The EMTs lift her into the ambulance and are quickly on their way and the scream of the siren once again shatters the late-night quiet. I watch as it speeds away, the tires kicking up clouds of dust, and wonder how they are going to find out who the injured girl is. I’m just getting ready to ask the cop this question when I realize that everyone else is looking back toward the railroad tracks.

Another small silhouette appears. This time on foot, emerging from the tall winter wheat that fills the field on just the other side of the tracks.

Again my heart nearly stops.

It’s Violet.

She is moving toward us as if in slow motion. Eyes unfocused, unseeing. The front of her white T-shirt blooms red. Her hands look like they’ve been steeped in blood. Something tumbles from her fingers and lands on the dirt at her feet.

“Oh, my God,” I breathe. “She’s bleeding! Call another ambulance!”

It feels like forever until I finally reach her. I sweep her up in my arms and run my eyes over her, searching for the source of all the blood. “Help her!” I cry, laying her gently on the ground. “Please,” I plead. “What happened?” I ask Violet. “Who did this?”

Suddenly I know exactly who the other girl is. Violet’s best friend, Cora Landry. I feel arms pulling me backward and hear Sam telling me to let them do their work. Violet’s lips move but I can’t quite make out what she says.

Dr. Madeline Gideon September 14, 2018

Dr. Madeline Gideon

September 14, 2018

Every doctor has a case that haunts them. A patient that runs through your thoughts while you sip your morning coffee, that tags along during rounds and therapy sessions. The case that sits shoulder to shoulder with you during the quiet moments and slides between the sheets with you at night and whispers in your ear, You could have done more. You could have done better.

For me, that case is the girl in the train yard. She’s how I measure time. Before and after.

Disorder—easy enough to define, right? A state of confusion. A disturbance that affects the function of the mind or body. Obsessive compulsive disorder, anxiety, ADHD, eating disorder, autism spectrum disorder, schizophrenia, mood disorder, posttraumatic stress disorder. And hundreds more.

Every day, through a combination of talk, behavioral and pharmaceutical therapies, my primary goal was to provide an organized clinical experience to my patients in the evaluation, diagnosis and treatment of children, adolescents and their families.

In the twenty-odd years I had walked the halls of Grayling Children’s Hospital, first as a medical student and then as a psychiatrist, I’d seen it all. I’ve seen children who compulsively eat dirt or paint chips or sharp tacks, and emaciated sixteen-year-olds who refuse to eat anything at all. I’ve counseled children who have been neglected, beaten and sexually abused.