2- Omar: Making it to adulthood

Making it to adulthood: why do we miss the warning signs?

Hatim Omar1 and Said Shahtahmasebi2

1Department of Pediatrics, Division of Adolescent Medicine and Young Parents Program, University of Kentucky, Lexington, KY. 2Good Life Research Centre Trust, Christchurch, New Zealand.

Correspondence: Hatim Omar: haomar2@uky.edu

Keywords: youth violence prevention, Bullying, Suicide prevention, Gun Violence

Received: 3/2/2018; Revised: 24/2/2018; Accepted: 1/3/2018



Adolescent morbidity and mortality worldwide continues to be the result of risk taking behaviors and is mostly preventable. Accidents, homicide, suicide, teen pregnancy, sexually transmitted diseases, substance abuse and eating disorders are leading the way. The development of adolescent medicine during the last five decades has helped improve our understanding of adolescent development and contributed much more research in the area of adolescent health. We understand teenagers a lot better today than we did 50 years ago, yet there are still many areas where our knowledge is limited. With the rapid proliferation of electronic media, other risk behaviors such as drug abuse, self-harm, internet addiction, and sexual victimization have also increased.

While treatment models may help in some aspects of teen problems, prevention remains the only real tool to the improve quality of life of young people and help produce more productive and well-adjusted adults.

During the last decade, much has been done to investigate ways to reduce mortality and morbidity in adolescents. A significant part of the research focused on ways to reduce risk taking while another part looked into increasing protective factors. The majority of published research, however, continues to target one issue at a time. Some of the research also considered cultural, ethnic and geographic differences.

Much of what we know so far indicates that unless attention is paid to the individual teenagers, their families, peers, schools and society as a whole, we will continue to face poor outcomes. More adolescent health professionals are becoming involved in prevention and in helping our teenagers develop in a friendly and safe environment that helps with better learning and hopefully better outcomes.

Many programs in the United States fail to produce desired and expected results, because of the narrow focus on one aspects of adolescent life; example: drug use prevention, smoking prevention, suicide prevention and so on. Without taking into account the holistic picture of each individual adolescent including peers, family, school and society as a whole, most of these narrow preventive measures and interventions fail to achieve their goal.

In my professional career, I have learnt a lot from books and medical journals. The most valuable education for me however, is what I have learnt from teenagers themselves.  After 23 years of listening to teenagers, I feel that the more I understand the individual teenager, the more effective I am in helping them. I receive an average of 200 messages per day from teenagers and every message teaches me something.

In this article, I am sharing some of the messages from my teenage patients. Many of them tell me, that having access to someone who cares and is willing to listen is the difference between making bad and good decisions and sometimes between life and death.


The letters and responses that the first author mentioned above are subject to analysis to be reported in the next and subsequent issues of DHH. They reveal quite a lot of information which casts doubt on our understanding of adolescence and how we have been managing adolescent development.

It could be argued that these letters can provide a biased view of the adolescent population because those who have something to say or have a strong opinion would normally comment on issues. But, it must be said that the letters are not written in response to a controversy or a policy enforcing change. The writers of the letters are adolescents who managed to reverse severe and life threatening adverse outcomes through appropriate intervention and willingness to survive. By sharing their experiences, thus, hoping to help other teenagers and their parents.

Their communications (the letters and emails) were written voluntary and were unsolicited.

Although each adolescent is unique and different, in this article we have chosen to share 3 letters that demonstrate some of the issues facing today’s adolescents and how a typical teenager may deal with them.

The letters have not been changed or edited in any way other than concealing the identity of the writer. So what you read is raw teenage angst as recalled by the writer.

Though, the letters follow the style of a report or an article with  a title, they are written in the style of an informal conversation as though the writer is narrating to the reader. A few, like letter 1, is written as a poem. The style of this writer reflects the person’s talent to poetically describe their inner feelings and thought processes at over the period leading to the advers event and through recovery. Note that how negative self-doubt and self-questioning in the end became a positive will to live.

In this article the letters are shared unedited without detailed analysis and it is left to the reader to interpret the messages in the letters.

Letter 1

Is it my Time?

As I look into the barrel of a gun, I ask Jesus if it is my time?

Can all the stress my mother has caused me by using drugs and not caring about me be gone?

Will the pressure to be great in sports and popular in school get off my back?

I have to move again and try to fit in?

Will the girls like me?

Even if I do fit in at school, I am a nobody to my family?

Family what family?

A Dad who I don’t know. A mother to high on drugs or drunk to care where or who I am.

I have not talked to coaches, teachers, counselors or even friends but I expect them to listen?

I find myself telling people how to remember me and how I want my funeral.

