Leaving David
=============

* Brian Deady

Frank stood at the nursing station, pausing to observe the boy who sat hunched over his drawing. The boy seemed not to care that his nurse was hovering around, stuffing tongue depressors and latex gloves into nearly full containers. Apparently oblivious to the noise of the emergency department and to his own predicament, he worked his pencil crayon until the tip broke, ripping the paper. He drove his fist into the stretcher and swore.

"It's okay, Davie. It's okay. Look, I can tape it up." Marie walked quickly toward the nursing desk; anticipating her, Frank picked up a roll of Scotch tape and tossed it over.

"This what you want?"

"You read my mind. Thanks." She returned to David's stretcher, flipped over the drawing and applied a piece of tape to the tear. "There, see? Good as new. I can bandage a picture just as well as a cut finger."

She turned the paper back over and looked at the boy's work. Frank noted the concern in her face. "It's okay," he heard her say, more softly. "You're going to be all right." She drew the boy close in an effort to hug him. David remained momentarily rigid, and then briefly relaxed into her embrace. He looked up at her and then twisted away. He returned to his drawing; she had been dismissed. FIGURE

![Figure1](http://www.cmaj.ca/https://www.cmaj.ca/content/cmaj/162/9/1330/F1.medium.gif)

[Figure1](http://www.cmaj.ca/content/162/9/1330/F1)

Figure. 

Frank recalled the events that had led to this exchange. Nearly through another busy shift in emergency, he had picked up the next chart in the queue. "Parents want to talk to doctor," was the presenting complaint. His interest piqued, he approached the pediatric stretcher.

"Hello, I'm Frank Breen, the doctor on duty tonight. You must be Mr. and Mrs. Spencer." They looked distracted; a current of anguish - or was it anger? - was palpable in the room. He shook their hands briskly.

"And you must be David. How are ya, big guy?" He smiled, trying to break the ice, but the boy's face was unreadable. Turning back to the parents, he said, "How can I help you?"

It was the woman who spoke. She was pleasant-looking, of medium build, with dark hair pushed back from her forchead in a hurried sort of way. Frank could see the gray just beginning to settle in. She seemed fragile, and he felt an impulse to protect her - from what, he didn't know. Her husband stood at her side; his droopy mustache and puffy eyes gave an impression of fatigue.

"I want you to understand that we've tried, doctor, we really have. But tonight we have made our decision and here we are." Her eyes were red-rimmed and moist.

"Okay, go on please," Frank said.

"We've had David two-and-a-half years. He was six when my husband and I adopted him. We knew it wouldn't be easy, but we wanted to bring him up as our son. We thought we could show him love and affection, give him a decent life. We thought he might show us love, maybe do us proud, in return." She stopped and wiped a tear from her eye.

"When we arrived home that first night, we changed him into fresh pyjamas, showed him the room we had fixed up for him, and tucked him into bed. When we woke up in the morning, we tiptoed into his room, hoping to catch him still asleep, all warm and cozy in his dreams. But there he was, awake, sitting cross-legged on his dresser. He had ripped the wallpaper off the wall. He said he hated stupid sports and didn't want pictures of hockey pucks and footballs in his room.

"It scared us. But we told him everything was going to be all right and gave him a hug. It was like holding a stone. Truthfully, I think I knew it was over right then. But we couldn't just quit; it seemed obvious that he needed us.

"By the end of the first week he had wrecked his bedroom. He broke the window, punched holes in the wall and ripped a pillow to shreds. And this went on. There was always a new problem. He'd hit other children, or swear at the teacher or find some other way to disrupt the class. And the lying. The constant lying. All this time and we haven't got anywhere with him. We have to face facts, doctor. He doesn't love us. And the truth is...I have to say it...we don't know anymore how we can love him."

"No, Mom!" David protested. "That's not true!" His face was contorted, his eyes glazed. "I love you, Mom. I love you too, Dad."

Frank felt a gnawing in his stomach. He looked at the child and then got up and lay his hand briefly on his shoulder. The gesture seemed weak, he thought, but he remained standing at the boy's side anyway.

"There you go again. Lying." She started to sob, mascara-stained tears running down her cheeks. "No. We're sorry, David. You just don't know how sorry we are. But we can't take you home with us. We can't be your Mom and Dad anymore."

"Pardon?" Frank said. "What do you mean?"

Her face seemed to harden, and her voice became more controlled. "Exactly what I said. We don't want him anymore. We're not taking him home with us. Call Social Services."

"I see." He looked at the boy. David's eyes were focused on some distant point; he was already somewhere else. "Do you agree with this?" he said to the silent father.

Mr. Spencer hesitated. Then looked at his wife. "Yeah, we can't go on like this, I guess."

"Okay, I'll call Social Services." He walked away, not daring to look again at the boy. He went straight for the telephone; it was clear that the parents had been pushed to their limit. Sending the child home with them again tonight seemed unwise, perhaps even dangerous.

"Another success story for the ministry," Frank thought, as he waited for the social worker to pick up the phone.

"Hello, John Wilson here, Social Services."

"Oh, hi. Dr. Frank Breen, calling from Emerg at City General. Listen, got a child here who's going to need placement." He explained the situation.

"Let me pull his file up. Okay, yeah. This kid's been around the block and then some."

"What do you mean, exactly?"

"How about sixteen different foster homes? One adoption prior to this, lasted six months."

"Poor kid."

"I'll say. Anyway, look, I don't know where I'm going to find temporary care on such short notice, but I'll be over in an hour or so."

By the time Frank hung up the phone, the Spencers were passing by the desk, on their way home. Breen studied their faces, trying to understand how they could abandon a child. He saw no peace in their expression, only bitterness and resignation. And he felt a twinge of pity.

The shift was nearly over. But there was the usual backlog of patients to attend to, so Frank hurried off, eager to put this case behind him. As he passed by the pediatric stretcher, he saw David there alone now, reading a book that Marie had dug up for him. She had brought him some milk and a couple of digestive biscuits as if hoping to soften the blow.

An hour and a half later David was marched out of the department, Wilson, the social worker, at his side. As much as he tried not to, Breen imagined David buckling himself into the back seat of the social worker's car, preparing for the lonely drive to temporary foster care. He pictured his arrival at another house to face a melancholy room with crisp, clean sheets on a sagging cot and second-hand toys to amuse himself with. He felt sure David would mistrust the new foster parents. He would remember a dozen, a hundred other adults, their faces blurred together.

"Stop it," he told himself. "Stop dwelling on the kid."

He saw Marie at the pediatric stretcher, tidying up. Having worked with her for years, he had come to know Marie well. He recognized her desire to shut out thoughts by focusing on simple tasks. Feeling a need to commiserate, he walked over to her as she picked up the drawing that David had left behind. Together they peered at the sketch of a boy with a down-turned mouth and tears leaping from his eyes, the central portion mended with Marie's application of tape. Beside this sad-eyed figure David has added a smiling woman in a nurse's uniform, her arm extended around his shoulder.

Beneath this was written: "To my nurse, from David."