The Swamp

by Robert Lanz, LCSW

I’ve been to the jungles of Mexico, Central America and South East Asia, but those were mostly walking trips with a little boating thrown in. My first trip to the Amazon was different-very different.

Bob driving boat

We had flown up to Manaus, in Brazil, an incredible city in the middle of the rain forest sitting at the confluence of the Rio Solimois and the Rio Negro where the “Amazon” officially becomes the Amazon. A thousand miles east, where it dumps its fresh water into the sea it is about a hundred miles wide. Where we were, by comparison, the grand river was essentially a creek, only five miles wide.

At first, I wasn’t scared. Manaus is a big city cut from the jungle, with most of the amenities found in big cities anywhere, movies, supermarkets, drug stores etc. However, unlike most first world cities, the safety factor diminishes when you step off the sidewalk. Alligators, snakes, piranhas, giant leaping iguanas, fresh water sharks and other fish big enough to swallow us like minnows were everywhere. Lots of reasons to not stray from the sidewalk.

So we chartered a boat, hardly more sophisticated than Humphrey Bogart’s famed African Queen, and we chugged up river, soon parting the jungle and totally losing sight of the Manaus skyline along with any sense of the safety of a sidewalk.

This journey would involve a new set of survival skills, most of which we had only imagined but had yet to put into practice. Luckily, we had the foresight to hire a native guide and a dugout canoe in tow behind us just in case. I’ve surfed most of my life and I’m comfortable in the water most of the time but being a good swimmer here might not be much help. Carrying a weapon of some sort might not either. It was the rainy season and normally exposed islands were now underwater. Large trees poking out of the depths were the only evidence of land, somewhere down there. A lot could go wrong.

Freeboard is the distance between the water and the highpoint of the sides of the boat-or canoe. On the boat we chartered it was about three feet, sort of a sidewalk separation from the unknown creatures we were undoubtedly floating over. The canoe had only about three inches of freeboard which meant fingers were dangerously exposed to those creatures when we held on to the sides to steady the delicate balance of the hand carved craft.

native fisherman

While fishing for piranhas, each catch of the steel-toothed carnivores had the canoe rocking. Without land to swim to if we got swamped, we’d have to try to get to one of the nearby trees and try to climb safely into the branches. So far, whenever we got close to those trees, the twenty pound iguanas living in them would panic and leap from their perch, hitting the water like guys cannon-balling in a backyard pool party, causing waves that could have easily swamped the low freeboard canoe. The fear I felt that day still lingers in my memory bank. Amygdala time again.

It’s surprising I had any room for these fears, given the night experience we had in the same low freeboard canoe when our guide suggested we abandon the relative safety of the bigger boat and look for crocs with a giant flash light. With their glowing red eyes, the crocs looked liked surprised kids at a birthday party getting their pictures taken with a powerful flash bulb. With such eyes, I imagined they would be able to back-track to the source of the light-us. Us in a low freeboard canoe. We even-well-not we, the native guide-grabbed a baby croc that was swimming by and pulled it into the canoe. Trepidation would describe my feelings and I just wanted to get back to the safety of the big boat with all of that freeboard.

We tied the big boat to a house on stilts, apparently the home of a family member of our guide, and hung our hammocks, then rocked gently to sleep. Not so gently actually, thanks to a few bad dreams about the denizens of the deep separated from us by only by a few inches of wood called our boat. Normal fears.

In the morning we were awakened by the sound of children laughing loudly and splashing vigorously. I looked overboard to see a dozen little native kids swimming around the boat, some even using it as a diving platform, straight into the darkened river we had been plying for piranhas and crocodiles.

kids in boat

Of course, they weren’t scared, they knew the swamp. They were familiar with the dangers and just acknowledged them as a minor inconveniences they had learned to accommodate in their lives, as we might if we stayed there long enough. When you live by the river, you soon learn there is no way around it, only through it. The swamp, of course, initially seems scary and there is a sense that it would be safer to go around it. But the swamp is endless. You can’t ever go around it-only through it. Attempts to circumvent those fears just postpone the inevitable, waste time and may get you lost. Nevertheless, my first inclination was always to stay in the boat. Thankfully I overcame those fears and soon found myself swimming with the kids, laughing and splashing like I never thought I would.