People will then understand what a rough life I live and am feeling depressed.

Will Jesus ever forgive me?

I am crying for help and feel I have nothing to look forward to and nobody to care!

So is it my time? No it is not!

I have asked god and tried to take my own life and it is just not working.

I jumped in front of a car and some how felt no pain?

I over dosed on medications in front on my mother thinking it was the easiest way and she would finally care and see my cry for help.

But waking up in the hospital I had gotten the depression, anxiety and pain pumped out of my stomach. But the thoughts still remained. And my mother did not care to change.

I said no more, {Russian roulette is the name of the game, I felt I needed to play} I Looked into a loaded gun and stopped shaking long enough to pull the trigger,    nothing. I spun it again and was expecting a BIG BANG but looked down at the gun and the bullet was one click away.

3 strikes and I am not out ??

I Found God and people who care to help me regrouped all my doubts and fears.

I stopped feeling sorry for myself.

Now want others to look through my eyes and relate to my pain to see what I worked so hard to achieve.

I can look back now at whom I have become and be proud to be him. [Editor: ‘him’ replacing author’s name.]

A moving car did not take my life, all those pills did not stop my heart and that loaded gun was one click to late.

I thank god for this everyday!! This was not in Gods plan for me.

So here I stand strong asking you to learn from me and do the same.

Live for the day and do not take life or other peoples lives for granted.

People don’t seem to care or miss someone till they are gone.

Believe in yourself and start caring about yourself and others.

Ask people this question and don’t be scared. People need help and look for it in many different ways. The question is this: Do you want to kill yourself and why?


Letter 2

The Problem of Life


You always hear people say that life is what you make it. But what if your life is full of problems? Two years ago, life was more than I could handle. Anything and everything overwhelmed me and life didn’t make sense.

I didn’t have a good coping mechanism and I started to play around with my food. I told my mom that a new medicine I was on had affected my appetite and that my stomach just didn’t feel well. My weight started to slowly decline and my parents didn’t have a clue. In mid-October, my youth minister, X, noticed that I wasn’t eating. She confronted me and contacted a social worker who was friends with my parents and also went to my church. One Wednesday night after the service, they told my parents. My greatest fear was that they would reject me and want nothing to do with this strange creature who used to be their daughter. Needless to say, they were shocked. My mom had no idea. They contacted a Christian counselor a few towns over and made me an appointment for the next evening.

I went to that appointment knowing that I probably had an eating disorder. I had heard of people that had eating disorders and watched the videos in seventh grade. But I didn’t really have any experience with anyone. I saw the counselor twice a month up until January. I went on with life as normal. But inside, I was miserable.

In late January, my dad called counselor. I was in a state where my health was beginning to be at risk and my parents were unsure of where to turn. He suggested that we go to my family doctor. She wouldn’t have known an eating disorder if it had hit her in the face. She told me to continue seeing my counselor and we would wait and see what happened. At this point, I was in a state of denial and she only confirmed that I didn’t have an eating disorder. The same social worker friend of my parents noticed that my weight had fallen sharply and recommended an adolescent medicine specialist at the University of Kentucky who dealt with eating disorders about fifty miles from my home.

My first appointment with this man, Dr. Hatim Omar, was on a Thursday evening of my spring break. By the time we were able to get an appointment, I would only eat three different foods. They were safe and not threatening to me. The whole time we were at the appointment I couldn’t wait to leave because I had a sleepover to attend with my youth minister’s wife, X, and the girls from my youth group. I was checked in and immediately handed a gown. “What am I supposed to do with this?” I thought to myself. I was led to a bathroom and told to take off all my clothes. I was going to be weighed. My weight was taken and I think my parents were surprised at it. Next, my vital signs like my heart rate and blood pressure were taken. We were led into an exam room. I heard a knock on the door and a young, sandy-brown haired, man walked in. He introduced himself as a medical student and said he was there to ask me a few questions. When a few questions had turned into a hundred, he walked out of the room and entered just as quickly with this most heard and feared about Dr. Omar. He told me in many words that if I didn’t begin to eat that I was going to die. My heart could give out at any second. I must start eating. He prescribed an antidepressant and some other medicines and told me to schedule an appointment for the next week. So I wouldn’t get fat like everyone wanted me to, I would throw away my lunch at school or come home and feed it to my dog. No one was ever the wiser.

