by Robert Lanz LCSW
When the overhead pager announces a trauma code everyone gets immediately focused, responding to some internal list of mental preparations and physical tasks to perform in anticipation of the arrival of the patient. That includes the social worker too, of course.
The social worker, like the rest of the trauma team, has to prep for anything that comes through the door. Will this be a frantic mom in the ambulance with the soon to be dead child? Will the paramedics be carrying a healthy baby with the soon to be dead mom on a stretcher? Under such circumstance, the healthy baby and/or the living mom will be taken aside by the social worker so the trauma team can work on the patient. What a place to start an intervention- so far behind the curve it will seem like there is no catching up. Catching up to what? Finding someone with some good news? Finding a functional family member who can take over some of the social work tasks? And on top of all that, having a trauma family doesn’t mean I get to forget all the other cases I’m attached to in the ER- it just means I get spread a little thinner.
More cops with questions. More phone calls to answer. More requests from the charge nurse about family coming. More lab values to be aware of. More interventions to discuss with the families. More radiological information to assimilate for when more family members and friends show up.
And when the family and friends and co-workers show up there is a reversal in the information flow. Is the patient on any medications or have any ongoing medical problems we should know about? Is the patient addicted to drugs or alcohol? More information to break down into its simplest elements and feed into the trauma team.
“The patient’s on Coumadin” or “The patient is a diabetic” or “The patient is undergoing chemotherapy this month.”
Everything out of the trauma bay is filtered to the family by the social worker. Everything relevant from the family to the trauma team is filtered back the other way too.
The night the nicest guy I never met showed up started out as a mystery as they often do. A young white man, could have been a garage band grunge rocker or a community college kid, had been struck on his bike while riding on a busy street. The car that hit him didn’t stop and the nice guy was knocked out immediately. Upon arrival he looked like he had been more functional than many of our trauma patients. No smell of alcohol. No marks to imply injections. Well groomed, clean clothes. But no identification.
Part of the social worker’s task list is to help identify the patient, notify the family and secure the patient’s valuables. Unless ruled out, it is assumed he may be the victim of a violent crime so the clothes and other personal property may become evidence and need to be treated as such. Gloved up I routinely plunge into pockets, shoes, pant cuffs, back packs and cell phones. Car keys and wallets or virtually anything can give me a clue as to what happened and who this person is attached to.
Over the years in my pursuit of identification I’ve found lots of drugs, lots of money, some fake ID’s, bullets, some porn, some sex toys, a few coke spoons and crack pipes and once a small live lizard in a homeless guys sock. I really didn’t expect to find anything strange in this young guys stuff. Wrong again. He had seventeen crisp one hundred bills in the front pocket of his levis.
Jeez, according to the police he was on a funky old three speed bike and no one around seemed to recognize him. No wallet but maybe that had been blown out of his pants onto the street and no one had found it yet, not an uncommon experience. Sometimes patients that come from board and care facilities have their names inked on the collar of their shirt or on their underwear. Not this guy. No cubic zirconium in his ear. No gold chains around his neck. No tattoos or obvious scars. Just all that cash. I’ve had several drug dealers brought to the ER with more money than he had but it was never in the form of crisp new bills like you get from the bank. More often it is crumpled small bills, and beside that, there is ink and jewelry as if to advertise, “Step right up. I sell dope.” Not this guy.
Somewhere, someone knew this guy and would be looking for him. I was right about that and soon my secretary called from the front.
“There’s a group of people out here. The police told them their loved one might be here. I think it’s the trauma guy’s family.”
I greeted them and we walked to the “quiet room” and got seated, the anxiety so obvious it could be cut with a knife. I asked for a physical description and it sure did fit the trauma patient and I already wished it didn’t. These nice people had no clue how bad he was, how bad the night would most likely turn out, so I started my slow slog into the bad news zone and watched as my practiced words sucked the color from their faces and the hope from their hearts. Mine wasn’t doing so well either.
“I’m going back to radiology, John (the patient finally had a name) is getting a CT scan. I’ll try to get the latest information from the trauma team.”
The news wasn’t good. When I spoke to the neurosurgeon he wasn’t hopeful as he explained that massive intra-cranial bleeding was not going to be fixed surgically. Too much blood. Too much swelling. John would go to the ICU, hooked up to all those machines and IV’s would be pumping all those medications. Desperation moves. Hope for the best.
I went back to the quiet room, now the desperation room, and did my best to ready them for the worst. This morning everything was great. Tonight, everything went wrong. In a few moments the neurosurgeon came in-one of my favorite trauma team members I’d add.
“John’s been hit hard and has bad fractures on both his legs.”
The family gasped as if that was the worst of the news. I cringed but kept my game face on.
“Orthopedics is tending to those injuries. He also has a collapsed lung and a badly lacerated liver and they were talking about removing his spleen. The trauma surgeons are tending to those injuries.”
The family gasped again and swooned but leaned forward towards the neurosurgeon, seemingly in anticipation of the real issues at hand.
“I’m the neurosurgeon. Unfortunately he’s had a major head injury too. We were just looking at his head scan. Doesn’t look good I’m afraid.”
Desperate for something, anything positive the family pressed on.
“But he’s going to live, isn’t he?”
“Well I’ve never seen anyone in my practice with this severity of injuries survive, but we’re not giving up. If you’ll excuse me I have to get back to your son.”
When the neurosurgeon left, the group finally started to understand how grave the situation was. It probably didn’t help much when I handed all that money to his father who immediately got tears in his eyes. The whole room looked at those hundreds. Dad turned to one of the female friends who I was about to find out was more than just a friend. Dad held the stack of bills in his hands, a future no one would ever see.
“Denny” he said to the pretty young woman, “John went to the bank today to get this money so he could buy an engagement ring. He was going to propose to you tonight.”
Tears of joy merged with tears of sorrow, a best and worst moment of life at the same instant.
The young man went upstairs and died. When the story got out to the staff we all died a little too….