By now I’m sure you recognize that this story, while true, is a great metaphor for the grieving process. No way around it, only through it, scary as it initially seems.
I have related this Amazon adventure tale to many patients who seemed to be stuck in the grieving process, fears often turning to somatic complaints that brought them to the ER with problems relating more to emotional pain than some disease process.

It’s a good story. It’s also a good metaphor and seemed to get a strong response most of the time. Maybe you could tell it yourself some time. Just say, “I heard a social worker tell this interesting story…”

Dividing line

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Pathology

 

by Robert Lanz, LCSW

People have often asked me, “What was the worst thing that ever happened to you in the ER?” (I take that to mean, ” — thus far.”) My answer: “There is no worst thing; the worser thing is always coming.”

But one of the worst things that did so far happened, happened the night I had a fight with our hospital’s pathologist (aka, the autopsy doc.) The pathologist works in a icebox-like laboratory next to the morgue. Day or night doesn’t matter to him: no windows, nor sunlight. He never sees a living patient. He never deals with loved ones of dead patients. He never speaks to the social worker. This social worker had no experience or friends or any resources available to him to smooth-out a bad connection with a pathologist, when such smoothing needed to be done.  Not good.

If the pathologist doctor was adept at or slightly more desirous of interacting with the living, he likely would have gone into another specialty. I could even understand urology or proctology. At least those guys make visits to the ER.)

It’s important for medical specialists who only occasionally consult in the ER to see how social workers interact with patients, their families and the ER physicians. Social workers then become ‘people’ to them. If the social worker has to have an interaction on another of their visits at least they know they can utilize these social worker ‘people’ if they need them.

Every ER social worker has tales of working alone on the night shift, having to be dragged upstairs to deal with deaths in the ICU, angry parents in pediatrics and mentally-ill alcoholics demanding to be signed-out against medical advice — all at the same time, of course.  I was unique in that I knew of no other ER social worker, who had pissed-off the hospital autopsy doc — at least to the extent I did.

There are twenty social workers “upstairs” (the part of the hospital where patients who are admitted reside — the ‘nemesis zone,’ which I have talked about in previous stories.) With so many social workers up there during the day, it’s rare for the social worker down in the ER to be called upstairs to help. But the ER social worker at night is the only social worker in the hospital and it is common when there is a crisis to get a request  from upstairs: ‘Bob, can you come up?’

Downstairs, where the patients I have already started to evaluate or began an intervention with, will now have to wait until I come back from an emotionally and time-consuming situation waiting for me in one of the wards upstairs. Being pulled upstairs when I am still needed downstairs in the ER is a challenging, time-consuming tug of war that always put a drag on my ability to service the ER.

Tonight, a new grandmother was upstairs visiting her daughter’s very premature baby. The baby was still-born, weighing under the requisite five-hundred grams to even meet the criteria for a child to be issued a birth certificate. The still-born was sent off downstairs to the pathologist. In this situation, a still-born is not wrapped in a towel and placed in a morgue drawer like a larger dead infant would. That would be an easy fix. Security would open the door to the morgue and I could show the body. Instead, what is referred to as pre-term tissue is placed in a specimen jar and sent to the pathologist for whatever analysis he’s going to perform down there in his lab. Whatever it is, I’m sure it has rarely ever included a visit to the ’tissue’ from a  grieving grandmother accompanied by a meddling social worker. I guess the pathologist didn’t read the current social work literature, so I imagine he didn’t quite get how important viewing the remains is to the grieving process (regardless of the condition of the remains.). And this grieving grandmother wanted to view those remains. Who am I to deny her closure?

The remains in this instance, were in a jar on a shelf in a lab — a lab neither the grandmother — nor I — had ever witnessed the inside of. A mother making such a request may have had more emotional or legal or policy energy behind it to pull it off. But such an unusual request by a grandmother: that was a stretch.  I worried the pathologist might hide behind hospital policies and procedures and keep us out of his private space. The insistent grandmother raised the issue to one of the nurses. The nurse punted to the charge-nurse. The charge-nurse punted to the night supervising-nurse who served as the hospital administrator on this particular night. Fortunately, the night supervising nurse and I had a lot of ER ‘mileage’ together with a lot of mutual respect. Grandma was insisting she had a ‘right’ to view the remains. But the remains weren’t in space I had access to. The space in question was the lab, access to which can only be had with permission of the pathologist. Being it was almost eleven at night, the pathologist had gone home hours ago and was probably in bed.