The summer came about and I ate just enough to maintain my very low weight. After all, Dr. Omar had told me that if I lost any more weight I would be hospitalized, no questions asked. Honestly, most of that summer is a total blur in my memory. That fall came and went with not much happening. In February, I was hospitalized for complications of my eating disorder. For the week that I was there, I have to say that it is the one thing that jumpstarted my recovery. I realized how much harm I was doing to my body and if I didn’t begin to eat, really eat, that the damage I had done would be irreversible. After I left the hospital, I began to really talk to my mom. Before this point, in my mind all she wanted to do was make me fat. I also began to really open up to my counselor who had been with me all this time. I discovered something called my counselor’s email and I began to email him on an almost daily basis. I slowly began to see my weight creep up.

But as I began to recover, my body began to fall apart. Heart palpitations, muscle spasms and electrolyte imbalances became a part of my everyday life. My body was falling apart and it was my fault. I wanted to get better now. What I didn’t know was how much more work I had in front of me and that wishes don’t necessarily make dreams come true. It was hard for me to accept that I had caused all this damage. I was in and out of my doctor’s office almost as much as he was and it became routine for me to receive IV fluids while in the office.

As I continued to progress, my counselor had me to name my eating disorder and to separate “Ed’s behavior from my behavior. “Ed” told me I was never thin enough to have anorexia. According to “Ed,” if anyone in the world was thinner than I was, I couldn’t have anorexia.

As my treatment began to become less intensive and reality began to set in, I flipped. I realized that I couldn’t continue to live with my anorexia but was so afraid of who I was without it. I was afraid of failing, afraid of succeeding, afraid of life without the constant presence of my eating disorder.

My anorexia had brought with it a sense of accomplishment, safety and security, and a tempering of the waves of anxiety that so frequently washed over me. Without my anorexia, I didn’t know how to deal with stress or how to communicate that I wasn’t okay. Not eating was a profound way for me to express myself and my feelings without having to use my voice. It removed any shame I felt about being inadequate and burdening other people with my problems.

Now, my mom can tell by the look on my face whether or not I have had a good day. She comforts me when I’m crying and holds my head when I’m sick, if need be. She is my best resource, along with my faith and is my solid rock. My counselor has been essential through all of this. I know that it must have been very frustrating during sessions when I was silent or would stare into space. He answers my countless emails and challenges me when I don’t want to be. Without him, working toward recovery is not and would not be possible. My parents and I credit Dr. Omar with saving my life. Without him, I can honestly say that I would not be alive and writing this. He has provided so much support for me and my parents and has taken three A.M. phone calls when I have been sick. He allows me to email him with any questions and concerns and welcomes me with open arms.

I am doing well now. Yes, I still struggle on a daily basis with my anorexia but I am learning to cope. I still have my good days and bad days but there are more good ones now than not. But I’m making progress and am realizing that I can’t be perfect. I’m still unsure about a lot of things but what I do know is that it has been a long, tough road but it’s been worth it. I am sixteen years old, driving and taking AP classes and those at Eastern Kentucky University. I’m going pre-med and my future is looking great. I’m still on the road to recovery and by no means is it an easy journey.

Yes, this has been a huge speed bump in my life. I’ve had to learn to love the implication of weight and of taking up space. I still don’t feel ready to recover, but if I wait until I feel ready, it will never happen. Life is all about what you make it and I’m living now.

Letter 3

The Day My Life Went From Bad to Worst

“Cry you big baby, I disown you!”

Did this actually come out of my father’s mouth? I couldn’t breathe. I thought I was going to die. Here I was sitting on the witness stand, my dad… the one I was testifying against.

Oh sorry, I guess you want to hear it from the beginning. Well it all started when he married my mom; she was sixteen, and he was twenty. At seventeen she had me, at nineteen my sister. My dad would beat her but she was scared to leave, terrified that he would get us kids.

After staying with him for seven years she left and got primary care of my sister and me. But my dad still had visitation rights, every Tuesday, and every other weekend. Now that my mom was out of the picture… I was his next victim!

He took everything out on me, he said I was a ‘bad girl’ and deserved it. I didn’t know what I was doing that disappointed him but he was my dad, I believed him. My sister would pee in her pants he would put them in a bag and make me stand in a corner holding them. If he was in a ‘good’ mood then I only had to stay for an hour or two, but the bad mood was until bedtime. She would mess up on reading I got the belt with spikes for not teaching her how to read. He would be mad at my step-mom; I got locked outside in the cold with only my gown on. But when it was me who done something wrong, even if I couldn’t figure out what I did, I got the horse whip. I had to lean up against the garage and if any part of my body came off I got three more licks. Then we would go inside and he would give me a bath he said “you are a baby you can’t do anything on your own, am I going to have to watch every move you make, and give you a bath for the rest of your life.” Then he would take all the phones to the room he was in and he would send me to bed and I had to stay there for the remainder of the time, I couldn’t eat, or go to the bathroom. So at night I would sneak to the bathroom, but I think he seen me because the next day I would get another spanking with the belt.

