We buried Shelly this morning. She was already dying when I first met her eight months ago. As she liked to say, the sound of a door slamming signaled the beginning of her end.

Ten months ago, Shelly’s father came home early from a business trip. Shelly’s mother had a boyfriend. You can imagine the rest. She told me that what hurt the most—the fatal heart wound—was that her dad didn’t even tell her goodbye. He just stormed out of the house, climbed into his car, and drove off “into oblivion,” as she put it. Her eventual death is traceable to that first wound.

A week after Shelly’s father left, the boyfriend moved in. By week three, he was bossing Shelly around and calling her names; by week five, he had slapped her twice and threatened to do worse. One night when her mom was at work, Shelly had to lock herself in the bathroom to prevent him from molesting her. She told me that she thought of her dad as she squeezed through the bathroom window and started running. She really didn’t know what “oblivion” meant at that point, but she was destined to find out.

We met at a bus station three weeks after she’d hit the road. She was dirty and hungry and seemed kinda spacey. Shelly had hitchhiked 700 miles, eating out of trashcans and sleeping under bridges. She had left home with no money, no ID, no change of clothes, and no destination. I took her to my sanctuary down by the docks, thinking she needed a friend as much as I did. I had run away four months before, but, like Shelly, I wasn’t very good at being on my own. We had that in common, at least.

Shelly was outgoing and took to panhandling easily. People were like ATMs to her: she artfully pushed the right buttons, and they handed her cash. At first she used the money for food and clothes, but then Lobo got his hooks into her. He talked her into smoking a joint with him one night, and just a month later he was selling her crack. How could anyone be so smart and so dumb at the same time? She said drugs helped obliterate the painful memories, allowed her to escape, to be free. When I pointed out that addiction is slavery, not freedom, she rolled her eyes and rolled another joint.

Eventually her habit was costing her more per day than she could panhandle, so she started trading Lobo sex for fixes. Rumor had it that he was pimping her out. When I confronted her about it, she just laughed, gave me a hug, and whispered that she knew what she was doing. I wept anyway.

On the eve of her fourteenth birthday, Shelly went out into the night and simply disappeared. No one on the street knew what had happened to her, but I feared the worst. When she showed up three weeks later, she looked like a wraith. Her skin and eyes were yellow, and her face was gaunt and haggard. She wouldn’t tell me where she’d been; she just said she wanted to sleep forever.

When she missed her next two periods, I convinced her to go to the clinic. She was still turning tricks, still doing drugs, still not eating, still chasing after oblivion. The doctor said that she was pregnant, was suffering from hepatitis C and malnutrition, and had walking pneumonia—among other things. He told her she needed to be hospitalized and, for her body’s sake, should consider having an abortion. I’d never seen Shelly cry before then.

As we were walking back to the docks, Shelly said she wondered what her dad was doing right that minute. Then she smiled at me one last time—and stepped in front of a truck. She was dead before she hit the pavement; in truth, she was dead before I met her.

We buried Shelly this morning. Rest in peace, my friend. You can stop running now.

Shelly is a fictional character, but her story is all too real. Hers is just one version of the downward spiral into sickness and despair that all runaways must endure. The health hazards these young people face are myriad and are often life threatening. According to the Journal of Adolescent Health, unaccompanied youth typically suffer one or more of the following health-related afflictions while living on the streets: alcohol and other drug abuse, mental health problems, sexually-transmitted diseases, malnutrition, pregnancy, and premature death from suicide and homicide.1

Dr. Margaret Taylor, Assistant Professor at the University of Texas School of Nursing, has treated countless homeless children at both LifeWorks Street Outreach Clinic and the People’s Community Clinic in Austin. In her experience, the health problems among the local homeless youth population span from those that can be addressed on an outpatient basis (e.g., respiratory problems, skin infections, dental problems, and sexually transmitted infections, and pregnancy) to those that require hospitalization and long-term care (such as mental health problems, including depression, anxiety, and alcohol/drug abuse). As Dr. Taylor explained, “Diets on the street are nutritionally poor, high in fat and carbohydrates and low in protein, vitamins and minerals.” Inadequate or poor nutrition often contributes “to fatigue, weight loss, and increased susceptibility to colds and other viral infections. The longer youth live on the street, the greater their potential for developing a chronic illness, such as hepatitis B or C or Human Immunodeficiency Virus (HIV) infection.” The likelihood of physical or sexual abuse also increases each day a child remains on the street.

While most runaways—like Shelly—will never turn up on your school’s doorstep, district personnel should still be aware of the health risks that these young people are exposed to and suffer from: knowledge of the risks and the reality of running away might prevent some children from making such a disastrous choice. Should a runaway youth join your student body, however, he or she should immediately see the school’s certified nurse or be referred to a clinic for a general physical and mental health screening. Life on the streets is bad for anyone’s health, particularly the young. With proper nutrition, hygiene, and treatment, many runaways can recover their health and resume a normal lifestyle, including securing an education. For those like Shelly, we can only pray that they will find help and hope before being lost to oblivion forever.

Health and Health Needs of Homeless and Runaway Youth: A Position Paper of the Society for Adolescent Medicine. Journal of Adolescent Health: 1992. http://www.adolescenthealth.org/html/homeless.html#introduction