by Robert J. Lanz, LCSW
In every crisis lies the seed of both danger and opportunity. This is a frequently quoted proverb based on the Chinese character for “crisis”, which contains the symbols for both “danger” and “opportunity”. Urgency brings out the survival instinct in us and forces us to think in ways we aren’t accustomed to. Crisis management is a very large part of hospital social work, particularly in the ER, where we’re often presented with one crisis after another. I learned early in my career how to alter my thought process to fit the demands of the moment, and to value critical thinking above almost all other tools. In doing so, I frequently found myself on the precipice of danger, but I was also presented with opportunities.
When I started as a hospital social worker in the early 80’s there was no internet. Only a handful of geeks had computers and the closest thing to a cell phone was a CB radio. We didn’t have a trauma center, about half of the nurses appeared to have been born there and most of the male nurses worked in either the ICU or in the ER where there was more adrenaline in the room than estrogen.
The social work department on the first floor was heavily female. My boss was a woman, her boss was a woman and all of the managers in the department were women. There was one other guy—an older man in his fifties—who worked part-time in the ER, but I rarely saw him. I did, however, read some of his charting, which I found to be unimpressive. I had worked previously as a probation officer in Juvenile Hall, where all of my documentation was likely to end up being read in court, so I had learned to write with precision and clarity. The writing had to make sense and be easily understood. Over time, I worked to radically change the charting format in the ER, but that came later. This story took place at the beginning of my employment there.
Shortly after I started working at the hospital, the other male social worker left. I became the only guy in a social work department of thirty-six women. But I worked the night shift in the ER, a kind of rugged, masculine job. Upstairs, if something like the death of a child occurred and a social worker needed to vent, get advice or even cry openly, there was plenty of support from co-workers. At night in the ER, the lone wolf social worker is the only non-medical employee on the shift except for the secretaries and housekeeping staff.
In those days, most of the doctors were—like me—white, male and middle-aged, so that’s who I tended to hang out with. I was welcomed into the docs’ social circle, but there were still some obvious professional barriers to full acceptance. I recognized early on that at some point, I would have to show what I was made of in order to earn their respect. I would need to display the right stuff, using a term popular at the time, and that’s what this story is about. Having and showing the right stuff. Opportunity from crisis.
I’ve always been something of a jock. I ski and surf and I‘ve studied martial arts. I worked in jails and I’m not afraid of physical confrontations. I’ve been in the military, I’m comfortable with firearms, and for a time, raced cars after figuring out how much pain could be involved in racing motorcycles. I’m into guy stuff. But in the ER, that only gets you into the boys’ locker room; it doesn’t put you into the starting lineup. For that, you have to do something to move things forward—something brave, maybe. Something smart. Something creative that no else has thought of—but most importantly, something that works.
Let me emphasize again that on the night shift, you are on your own. You can’t ask another social worker for help. There are no hallway consultations on difficult issues, and if you need a good cry, well — get over it. And it isn’t just hospital resources that are scarce at night: it’s everything. If I had to call Adult Protective Services (who, believe it or not, were closed at night), they would tell me to hospitalize the patient and wait for a case worker to contact us in the morning. Calls to Child Protective Services went through an office over twenty miles away. So it’s good to have friends on the local police force, because, believe it or not, you can’t call 911 from our ER. You have to call the police station and hope to hell the person who answers remembers who you are.
Aside from Adult Protective Services, the Greek embassy is also closed at night. I found this out when a Greek fisherman ended up in the ER, brought in by paramedics who had responded to a call about a man lying unconscious at a bus stop. The Greek fisherman spoke no English and had no phone numbers in his wallet. The office at a wharf in San Pedro where fishermen of all nationalities worked wasn’t answering my calls. They too were closed.
The ER staff started all the usual tests on the Greek, but they were flying blind because the patient couldn’t provide the most basic medical history: what hurt, when did it start hurting? With an unconscious patient, you don’t want to be guessing. The docs did a lot of blood work and waited. It would be hours before the lab results were in. Then, the Greek woke up — screaming in agony. It was time for the Right Stuff. Now we knew where he was hurting, but we didn’t yet know why.
“Hey, Bob,” one of the ER docs said. “Can you try and find out something about this guy? Maybe who he’s connected to? He doesn’t speak any English. He’s got a Greek passport on him but not much else.”
We now had a social work issue. The patient was in the ER and all the proper medical stuff was being done—tests, monitoring, observation—but he was getting sicker. Worse, he was screaming in Greek. This is when I had a revelation concerning my job description. The social worker, between doing all the other typical social work tasks, does Everything Else. Once I grasped that concept, my role became clear.
It was all low-tech back then: a three-way conference call was a big deal. But it had to be done. First, I positioned the phone in the Greek’s room near his bed. Second, I made sure that the attending physician could stand by with another phone. Third, I got out the Yellow Pages — and turned to the section on restaurants.
“Hello, House of Ouzo,” a man answered.
“Is this a Greek restaurant?” I asked.
“Do you speak Greek?”
“I’m not sure. Maybe the chef.”
Silence on the phone. The Greek patient kept howling.
Then, “Hello, this is the chef. Hey, who’s that screaming about their stomach?”
The Right Stuff is only right when it works. The bilingual chef was kind enough to make the translation, and the doc quickly made his diagnosis. Even better, someone from the restaurant actually showed up to pick the Greek up when we discharged him. Who knows — maybe it was the chef himself. All I do know is that someone left me a pretty tasty plate of stuffed grape leaves.
So my Everything Else list started with (1) Greek restaurants, (2) the Right Stuff and (3) the seeds of opportunity. Some of my most enjoyable moments on the job came from compiling that list over the years. It explains why every ER should have a social worker on staff 24 hours a day.
Everything Else is a really long list.