AAP Voices Blog

*Editors’ note: This is one of a series of “AAP Voices” blog posts highlighting how racism impacts the health and well-being of children, adolescents, young adults and their families. To learn more, see the newly released American Academy of Pediatrics' policy statement, "The Impact of Racism on Child and Adolescent Health."

I skimmed my patient’s electronic medical record before entering the exam room. His name was Jorge, he was a new patient to our clinic, and he was 14 years old. The chief complaint: “mom concerned about mood.”

I knocked, entered the room, and introduced myself. Jorge was a skinny Latino kid, a couple inches shorter than myself, wearing a soccer jersey and baseball cap.

“It’s really nice to meet you,” I said, sitting down on the black stool next to the desk. Jorge was staring at the floor by his feet, shoulders hunched, avoiding eye contact. I started with my usual openings: asking how his day was going, and what he knew about adolescent confidentiality. Jorge answered the first few questions with short answers, but as I probed for more information about his favorite sports teams and video games, he started to open up. He was in 9th grade at a local high school. He didn’t like school much – “It’s soooooo long” – but his grades were good, and he had plenty of friends.

I asked why his mom thought an appointment in our clinic was a good idea. “I dunno,” he muttered. She, like, thinks that I’m depressed, or something.”

“Why do you think she thinks that?”
“I dunno. Maybe cause I’m in my room all the time, I guess.”

Jorge gradually shared that he’d been feeling down for a few months, ever since a romantic relationship had ended. He’d been skipping a few classes, at first because it seemed hard to get up and face the day, and later because he felt overwhelmed and behind in school. His grades were dropping, he said, sounding anxious, and he didn’t know how to catch up. He told me about how he had been losing weight, and feeling like school was pointless.

I probed about thoughts of suicide. “Has there ever been a time when you thought that you didn’t want to be alive, or thought you might be better off dead?” I asked gently.

“Yeah,” he said, tapping his fists nervously on his knees. “I wouldn’t have done nothing, though. But I thought about it.”
“When was that?”
“This weekend,” he muttered.
“Did anything in particular happen this weekend?”
He glanced up at me. “So, like, is this stuff that you would have to tell my mom?”
“Well, it depends what you tell me, and if I have concerns about your safety.”
He took a deep breath. “Well, okay, this is what happened.”

“Sure, he might have been argumentative; maybe he shouted at the police officers. But my patient was a child. In the event of a conflict with adults, whose responsibility was it to maintain a calm environment and avoid violence?”

When the protectors are the abusers

He launched into his story. He had been standing near a bus station with a female friend, in a local neighborhood known to be predominantly Latino. His friend had been crying because her boyfriend broke up with her. “I wasn’t doing nothin’ to her,” he said earnestly. “I swear. I was hugging her, and she was crying, but she’s my friend, and I wasn’t the one making her cry.”

A police car pulled up, and asked Jorge what was going on. The pair of white police officers quickly separated Jorge from his friend. “They were yellin’ and stuff,” he said. “So, I yelled back a little bit, but I didn’t do nothing to them physically. It’s not like they could’ve been scared of me, you know?”

Jorge described how the police officers had continued yelling. They had pointed a gun at him. One of them slammed him on the trunk of the car, and he was thrown to the ground and handcuffed. He showed me the still-present red and bruised marks around his wrists from the handcuffs, and a scrape on his cheek. He was taken to the juvenile detention center, “but in the end they couldn’t do nothin’.” Jorge was released.

I was taken aback, but I tried to hide my shock. “Jorge, I am so, so sorry that this happened to you,” I said emphatically. “You know that was really unfair, and no one deserve to be treated like that.”

He shrugged. “The night that it happened – that was when I sort of thought I’d be better off dead. And I thought about killing myself. But now I’m over it,” he said, almost proudly. “I’m, like, okay now.”

I smiled a little. “Well, I’m glad to hear that things are better today,” I said, dryly appreciating my 14-year-old patient’s certainty that his present emotion would last forever. “But I think we need a plan to keep you safe.”

Internally, I felt sick to my stomach. The child in front of me could not have weighed more than 120 pounds. He had a couple bristly hairs on his upper lip which he was valiantly trying to grow into the start of a mustache. The idea that he would have been considered a threat to two grown and armed police officers seemed ludicrous. Sure, he might have been argumentative; maybe he shouted at the police officers. But my patient was a child. In the event of a conflict with adults, whose responsibility was it to maintain a calm environment and avoid violence? His injuries were clearly visible; he had not been restrained gently or in a compassionate manner.

‘Don’t fight back’

I staffed with my preceptor, a phenomenal Latina woman who knew exactly what to tell Jorge. "Next time it happens, you memorize their badge numbers,” she told him. “Don’t fight back. Memorize their badge numbers, and raise hell later.”

The ease with which she knew how to counsel him made me reel. Clearly, in her world, this was not a new experience. I thought about my own childhood, growing up in a rural red state, and my own certainty as a child that police officers were there to help.

“One’s thing for sure,” my preceptor said as we returned to the team room, “This would not have happened to a white kid in the suburbs.”

I couldn’t sleep that night. I stayed up late texting friends and colleagues: what should I do? Was this reportable to child protection? When the police are the abusers, who do I tell about the crime? One friend – an attorney – said to report to child protection. Another physician sent a shrug emoji and said maybe I could try. A child abuse specialist made the final call in a midnight text: “nothing will come of it. no one to report to.”

I couldn’t shake my fury. Days later, a local neighborhood watch sent me an alert about an armed robbery of a wealthy white woman; I felt outraged that this somehow made local news, when my patient hadn’t had the luxury of any public reaction. Indeed, his victimization was routine, normalized, part of the daily grind. It was not worthy of a news story, or even a police report. The fact that his parents were undocumented made Jorge’s safety even more precarious: if Jorge had even wanted to file a complaint, I could not guarantee that his family would stay safe.

Communities of color experience police brutality at shockingly high rates. As a white woman, I have never had to wonder if the police would support me if I were to ask for assistance. I know that my version of the story will probably be believed. I will not be considered a threat. It is very unlikely that they would point a gun at me, handcuff me, or throw me to the ground.

Our children of color do not have the same luxury. Children of color experience adultification and are seen as perpetrators, rather than victims. Even pre-school aged African-American children are disciplined at higher rates than their white classmates; our implicit bias and racism includes (but is not limited to) toddlers.

Community violence, police brutality, and racism cost lives. Sometimes, they take lives loudly, like when a police shooting results in a well-publicized death. But all too often, they take lives quietly, in the form of trauma and victimization that result in depression, anxiety, substance use, suicides. Those deaths will not often be attributed to racism or health disparities. But we don’t have to look very hard to put the pieces together and find the real culprit.

We need to do better. We must do better. We know too much about the effects of trauma and violence to stay silent in the face of these inequities. For Jorge, and for every one of his friends, classmates, neighbors: we must do better.