Yep, he was  asleep when the hospital operator called and got him on the phone. I told him of grandma’s request. In no uncertain terms, he told me that it might be a good idea if I went back to social work school if I thought that grandma seeing the macerated remains of her still-born grandchild was a good idea. Click. That from a guy who worked in a room with no windows.

Macerated. Hmmm.  More dilemma. Should I try to de-tune that word and explain to grandma why the pathologist is reluctant to have her view the remains? I tried my usual ‘soft version’ of the truth, deflecting her ire towards hospital protocol instead of me.  “You tell that pathologist I’m tough and I can take it. And tell him I insist on seeing my grandchild!”

I had the hospital operator dial him again.”Uh. Doc, the grandmother here says she insists. She says she wants me to view the remains first, and if I think her viewing them will be too gruesome, she will trust my judgment.”

“Jesus Christ! Tell security to open my lab and let you in! The jar is labeled. Anything goes wrong, it’s on you. Don’t wake me up again!” Click.

Whew. He didn’t did ask for my name.

I went in. It was the middle of the night. It was quiet. It was dark. I groped around for the light switch and finally, I found it –the room lit up brightly: everything was either medical-green or stainless steel. I saw saw lots and lots of jars on metal shelves lining the walls and I did the best I could to avoid looking too closely at the contents. When I found the appropriately-labeled jar containing the grandchild, the remains didn’t look too macerated at all. Just very small.

I brought grandma in. She had her closure.

As she was leaving the hospital, grandma thanked me and apologized for pitting me against the pathologist.

I never heard from or spoke to that pathologist again. For all I know, he’s still down there in that lab.   Maybe one of these days, I’ll take a look. Maybe try to friend up a little. Do a little social work.

Dividing line

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Dying With Dignity

5 wishes

by Robert Lanz, LCSW

In case you don’t have a TV or a newspaper or internet connection, a young woman with terminal cancer named Brittany Maynard has been in the news for the last few weeks. She was well aware of her impending death and the painful and debilitating “cure” available to her that perhaps might squeak out a few more days of of life. She decided against it.

Those of us who work in hospitals know there are physicians who will buck the system and bend things around in an attempt to help someone with Brittany’s particular end-of-life wishes. But Brittany’s wishes are not the routine. To die her way, Brittany had to move to Oregon, where the medical establishment is more open — and more caring, I might add — to people making Brittany’s choice.

Since then, letters to the editors of many large newspapers have been flooded with personal stories of terminally ill people who changed their minds about trying to control  their process of dying.  I have never read anything by anyone who thought a few weeks of torture before a sure death was a workable idea. If you have been following this blog for a while, you may know that in my first story, Dying Sooner (ninety-five stories ago,) I outlined my personal belief about the dying process and argued that it was incumbent on the social worker to help families formulate a plan for their terminally ill loved ones. That story was based on my own experiences fifteen years ago, and I’m ambivalent about the “progress” we have made with the end-of-life rules in our health care system.

The introduction of the Five Wishes seems to be a start, and I’d suggest everyone make themselves aware of the document and get one signed for yourself and everyone else you know. Click on the link:

5 wishes preview

To me, it is like the shingles vaccination was: I didn’t think about it until I got shingles. Fortunately, most people who had chicken pox are now aware of the vaccine.  (I will add that having personally suffered the torment of chemotherapy and radiation, accompanied by some serious surgical scraping, I vigorously spread the word about the HPV vaccine too.)  Like vaccinations, the Five Wishes are a good prevention for what might happen.

