skin isn’t as taught as theirs, and maybe I am not quite as computer literate as they are but I do like to think that I’m still sort of hip, I can still remember what it’s like to be young and not trusted and clueless about so many things. So I really make determined efforts, when young women come in for birth control or their first annual or an unwanted pregnancy, to make them feel safe and at home and like they can be honest about themselves and their situation. But sometimes, the adult in me comes out. And it surprises and actually upsets me when the adult/caretaker head rears itself at unpredictable times. I can’t tell if it’s actual caring that’s happening or just frustration and anger with the bad mistakes I see being made by some of these girls.

Yesterday I had a 16 year old girl on my panel who was coming in for her annual exam and her depo shot. Just seconds after I walked into the exam room it became clear that I would not have a huge amount of patience for this patient and that my “adult” head was starting to grow and grow and grow. She hadn’t filled out her intake form that each patient is asked to complete prior to their visit. She “lost” it. So, we filled it out together. She is a sexually active 16 year old female with NKDA currently not in a relationship but using depo for contraception who feels safe at home. She has been using depo for just about a year now but doesn’t like the “irregular” bleeding, which for her is spotting q 2 months. She’s interested in another form of birth control but can’t remember to take the pill and thinks the nuva ring is “confusing”. Her medical history is benign. She has a significant family history of alcoholism and a cancer that she does not remember the name of. She smokes ½ a pack a day but denies drug use. She uses ETOH 1-2 times a month.

She does not perform monthly self breast exams. She does not wear her seatbelt.

“You never wear it?” I ask.

“Nah…I don’t like to.”

“Why not?”

“Well, I wear it when I think I’m in a dangerous situation.”

“You should really wear your seatbelt all the time.”

“Well, I’m really good at knowing when the situation is dangerous. And basically when I’m in the car I just put my feet up on the dashboard so that would brace me if there was a crash or something.”

“Your legs would break if you were in a head on collision.”

“Well…better my legs than my head, right?”

“You should wear your seatbelt.”

“My friends and I were in a car accident and one guy got hurt pretty badly.”

“That’s too bad.”

“I saved his life.”

“uh huh”

“I did. I saved his life. There were four of us sitting in the back and I just laid right across everyone. If I hadn’t bee there he would have gotten hurt so much more. Human seatbelt!”

“…”

“So, I think about wearing my seatbelt more I guess.”

“I hope one of your friends doesn’t have to die before you start to wear your seatbelt all the time.” My “education” was devolving into scare tactics. It was terrible.

“No, I really saved his life.”

“Listen, I know when you walk out of this room you are going to do whatever you want to do. But as your care provider I have to encourage, no advise, you to wear your seatbelt.” And then it got worse. “I’m sure you and your friends are incredibly safe people and drivers.” I said. “It’s the other drivers on the road I’m concerned about. That’s where the unpredictability is.”

She didn’t buy it. She just smiled her sweet 16 smile. And started texting someone.