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To the Boy Who Was Late for Class: I Should Have Reached for Your Hands

      I do not remember the name of the boy in my high school who was perpetually late. I do remember that he was tardy four times in one semester, and the fourth tardy meant detention. I had perfect attendance in high school. Had I been presented with that ominous yellow slip, I would have broken down on the floor in tears right then and there, blubbering excuses and groveling for mercy and pardon. Fortunate to never have been tardy, absent, or sick. Sounds neurotic, and looking back I shall admit I was…and maybe still am. Doing well in school meant everything to me. The numbers, the letters, they were my markers for success. Plus, school came easily. So easily, I passed judgment over classmates who were not as high achieving. Why is that kid always late for class? Does he even care? Why can't he be more like me?
      The boy silently received his detention slip, branded with the teacher's black signature of doom, and shoved it into his pants pocket, where he buried his hands while he shuffled between rows of aloof stares toward his desk. The clock loudly ticked away at the seconds, penetrated the uncomfortable silence, as if reminding the boy of his lack of punctuality. He nonchalantly took his seat, tossing a tattered, deflated backpack on his desk. I looked down at my own desk—a planner in the upper left corner, opened to the day's date and with today's assignment clearly marked, a pencil in the groove at the top of the desk, and an unblemished eraser parallel to the pencil. He must not care. He must be lazy.
      Fast-forward 10 years, to an overcast and chilly December morning. I was rotating at a clinic in an underserved community as a third-year medical student. I was over half-way through medical school, finally feeling I was getting the hang of medicine, proudly thinking my high school neuroticism was paying off. The intake paperwork for my next patient: C., an 18-year-old boy presenting with pain and tingling in his hands. I glanced at his unremarkable vital signs posted on the intake form, gave two knocks to the door, and entered the cramped clinic examination room.
      I took a seat on the creaky rolling chair in front of the room's small corner desk, which held a dusty, unplugged computer monitor. Birth control, prenatal care, and flu vaccine pamphlets decorated the otherwise bare, pasty walls. In the opposite corner, C. sat alone in the room on the end of the examination table. He was broad-shouldered and slightly overweight, his short black hair neatly trimmed, his skin a rich, youthful brown that became darker immediately below a pair of heavy, withdrawn eyes. White sneakers easily gripped the pullout footrest, with length in his legs to spare. He wore an oversized dark gray sweatshirt and loose black sweatpants. I quickly detected the distinctive aroma of a person who has returned indoors after spending hours outside in cold weather—a blend of brisk wintertime air and mildewy body odor. He was gazing down at his hands which were folded across his lap, but immediately looked up and offered me a kind yet distant greeting as I sat down, “Nice to meet you, ma'am,” after I introduced myself.
      I discovered the boy had spent last night walking the streets, so my differential for his hand symptoms quickly narrowed, as we were in the dead of winter. It was just C. and his mother living in their apartment. He told me that last evening his mother had become angry again, which was nothing new for her. When this happened, staying at home was “dangerous.” C. recounted the prior evening, as a news reporter recited the facts, one of an innumerable amount of society's tragedies. His mother did not hurt him last night, he explained. Not this time. Fortunately, the hood of his sweatshirt shielded his ears and head from the cold, the sneakers protected his feet, and the miles spent walking through dark and empty streets of his small town kept his body warm enough. The single, wide front pocket of a sweatshirt, however, could only block so much of the night's frigid air from a pair of bare, defenseless hands.
      I proceeded to the physical examination, taking each of his hands in mine. His long, thick fingers were flushed, a rosy red. Lining his palms were dry, hardened calluses, like my grandfather's, whose untiring hands spent decades working in a factory by day and plowing fields by night to put food on the table for his family. However, my patient was not a father or a grandfather. C. was a child. I meticulously pressed along the bones, manipulated each joint, as he stared down at his hands, scrutinizing my every move. The examination maneuvers did not elicit any jolts or wincing, but rather he continued to describe a generalized tingling consistent with his recent prolonged exposure to the cold.
      As I finished my examination, C. timidly made a request for the doctor to come in and see him soon. He did not mean to be rude, he said, but he needed to take three busses to get to school so wanted to be on his way as soon as possible. He had already missed his morning classes. He dreamed of becoming an engineer. Being late for calculus and physics would interfere with this dream. I promptly finished my examination, thinking back to the anxiety I would have felt if I missed any high school classes, and reported to my attending.
      We sent C. back into the streets to embark on a three-bus trip to high school physics class with a pair of donated gloves, phone numbers for homeless shelters from our clinic's social worker, and a doctor's note for school. C. grabbed his tattered backpack and shoved the phone numbers and doctor's note into his sweatpants pocket. A fire ignited in my throat and swept across my face without warning. The thought of C. returning to rows of aloof stares, to a neurotic student with her pencil and eraser in parallel, intensified the burn. C. politely thanked the doctor and me for our time. I mustered a tense smile but could not bring my eyes to his.
      If I could go back in time, I would reach out for my classmate's hands, listen to his story, and get to know the boy behind the baggy sweatshirt and tattered backpack. Regret stings my skin like a bitter gust of wind on a winter night. Yet, it also pushes me forward, reminds me to be gentler with each patient I meet, and drives me to appreciate each individual's hidden battles so I may more fully understand. To the boy who was always late to class: I am sorry I did not reach out for your hands. However, because of you, and because of the boy I met with tingling hands whose legs were too long for the examination table, I know I can do better. For that, I thank you.

      Acknowledgments

      Dr. Hadler is a lieutenant in the United States Navy and a first-year resident in the Department of Psychiatry, Naval Medical Center, San Diego. The views expressed in this article reflect those of the author and do not necessarily reflect the official policy or position of the Department of the Navy, Department of Defense, or the United States Government.