I’ve seen hundreds of people die, and dignity is rarely part of the equation, especially in the ER.  Trauma patients are naked in a room full of strangers, each stranger working on a different part of the patient’s body: IV’s in the arms, catheter in the urethra, a finger in the rectum, a tube down the throat, and if you have really bad luck a, tube painfully placed into your chest cavity.  With extremely bad luck, the surgical resident will crack open your ribs, spread them wide enough to put his hand into your chest so as to do the pumping movement necessary to squeeze the last remnants of blood fr0m your heart into circulation. I’ve never seen it work successfully, but we try. Dignity? Well, if you’re young, one of the nurses will put a towel over your genitals. Maybe.

When your monitor flat-lines the trauma surgeon declares: “That’s all. I’m calling it. Time out 19:47.”A sheet is placed over the body and everyone exits the room.  A police photographer enters, removes the sheet and snaps a few photos. Often, police will look for evidence of a crime on or around the patient. As a final act of ‘no dignity,’ the housekeeping staff enters to clean up your waste. A part of you — the detritus of our futility — is thrown into the hazardous materials bin. When we’re trying to save your life, dignity is not an issue. We at the ER, do hope you led a dignified life and we hope that is how people will remember you — instead of like this. But we did what we had to do. And we did it for you.

Non-trauma deaths (heart attacks, pulmonary embolism, sepsis and the like) are far less gruesome and usually less intrusive into your body. But even then, the necessary violence of CPR is brutal and sometimes breaks ribs. Of course, the patient is unconscious for the procedure. Eighty percent of the time, unconsciousness will be permanent. Time out 21:02. Not a lot of dignity there, either. It’s obviously why ER physicians don’t allow a patient’s family into the treatment room during resuscitation attempts. I have had more luck with patients’ families in that regard, but less with the docs, though I found the docs did soften over time. In one instance, a young man wanted to be with his father while his father died. I brought the young man into the treatment room. At first the docs gave me the stink eye, but in moments the docs forgot him, and furiously concentrated on their work to save the patient. The son held his father’s foot for almost half an hour while we desperately tried to save his father. He later told me that he was an airline pilot, and that his training had been helpful in keeping him calm and focused during this ordeal. For my intervention, he thanked me generously. As the social worker, I knew exactly what the son got out of being with his dad in those last moments of his dad’s life. I wanted be sure the docs knew, too. I suggested to the son he tell them so. He did.

On the other hand, there is “upstairs,” where some patients die after being admitted. There may be more dignity up there, but dying up there is a slow and expensive fade-out rather than the quicker death — and medical beating — they get in the ER. Upstairs still lacks the dignity of dying peacefully at home, the way most people died, until medical technology came along and extended certain lives for hours, days, weeks or even months. But upstairs still beats dying in the ER. Most of the people in my family died at home quietly in their own beds. Of course, they had a real advocate fighting for them for have the dignity (me.) That’s how I’d like to leave when I die. The dignity upstairs comes at a very high price. No doubt that price will be a big issue for medical ethics people in the very near future.

In reality, there is about as much dignity at the end of our existence as there is at the beginning. The beginning, of course, is filled with hope and promise. But, each is a bookend to the amazing thing we call life.

Smiling baby

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Unintended Consequences

Jacket

by Robert Lanz, LCSW

I should have known better. I’d been in the Amazon and I’d worked in jail. Bad guys are bad guys where ever they are, whether they are locked in a cage the size of a cubicle or live an apparently unfettered life in the remote rain forest of the Amazon Basin. A case in point:

When the old-world missionaries arrived on scene in the nineteenth century to attempt to “save” the heathen Yanomami tribes by getting them current with the modern tools of Europe, the deal soured quickly. The introduction of steal axes to a select tribe proved to be a game-changer for the recipients of the updated technology. Suddenly, it allowed them to fell large trees in hours versus the months it used to take them using their ancient stone-age tools. ‘Modernity’ allowed them to create larger slash-and-burn areas for farming, exponentially expanding the  reproductive abilities of the previously “primitive” tribe. This idea wasn’t lost on the other other tribes. Lest the balance of power in the area go out of kilter, the other tribes preemptively slaughtered the ‘modernized’ tribe while they still could.

That intervention, much like many interventions in later centuries, had unforeseen consequences. Hearts were in the right place, but heads…well…you know the saying.

