I looked at the 17 year old young man sitting at the exam table and paused in silence as I thought about the ten minutes we just spent talking about his life since he dropped out of high school last fall. "You're really at quite the crossroad in your life here aren't you?"
"What do you mean?" he asked brushing his wavy brown hair out of his eyes.
"Well, it sounds like you can either go down the path of hanging out and playing on the computer all day and going over to your uncle's house and drinking beer with him at night, or you can go down the path of finishing your GED like you planned, get a job, and work toward your goal of moving closer to your long distance girlfriend."
He reassured me he would take the more productive path in life and I believed his sincerity and obviously encouraged him, but we both knew there were a lot wild cards out there. The most obvious of these was hunger.
Our conversation started like any adolescent physical. I asked him if he had any questions and concerns. He felt he was too skinny and at 5' 10" 135 lbs he didn't appear emaciated, but he was thin. As we probed this topic it was clear to both of us the issue was not medical, but social. His mom was having difficulty bringing home enough money as a bartender to support her two young adult kids the other of which is pregnant. It was unclear if they had looked into the local food bank or any other resources. The 17 year old's food intake the day before consisted of two tuna fish sandwiches. I remember being a metabolically revved 17 year old and eating 2 tuna fish sandwiches for a snack.
The next question from me was logically, "Well, why don't you get a job to have more money for food?" In a county with an unemployment rate at least at 14% I knew the answer to this question before the question was finished being asked.
Hunger was clearly going to be a major determinant in the life of this young man. How would it effect his ability to study for his GED? Would he come to use his uncle's beer as a source for his calories? Would his teenage alcohol use further derail his plans and potentially lead him down a darker path of drug use. If he couldn't find honest work, would he turn to some type of illegal activity to feed himself? How could he live a life of hope and avoid despair on two tuna fish sandwiches a day?
Sitting there in the exam room I felt completely helpless and knew that this must be was he felt every day.