A seductive, sad girl

I just scratch my head when Cirulia comes in. She has come in numerous times in the past year, for headaches, depression, menstrual pain, pelvic pain and stomachaches. On the exterior, she is overly seductively dressed, with skin tight jeans, piercings, and stiletto heels. But face-to-face, she is a shy, sad girl with very little to say, and constantly hovered over by her mother despite her 19 years of age. When she had severe pelvic pain, her mother refused letting her have a pelvic exam because it would destroy her virginity, no matter if she had a severe, fertility threatening disease, even if exam was performed by a female physician.

But today everything became clear. She came in for a followup of unexplained stomach pain. We reviewed her upper endoscopy which was absolutely normal. I spoke probingly, "sometimes this pain could be caused by a problem in the gallbladder or the liver, though I see nothing in your history to suggest these problems, and sometimes it can be caused by stress or depresssion", trying carefully not to induce a defensive posture. Then the floodgates opened. Cirulia began to cry uncontrollably. I knew I had hit pay dirt, I had finally gotten through her defenses. She came up for air long enough to sob, "My father....he is with that girl, and they have a baby, and he doesn't pay any attention to me". Her father continues to live at home while maintaining an affair with a young lover somewhere, and now there is a baby. He pays no attention to Cirulia, his beautiful daughter, who now tries to compete with the charms of his young girlfriend by dressing as provocatively as possible. As I dialed the bilingual therapy center, I was surprised and amazed to find out that the bilingual therapist on duty was my friend K. from church. I am so thankful she will be there for Cirulia. Maybe there is a chance that Cirulia can find her own value as a woman and a daughter before she falls in with some loser boyfriend on drugs.