A book from my school days, “That’s Not What We Meant To Do” by Steven M. Gillon, pretty much sums up the dilemma:

Not meant to do book

That’s Not What We Meant to Do: Reform and Its Unintended Consequences in Twentieth-Century America, by Steven M. Gillon

Mr. Gillon’s book is a macro-view. Most critical problems of the ER are micro-view, though they usually reflect larger social trends. We can’t fix larger social trends in the ER, just tend to the results of them. In and out: that’s it.

In my first months in the ER, I realized that homeless people, thirty years later there are still lots of them, would always be a time and resource problem: difficult people with the obvious and well-known difficult problems. Poor self-care. Poor judgment. Overuse of drugs and alcohol. Poor follow-up with medical care. Manipulating the system to their advantage, and overtaxing it at the same time. All that stuff. They are difficult to care for and difficult to follow-up and difficult to get rid of.

The social worker’s job ,in part, is dealing with difficult patients, but  especially helping them get discharged from the ER after their medical issues have been addressed. Considering the alternative (a cold night, hard ground with no drugs or alcohol or decent company) most homeless people would prefer to sleep in a warm bed, get some decent food, maybe flirt with a cute nurse, and even prescribed some mind-alternating drugs. Those, too, are macro problems.

While the ER social worker may be empathetic to large and complicated social issues, the ER is not a social-work agency: it is a medical facility with social-workers in it. Those social workers are no where near the top of the food chain. Rather, they are often guests in someone else’s house, perhaps pushing their social work agenda when able to, and trying to massage the policies of the hospital. In the big picture, that should always be the social worker’s goal.

But the main goal of the ever-crowded emergency room is medical: get the patients in, get them stabilized and get them out. Fortunately in my hospital, the doctors had respect for social-work philosophy and tasks, and frequently referred patients to the social worker when they were “medically clear” but not quite ready to leave the ER.  Without social-work presence the patients would be discharged by whatever means necessary and newspaper headlines would scream out horror stories of patient dumping and patients dying right after discharge. For social workers, that is an intolerable situation, and in my facility our influence allowed for the occasional sleep-over, some opiates to avoid withdrawal, a decent meal to the regulars who were not abusive, rain ponchos, warm blankets on a cold night and fresh clothes for a new start.

In that sense I was like the lame missionary that selectively gave steel axes to the Yanomami and neglected the neighboring tribes. But on this occasion, I didn’t see it coming the same as those missionaries of old didn’t see it coming when they placed the other tribes at a disadvantage. And like prisoners in jail who perceive being ‘disrespected,’ the reaction of those ‘disadvantaged’ tribes was quick and brutal. Like I said: good intentions, bad outcome.

Like many stories this one starts with, “It was a cold and rainy night,” And on that night I had to get rid of a relatively healthy, medically-cleared homeless guy. I let him shower and get some fresh clothes from our abundant stash – most which I provided myself. (It just saved me a lot of valuable time.) ER beds are valuable, and sick people or people with sick kids don’t want to hear about there being no bed space because a homeless guy brought in by paramedics with urine soaked pants and vomit on his chest now won’t leave.

A good social worker is ready for such an issue, even if it costs him or her a few bucks from their own pocket. Cheap, compared to not being able to clear a bed when a sick patient was waiting to be admitted. That’s a micro issue.

Perhaps had I studied anthropology more vigorously or reflected on my jail supervision experiences, I could have seen the unintended consequences of my act of missionary zeal. Besides the clothes I kept on-hand, someone recently donated several warm coats. The one that fit my soon-to-be-discharged and now well-dressed and fed patient, was a nice leather jacket, well over a hundred bucks when new. The guy looked sharp when he departed. Several nurses didn’t even recognize him all cleaned-up.

They did recognize him however, when he returned a couple of hours later, again with  paramedics, his face bloodied and bruised, his clothes covered in dirt and mud.

The ER doc barked, “Let’s call a trauma code on this one — he’s got a lot of facial injuries and he can’t remember what happened! Hey — wasn’t he just here?”

Charge nurse answered “Yeah, we signed him out a couple of hours ago. Ask Bob — he was the last guy to see him.”

Right: ask Bob what he was thinking when he sent a homeless guy back to the street dressed in an expensive leather jacket! And, of course, that jacket that was nowhere in sight.

