I heard Destinee screaming before the ambulance bay door opened.  She rolled in, 18 years old but looking around 30.  Long, wavy red hair, formerly pretty.  She came in yelling "Where's my baby?  Do you have my baby?"

Her baby, it turned out, was with her grandmother.  The neighbors had called 911 because of her erratic behavior, out on the front lawn of the apartments at 10 pm.  When the paramedics got there, she told them that two big guys had broken into the house and made her take "a bunch of pills" at gunpoint.

Her eyes were dilated.  Her heart rate was about 130.  That, and her hypervigilant, sped-up behavior convinced me she was on meth, as are so many young people in poor, working-class neighborhoods like some my ER serves.

She maintained that she hadn't done any meth, but that "those guys made me take pills - they held a gun to my head" (meth doesn't come in pill form, by the way).  Destinee cried dramatically, but produced no tears.  In ER, you get skeptical; some people are habitual actors.  When some people sob, you check for tears.  She was crazy on meth, but not too crazy to cover her ass.

We called the police because a crime had been reported by Destinee.  They took a report, which became ever more far-fetched and contradictory, and left, saying her story was not credible, nor was it supported by witnesses. 

While we waited for lab tests to come back, she paced in her room, calling out "Is my baby here?  I heard somebody say there was a baby stabbing".  She said the men had run toward her grandmother's house and she was afraid they were after the baby.  "Do you have my baby?  Can I see her?", she asked over and over, and we got tired of reassuring her.  She cried out periodically in response to voices she was hallucinating, or her own tormented imagination.  She wandered out of her room undressed, and accosted other patients who were there for actual medical problems, asking if they had seen her baby.  She took most of the staff's attention while she was in ER.

She was, in short, a pain in the ass, and one who was mothering on crank.

After her tox screen came back showing nothing more than methamphetamine, she was discharged, but had nowhere to go.  On meth, the world feels threatening.  And, on meth, your world BECOMES threatening, because of the kind of people you hang out with, increasingly.  Your functional friends who don't use stop wanting to be around you; more and more, you're with people to whom nothing matters but getting more meth.

She called her mother on the phone at the desk where I was charting.  Again, lots of crying, no tears. 

"Mom, I was asleep when they put all that shit in my mouth and put a gun to my head"  "I'm NOT using - I told you!"  "I wanna come back home, Mom.  I wanta go where I'm safe"  "No, Mom, I swear to God, I'm not using.  Two big huge men broke in.  They put a fuckin' gun to my head".  "I just wanna come home."  "They can find me - (whispering) I think they're already here"  "I'm startin' to hear stuff in here - they're talking about a baby stabbing."  "Mom?  Can you hear me?"  "You're pissed?  About what?  You almost didn't have a daughter!"  "They told me I fucked up."  "I'm NOT.  I told you!"  "Shit, I don't know.  I just want to come home, where nobody can fuck with me.  Mommy?  Can I just come home?"

Mom eventually caved, came to pick her up.  We filed a CPS report, which that overloaded agency will file with lots of similar ones.

I walked out with her to talk to her Mom, who looked close to the same age.  I asked if the baby ever stayed with Destinee - Mom said "No, she took her to her grandmother's, because she's been fuckin' up".  "I told her she could stay with me if she lives by my rules, but she don't wanta do that."  Mom was a working woman, scraping by.  Trying to do the right thing, not sure what that would be.  "I'm thinking I should send her out of state to stay with family in Montana, to get her away from her friends who are doin' meth." 

Mom had the look of someone who stumbled into parenthood too young, without a way to make a decent living and without much understanding of what kids need, or the wherewithal to learn it.  Someone for whom life is a treadmill, who loved her kid but really had no idea what to do with her.  And so it continues.

I try not to get that tough-as-nails quality that ER nurses can have, the kneejerk judgement, the global skepticism.  I know that Destinee, as infuriating as she is, is living in the hell she created.   I try not to despair for the babies these people are having, innocent and unwanted byproducts of lust, amplified by meth.  I try to stay kind.

It's hard.