" - yeah, actually, being taken into foster care can count as a traumatic childhood experience. Even if foster care is a lot better and safer than where you were before, being taken into foster care can be a really upsetting experience. You can answer the questions thinking about being taken into foster care if you want."

" - why do you do it to people if you want to be helping and you know it a really bad thing that happen to them?"

"At the end of this we'll get you a referral for a therapist who you can talk to about that. I just need to get through these forms. Since your traumatic experience, have you been bothered by feelings of being “super alert,” on guard, or constantly on the lookout for danger?"

"I do that but I no bothered by it. I a holy warrior. Holy warriors supposed to do that."

"Uh huh. Have you been bothered by having a very negative emotional state (for example, you were experiencing lots of fear, anger, guilt, shame, or horror) after a stressful experience?"

"I think I do not understand 'bothered by'. Being sad is not as fun as being happy but is more - correct. When I was happy in foster care it was because I was wrong what foster care was."

"It's just meant to get at that if your symptoms aren't negatively affecting your life then we're not worried about them."

"Oh. My symptoms aren't negatively affecting my life."

The nurse looks so skeptical. "Okay. Have you been bothered by being extremely irritable or angry to the point where you yelled at other people, got into fights, or destroyed things?"

"No."

"Have you been bothered by feeling very emotionally upset when something reminded you of a stressful experience?"

" - actually yes! I feel very emotionally upset when I am reminded of being made a slave. When the doctor said to me we would not get in trouble if we reported a man had sex with us, I feeled so angry at him even though I think he was not lying on purpose. And when you asked questions about if I was lonely I feeled very angry even though asking questions is not worse than other things to make your slave do and makes America happy."

"No one is making you do this. It's just important for your health and it's a good idea to do it so that we can help you."

"You saying that also make me angry," she says thoughtfully. "I am no sure if is because it reminded me of a stressful experience or a different reason."

Eyeroll. "Right. Well, we're done." She turns to Evelyn. "Obviously off the charts anxiety and anger, which I'm sure you've noticed at home. Given how much of the anxiety and anger is tied to the foster care transition, medication isn't necessarily indicated at this point. Of course if it's causing behavioral problems at home, we can move to medication sooner, but the doctor's recommendation is going to be therapy, maybe some group anger management classes, and we can talk about an SSRI if the anxiety's not getting better on its own as she adjusts."

Evelyn HATES when medical staff do that when the kid is right there. Ugh ugh ugh. 

She addresses her answer to both of them, making eye contact with Iomedae. "It's not causing any problems at my house, actually." Not exactly true but 'Evelyn constantly feels bad about herself' is not a problem that's any of the clinic nurse's business. "Iomedae is understandably angry, but she's - in very good control of it, she has excellent impulse control for a young person - and she never takes it out on us." At least not in ways that Evelyn is inclined to count. Indignant speeches expressing pretty valid grievances do not count. "And I think a lot of things are stressful right now, but I've never noticed her being impaired by anxiety. ...I would take a referral for therapy, since I know there are long wait times and I do want Iomedae to have the option if she decides she wants it. I don't think anger management classes are likely to help, since as I said, my impression at home is that she's already managing it." 

...Ugh that probably had a lot of words that Iomedae won't have understood, which is unfortunate, even if right now Evelyn is treating it as more important that the nurse takes her seriously as a competent and experienced foster carer who knows what she's doing here. 

"I do not know what anxiety is, or transition, or indicated, or behavioral, or SSRI, or adjusts."

Slowly, loudly. "You are scared all the time because you are in foster care now, and usually if someone was scared all the time we would give them medication that made them feel better, but since we know the cause and it is just that you are in foster care now, we are going to instead get you someone you can talk with about your feelings."

"Emily say that happen," says Iomedae. "I obey Evelyn."

"I'm glad to hear that. Well, this, uh, took a lot longer than planned, and we're about out of time. Do you have any questions for me?"

She has so many questions. Not for anyone here, not even Evelyn. "No."

(Evelyn is learning kind of a lot of what exactly was talked about with Emily last night, and almost feels bad about it. She had genuinely intended to give Iomedae the option of confidentiality, and it seems sort of unfair for that to end up not working because Iomedae has zero instincts around keeping secrets - which she's pretty sure now is what Emily advised her to do - and has to work very hard to remember not to just speak her mind at all times.) 

"Okay! Last thing is reconstructing a health history. You've never been to a doctor before, Iomedae?"

"I don't feel comfortable answering questions about my childhood when you're in a position of power over me."

" - this isn't about the ritual scarification, this is just about, do you remember what illnesses you've experienced, did you break any bones, things like that."