The overhead speakers went off:  “Code Trauma! — Code Trauma!” I put my hands over my ears and closed my eyes. What was I thinking?!… Unintended consequences. Should have seen that one coming. No excuses and now none for you either.

Pay attention: it looks very bad when the social worker is the cause of a Code ‘Lame.’

Dividing line

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Another Reason Not To Smoke

Gas explosion 2

by Robert Lanz, LCSW

An old motel not too far from the hospital, a roll of duct tape, a pair of pliers, a pack of smokes and a fifth of Jack Daniels – the only thing missing in the list of props is a depressed old guy who would soon be dead. Remember the statistics on who is most likely to take their own life: old white men living alone and drinking. Well, we’re all matched up now so let’s go to the script.

Depressed old guy rents a room at the old motel that still has the gas stove in the kitchenette. Depressed old guy puts duct tape over the window frames and goes out for a bucket of ice from the machine. When he returns with the ice he puts a couple of cubes into a glass and adds a double shot of the whisky, knocks it back and pours another, thinks a moment, then goes back to the duct tape and tapes up the door sill and jams. No use stinking up the parking lot he thinks.

He then pulls out the pliers and twists the connecter that ties the gas stove to the gas line and turns on the valve –whoosh, the gas escapes into the room while the depressed old guy takes a seat on the couch and pours another drink. The pouring and whooshing continues. Despite his level of intoxication he remains melancholic, sniffs the gas, puts more ice into his glass and pours another shot of JD.

Over an unknown period of time, maybe an hour or so. according to the night manager of the old motel, he continued drinking apparently thinking (and I could be wrong about this) all that natural gas from the stove would eventually kill him painlessly. In a way, I guess, it did. But not the way he thought.

The fire investigator thought the depressed old guy grew impatient as he became more and more intoxicated. He most likely pulled out his smokes and his ancient Zippo lighter. When he rolled the little wheel against the flint a super whoosh blew the walls right out of the motel and flashed-burned the depressed old guy. He was found, unconscious, but alive, but seated on the smoldering couch which was now located in the parking lot of the business next door.  He was covered in white powder. Apparently someone (no one knew who) sprayed him with a fire extinguisher. Probably a good thing he was still unconscious: he would otherwise be in a lot of pain.

Sometimes, even though a severely burned patient comes to the hospital alive and breathing, we still can’t save him. Too much damage. When flesh gets burned, the underlying tissue swells from the body fluids being released. Dermis destroyed by burns is the perfect storm for infection. Third-degree burns imply that there will be areas of first and second-degree burns as well. Third-degree goes all the way down to the fat, or worse, to the bone: if a victim is lucky, the nerve endings have been burned away.

With this level of destruction, every patient I have ever seen with burns like this old depressed guy had (except one) were in such acute pain that they begged for death or unconsciousness. This old depressed guy’s nose hairs were burned completely away so we knew his lungs were equally damaged to the point we could barely get a breathing tube into them. While a machine breathed for him, his muscle tissue started breaking down, and once into circulation in his blood, released myoglobin damaged his kidneys. The heat from the explosion burned his trachea to the point where no machine could save the life the depressed old guy wanted to end. Simply too much damage. In the ER, he died.

He had no I.D., so I never knew who he was. ‘John Doe #2634-87,’ I guess. He looked really bad, but he did get what he wanted. With the police present, the coroner took the  body and that was the end of it for me. Except for the nightmares.

Somehow, a guy should learn how not to do that: not be afraid of any of one’s feelings, that is. Let them in, let them through, and let them out. But sometimes the passage is simply too treacherous, and they linger forever…

Dividing line

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Butt Burns

Grill marks

by Robert Lanz, LCSW

Lightening things up a little this week…..

Dog in car captionedsmall divider

“Hey Bob. Can you go in room nine and talk to that kid and his dad? He’s got a weird burn pattern on his butt.”

After a while in the ER it becomes almost obvious that some injuries are seasonal. First week of football practice? Call ortho.  Start of ski season? Call ortho — and warm up the CT scan.  Summertime? Forest fires in the local mountains. (Our paramedics and firefighters get fall and burn injuries.) Christmas? Drunk drivers. And the one that brought room nine to my attention tonight: October chills bringing on old wall heaters.