The very few times that I would get sent to bed and he happened to let me eat I couldn’t eat a lot from getting used to not eating for a long period of time. So he would shove it into my mouth and if I got sick he made me eat that too.

My grandma lived next door but I couldn’t tell her, she wouldn’t believed me anyways. What parent would think that their child the one they raised to commit a crime that makes someone miserable?

I had to go to a counselor for a few years but it didn’t help. Everything kept going like it was. He knew the social worker so she didn’t do anything. When we called the police and they went to the house he told them, “she went skating, she fell, and that’s how she got the bruises.” And when I got to his house the next time he would either send me straight to bed for telling a “lie” or he would make me sit in the room with all the kids and watch them play but I couldn’t talk to them or turn away from them. That was the worst. Everything he done he had a reason to cover it up.

All this made me depressed and I couldn’t get over being so bad. The psychologist put me on Prozac, an antidepressant, but it didn’t help it. I also lost a lot of weight and was borderline anorexic. None of this made it better. But I can handle it happening to me but when it’s somebody else I didn’t know what to do. But all that was nothing compared to what happened next. My life went from bad to worst.

One day I was home with my two little sisters and my step-brother. I wanted my best friend to come over. Dad was gone so I called and he said she would but we had to wait until he got home so she would have a way. Then my grandma said she could go get her. When dad got home he let us go swimming, after we got ready and went outside he picked her up and held her for a long time and wouldn’t let her down. After we went swimming he tried to come upstairs where we were changing. Then he hollered for her to come down there and he took her hand and put it between his hands, then he dropped it and said, “Oh never mind you might tell.” I was standing around the corner so he couldn’t see me looking. Then he kept asking her if she has ever been kissed. And if she has a boyfriend, and who is the oldest guy she would do anything with. Then he put her in his lap and held her down and wouldn’t let her up. She was crying so hard yelling my name every time I went to help he told me to get away he was playing with her she didn’t need me. I could see the terror in her eyes. He finally let her go as she got up he smacked her butt.

He went outside and told the other kids to go with him and for me and her to stay. As soon as he walked out we called her mom. Dad let me stay with her he knew we knew it was wrong.

I knew we had to tell her mom this wasn’t the first time, a few years ago he raped two little girls they were sisters ages twelve and eight. I couldn’t let this happen to her too.

A week went by and I had promised I wouldn’t tell but I broke the promise and told her mom. We called the police. Then we went to court and I had to testify against my dad not only what he done to her but what he done to me too. It was horrible, I never thought I would be sitting in front of my dad telling so many people what he had done. And then it was over the words I never wanted to hear, “Cry you big baby. I disown you!”

Now two years later I still have to go to the psychologist and take the Prozac and I’m working on my eating; but it takes a long time when you forget what the right way to do things is. I only see my dad a few times a year but the memories keep coming back.

It’s hard for me to make friends with some people and it takes a while to trust people but I work through it all and try as hard as I can. It may take some time but I’m working on it and now most people can’t tell that my life with friend and my life at home are two totally different lives!

Concluding comments

There are a number of important messages within these letters.

It is clear that practical, quality and appropriate information is lacking during the adolescence period. Whether it is the responsibility of the education system, e public health or health promotion, parents (who themselves may not have had access to information), or some other entities the adolescents must be given access to appropriate information about the dynamics of growing into adulthood.

It also appears that there is very little in the way of support for adolescents where impending changes (e.g. changing schools, relocating, migrating, and divorce) may cause disruption in the way of life leading to adverse outcomes following the change.

Finally, if a preventative approach has failed to stop adverse outcomes then an appropriate and relevant course of intervention must be considered as (evident in the letters), having access to someone who cares and is willing to listen can be the difference between a positive or an adverse outcome.


  1. Davidson, Lesley, Briggs, Alissa, Omar, Hatim A. Impact of environmental health on teen outcomes in rural Kentucky. Int J Child Adolesc Health 2015;8(4):471-6.
  2. Huff MB, McClanahan KK, Brown HA, Omar HA. It is more than just a reproductive healthcare visit: experiences from an adolescent medicine clinic. Int J Adolesc Med Health, 2009;21(2):243-248.
  3. Omar HA, Ventegodt S, Merrick J. Holistic Adolescent Medicine, Italian J Ped, 2005;31:284-287.
  4. Tsitsika A, Janikian M, Greydanus DE, Omar HA, Merrick J. A new millennium: A new age of behavioral disorders? Int J Child Adolesc Health 2013;6(4):363-8.