I always look at it first. Question Number 9:
Sometimes the questions on the Patient Health Questionnaire 9 (PHQ 9) are completed and ready for me to score before I walk in the room for a teen check up.
Sometimes, the teen is holding it and I gently take it and steal a glance at question #9 as I am saying hello.
Always, I cross my fingers and pray that it says “not at all,” and I exhale a little when it does.
Today, though, I sit on the exam table next to this lanky 15 year old boy, and his answer is not “not at all.”
His answer is “several days.”
My eyes go backwards, up the page, and I am crushed to see that he feels “down depressed and hopeless” nearly every day, that he feels bad about himself, that he is a failure and that he has let himself or his family down more than half days. These are his answers, but my heart hurts as if they were mine.
This child I have watched grow since birth, this child with the energy of an oversized Tigger tells me he feels isolated since starting high school. “My friends have other friends,” he says. “We don’t have classes or lunch together. It’s like they’ve forgotten me.”
He doesn’t know that many of them have been sitting next to me on this same table saying the same thing in the last few months. He doesn’t know because none of them are talking much to anyone anymore, and even if they were, they wouldn’t talk about this.
We talk about question #9. He tells me that his loneliness makes his thoughts wander toward how people might feel if he ended his life. “Would they even notice?” His eyes well with tears.
So do mine.
I tell him I know this is a hard time for him.
I tell him I think I can help.
I tell him that there is hope, that I truly believe that this loneliness will get better if he will hang in there and that I am planning to hang in there with him.
I ask him if I can partner with him and his mom to come up with a plan to help him get to a better place, and he agrees.
When she joins us in the room, the three of us talk about the options: changing some patterns in his life, counseling, medication. We talk about keeping him safe and what that might require.
I tell him that I am not going to fix it because really, he’s the only one who can truly do that. I tell him I will help him find the tools and that often the most helpful tools have to do with forging stronger relationships and connecting with others.
I ask his mom what she thinks might help.
She tells me that she will check in with him, take walks with him, keep him safe and help him brainstorm ways to reconnect with friends.
“And I have actually been thinking of finding a counselor for myself,” she adds, “so that I can be in a good place to help him.”
I tell her that is the best answer I have ever heard. Like ever. Start with yourself. Always start with yourself.
I say good bye and stand outside the door of the next exam room, afraid to look at the answer to Question #9,
And thanking God for those who had the wisdom to insist that we all begin to ask it routinely.
*this is not one particular teen. this could be any teen.