This is California. We turn off the gas to heaters in our homes around the end of April and turn it back on in October or later. That’s half a year for kids to forget simple things like the fact that in their trendy old Craftsman homes, heat comes from registers on the floors or walls. In those six months, kids either forget how hot the registers get or they grow to be more mobile and can’t seem to avoid scooting onto the hot metal floor registers before their parents can stop them. The result of those lapses could result in grid-pattern burn (matching the pattern on the register) on kids’ hands and feet and sometimes even their knees.

Hardly child abuse or neglect.  Though that’s possible. Usually those kids from Craftsmans showed up at the ER with both parents, and seemed to take comfort equally from mom and dad. (The parents had the same six months to forget about the heater.)

I suffered one of those butt burns myself, just out of grad school while living in a funky old house in Echo Park (now hip part of L.A.’s music and movie scene.) The house only had one gas heater to heat the whole house — not that difficult in L.A. weather, even in the winter. (I even had a gas faux fireplace with cement logs, if it ever got that cold.) And one night, it got that cold. I set the wall heater to its highest level. I got out of the shower and stood in front of it, shivering (naked of course, holding a big towel in front of me, enjoying the warmth on my bare back. Enjoying it, until I dropped the towel. Most social workers I know don’t fantasize about being engineers or physicists and I’m solid on that list myself. Perhaps if I had studied harder in my undergraduate science, technology and math classes I would have understood the mechanics of the butt burn move that was to come.

If your rear-end is only a few inches from a wall heater and you bend over very quickly, your ass will press right on to the heater: instant pain, and a grid-pattern burn on your derriere that matches the pattern on the heater guard Pretty lame. But as the president’s right-hand man used to say, ‘never waste a crisis.’ Or in this case, a butt-burn.

At the time, I was working in juvenile hall, Here I was on my shift, with burnt skin and grill marks on my ass.  My secretary asked why I was walking funny. I turned to tell her the story of how it happened, but being young and impulsive, when I opened my mouth, out came this tale:

My friend Danny and I were at the Pancake House in Hollywood after some serious carousing at a couple of blues clubs. A food fight started (and we weren’t participating) that turned into a fist-fight that turned into a near-riot. I resisted the impulse to pull out my probation officer’s badge and try to break up the melee. Clinical judgment screamed out to me: ‘Too late for that Bob — get out of here.’ With about twenty people brawling it looked more like a biker bar than the International House of Pancakes. We made a beeline for the back door through the kitchen. When I tried to run past the huge Samoan pancake chef, he put a giant shoulder into my gut, stood up and lifted me off my feet and I sat me right onto the waffle iron.

It was about that time in the story that I pulled my pants down and said to the secretary, “Look what happened.”

There it was, the marks on my butt cheek looking very much like a Samoan-induced waffle iron burn.Repeating the story over time, I kept embellishing it, but always kept the same ending and showed-off my right butt-cheek with the cross-marked pattern. Hell, I was almost a little bummed out when I healed all up. No one, until now I guess, ever knew the true story of the injury, the fiction being a much better presentation than the facts.

So I walked into E.R. room 9, introduced myself to dad and the boy and told them a social worker was required to see all children coming into the E.R. with any kind of burn. I already surmised what happened, but legally I had to hear it myself. The kid showed me his grid-pattern burned butt cheek and gave sort of a frown. It wasn’t funny to him and I figured he probably wasn’t old enough to massage this painful experience into a humorous one. I hoped he someday might acquire that skill. (I’d be happy to help if he ever asks.)

The child said, “I was standing in front of the heater after my bath and I dropped the towel. When I tried to grab it, my bottom went against the heater and it burned me.”

I looked at dad. He shrugged.

“Sounds like an accident for sure. Case closed.”

And dad says, “That’s it?”

“Well. I lived in an old house too.”

If I still had the marks I probably would have compared butt cheeks and maybe at that very moment the kid would have learned the valuable skill of laughing at pain.

“That covers my part. The nurse will come in and put some Silvadene on it and tell you how to watch for infection. No big deal.”

Dad said, “This won’t ever happen again.”

“Yeah. I know.” I could say that with all sincerity.

Dividing line

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