I Wonder What Happened to Tiffany?

There are many reasons why I love what I do for a living. One of them is the perspective that I feel I've gained through working with my patients.

I'm currently working exclusively in the world of outpatient orthopedics. Up until 5 years ago, I was also employed as a physical therapist in the New York Department of Education, primarily working with children with multiple handicaps. It was a very different daily experience from what I now see in the clinic. These kids weren't necessarily going to see an end to their need for care. Progress, if any, was slow and difficult to measure. In my years working at PS 79 in East Harlem, I learned to be patient. I learned about the incredible hardships that parents and caregivers have to go through on a daily basis just to get through the day. I also met so many awesome kids along the way, each of whom had something unique to offer.

While working at the D.O.E., I also began working as an early intervention provider. This is a program that was established in the early '90's with the intent to help children with developmental delays "catch up" before reaching their school years. Services are generally delivered in the child's home. Ninety percent of my cases were in either East Harlem or the Bronx.

The first child with whom I worked was a little girl named Tiffany, who lived in the Kingsbridge section of the Bronx. She was a sweet little girl who lived with her grandmother and several older siblings. The man of the house was her brother Dante, who seemed older than his actual age of sixteen. There were also other adults who would be present at various times, some faces new, some familiar each time I'd make my twice weekly visits. I never really knew who they were, but assumed that they were family or friends. I was always welcomed into their home with a warm smile and treated very kindly.

I saw Tiffany for months, working on her motor milestones. I watched her learn to walk and climb stairs independently. We worked on her coordination through various games and activities. My favorite memory with Tiffany occurred during a massive blizzard on President's Day in 2003. I trekked up to the Bronx because I wanted to take her outside to play in her first ever snowstorm. Months after that, when we went out to work on skills in the park across the street from her apartment, she would point to the spot where we built not one but two snowmen (one bigger one for me, one smaller for her), and fondly recall the memory.

One day I received a call from the case coordinator. She had some very disturbing news about Tiffany. She had been abused and had tested positive for a sexually transmitted disease.

Tiffany had yet to turn 3, the age at which children age out of the early intervention program.

The case coordinator told me that Tiffany was removed from the home and placed in a foster home for the time being. She asked me if I would be willing to stay with her though in order to provide some sense of consistency during this period of transition in what was already a tumultuous young life. I agreed to continue to see her.

The next week, I navigated my way to the foster home, which was double the previous commute. The foster mother seemed like a very nice person, and the apartment was well kept and clean. Tiffany seemed as happy as when I had last seen her. So we continued where we left off. Things seemed as good as they could be under the circumstances.

After a couple of months seeing Tiffany in her new home, I showed up one day to find some marks on her arms. They were cylindrical in nature, and she had several of them. There was not much mystery about what caused them.

"Tiffany, what happened to your arms?" I asked. "How did you get those marks?"

"A cigarette," she replied, matter-of-factly.

I felt a pit in my stomach. What stuck me was the nearly nonchalant manner with which she responded. This poor kid hadn't even gone to school yet, and had seen more abuse than ANYONE should ever have to endure in a lifetime.

After confronting the foster mother (who of course denied any wrong doing), I reported what I saw to the care coordinator, as the law obligates me to do. I never saw Tiffany again.

Tiffany is 16 years old now. I wonder how her life has turned out to this point? I wonder is she found a safe place to live, where she could simply grow from the toddler I knew her as into her early teens. The odds were certainly stacked against her, based on the tragic accounts of abuse she endured at such a young age.

Working with children with special needs, and meeting a kid like Tiffany, taught me a lot. It has made me realize how fortunate I was growing up. It reminds me of how lucky I am now. It taught me that every person with whom I work has their own unique back story, and that I won't necessarily know what's influencing their current condition. It taught me that while the potentials for reaching our goals are limitless, not everyone's starting lines are equal.

I hope and pray that Tiffany gained her stride after stumbling out of her starting blocks.