"You just bring her on in here, and we'll check her out. Dr. Harrod is
a whiz at figuring out what's wrong, and I"m sure she'll take good care
of your daughter." Marnie Richards paused, listening to the frantic
voice in the phone earpiece.

"I understand she's in pain, and I know she's your baby, but taking her
to emergency won't get her helped any faster than bringing her here.
And the insurance company requires that you bring her here if you want
them to pay for it. The faster you get her here, the faster we can help
her. You'd probably end up waiting hours at the emergency room. We'll
see her right away, but you're going to have to hang up the phone and
bring her in." The voice on the other end calmed a bit, and Marnie

"Okay, Mrs. Miller. You hang up and bring Kelsey in."

Marnie hung up the phone, and turned to the desk clerk. "Tina, when
Darcy Miller comes in with her daughter Kelsey, just send them back to
curtain 2, and I'll take care of them. I've got the chart already."

Tina rolled her eyes. "Yeah. All right. Kelsey. How old is the kid?"

Marnie resisted the urge to snap at Tina, and simply answered "She's

Marnie thumbed through the shelves full of file folders, got to the
red and orange tabbed "MIL" section, and found Kelsey Miller's file
buried in the middle of about a hundred other "Millers."

She flipped through the file, and sighed wearily. Kelsey Miller hadn't
been seen for the usual well-child checkups, but had been seen several
times for broken bones. The section on the history titled "Father" was
conspicuously blank, and the handwriting on the patient forms was round
and child-like.

Going back to the files, she found Darcy Miller's file, and discovered
that 12 year old Kelsey's mother was 27.

She slid the mother's chart back into its spot, and walked back to find
Dr. Harrod.

"The mother says she thinks her daughter has a ruptured appendix. Could
be, too. Said the girl hurts low on her abdomen, mostly on the right
side, that it keeps getting worse and worse. Wanted to take her to
Emergency, but they're on Medicaid, going through some new HMO, and if
they go to emergency and find out it's a stomach flu, they'll have to
pay for the visit."

Sally Harrod sighed, took the chart, and frowned. "Do you think it's an

Marnie shrugged. "I really don't know. The kid's 12, could be an
appendix, but also could be her first menstrual cramps, or, given her
history, someone could have slugged her. But whatever it is, she'll get
seen faster here than if they go through triage at the hospital."

Tina walked up to them, and said, "I'll lay odds on someone slugged
her. She's back in curtain two..."

Dr. Harrod raised her eyebrow, and handed the chart back to Marnie.
"I'll give you about three minutes. Holler if you need me sooner."

Marnie slid back the curtain. The girl sat crosslegged on the examining
table, her dishwater blond hair hanging stringy around her pinched
face. She seemed to be hiding inside her baggy clothes, hiding behind
her hair as well. She looked both older and younger than twelve, her
face and body could have belonged to a 17 year old, but her eyes
skittered frightened like a shy child.

The woman standing behind the girl shifted, and Marnie noted that she,
too looked both older and younger than she ought. Her face, body,
looked 10 years older than the professed 27 years, heavy and weary,
but her makeup, her hair, seemed the style that a teenager might wear.

Suddenly Marnie realized that the last teenagers she'd see wearing hair
in that style had been during her own high school days.

"Hi Kelsey... How are you doing today?" Marnie smiled gently at the

The woman answered gruffly. "She's in pain..."

At that, Kelsey rolled over on the table, clutching her abdomen
through layers of cloth, and groaned.

Marnie spoke as she swung the curtain shut behind her. "I just need to
check her blood pressure and temperature, and then we'll get the doctor
in here."

Darcy Miller glared at her. "You get that doctor in here *now*."

Marnie started to speak, but stopped as she heard the curtain slide

Sally entered the curtained area. "Mrs.," she paused, looked at the
chart, "Miller. I'm Dr. Harrod. Call me Sally. I'll be helping your
daughter today. But Marnie here needs to check some things out for me."

Marnie moved over to the girl, who had curled up on her knees, leaning
on her mother's shoulder and crying.

Sally continued speaking. "Can you tell me when she started hurting
like this?"

Mrs. Miller frowned. "Oh, I dunno... Maybe 3 this morning... but it
wasn't this bad then..."

Marnie quietly took the girl's blood pressure, and was unpleasantly
surprised to find it at 180/120, sixty points on both sides higher than
she would have expected for a twelve year old girl. A quick count
showed the girl's pulse was racing, 120 beats per minute.

"Dr. Harrod..." Marnie's sharp tone caught Sally's attention

Sally glanced at the proferred chart, and her eyes widened.

"Kelsey? Honey, I need to check your tummy... can you lie back for me?"

Kelsey turned around, and started to lean back, saying "It doesn't hurt
as much right now..." but then stopped, and shook her head. "I can't."

"Okay honey. I can try doing this with you sitting up."

Kelsey nodded. Sally pulled aside the enormous sweat shirt, and lifted
up the girl's baggy t-shirt.

<oh shit.>

Sally froze. Marnie looked over, closed her eyes briefly, and then
asked, in a surprisingly calm voice, "Is the pain there all the time,
or does it come and go?"

Kelsey's voice was small as she answered, "It comes and..." She
grimaced, then gasped, her face tightening with fear and pain. "Mama,
it hurts me..." she whimpered, squeezing her eyes shut.

Sally and Marnie looked at each other, then Marnie moved forward and
took the twelve-year old's face in her hands. "Kelsey, honey... look
at me..." The girl's eyes shot open, darting wildly back and forth
before focusing in on the nurse's eyes. Her breath came in small
panicked pants.

"Good, honey... now I want you to breathe like I do." Marnie took in a
slow breath, then another, then another. A few more, and then Kelsey
was breathing with her, echoing her breaths. Marnie rested her hand
on Kelsey's belly, and when she felt it soften, she stood back, looked
at Sally, now sitting on a stool a few feet away.

Sally stood up. "Mrs. Miller, could you come with me for a moment?"

Her tone clearly indicated that anything other than immediate
cooperation would not be tolerated. Darcy Miller followed her out of
the curtained area.

"Kelsey," Marnie said, "When is the last time you had a period?"

Kelsey looked away. "I... I only had three... I think the last one was
when I was 11. At school they said it was normal for them to start and
stop, at first."

Marnie looked at the chart. Kelsey had been 12 for 4 months.

Marnie pulled the stool over, sat on it, placing herself down lower
than Kelsey's eye level.

Looking up, she said gently. "Honey, did a boy touch you... hurt you?"

Kelsey looked away. "Uh..."

Marnie swore internally, but kept her tone gentle. "Kelsey... I need
to know if a boy put his penis inside you. And I need to know when
it happened... what month."

Kelsey's voice was almost inaudible. "It was right before school
started." Her face twisted, and she curled around her small, but round
belly, moaning softly and rocking.

Beyond the curtain, Sally Harrod was straining mightily not to
physically injure the woman standing in front of her.

"Mrs. Miller. Your daughter is pregnant. Were you aware of this?"

Darcy's face crumpled. "Oh no...."