by Robert J. Lanz, LCSW
Every business has its regulars. Sometimes they’re a pain and sometimes they’re a pleasure. Sometimes they matter and sometimes they don’t. Every waitress in an all-night cafe can name the guys who nurse a cup of coffee for hours and chain smoke like they think it won’t hurt them. Every maitre d’ knows the rich customers by the tips they leave and he seats them wherever they want. At Nordstrom’s, they bring their gold cards and stay for hours, and at the local bar, the bartenders can be suspicious of drinkers who haven’t passed their unspoken test of loyalty. They’re the regulars. They come and they go, but mostly they stay.
Emergency rooms shouldn’t have regulars, but they do, and it doesn’t take a fertile imagination to figure out who these regulars are. Or maybe it does. You would expect that the diabetic might come in on a regular basis because of blood sugar getting out of whack. You would expect chronic seizure patients to come in frequently because they have chronic seizures. The asthmatics show up on a regular basis with changes in weather or seasons. A large number of patients have some ongoing medical problems and need regular treatment for them. An equally large number think they have chronic medical problems, for which they think they need emergency treatment on a regular basis. These are what I call the “regular” regulars.
Many of them truly do the best they can with their medical conditions, and when it gets to be too much, they come in for some help—a transition if you will, a temporary fix, pending a return to their “normal” state of health, which probably isn’t too good. Most of them however, don’t fall into that category. Most of them don’t take their medications like they should. They drink alcohol when they shouldn’t and don’t take care of themselves in a manner consistent with their diagnosis, or in any consistent manner at all, for that matter. What should be a chronic manageable problem frequently becomes an acute and expensive problem. They’re not paying for it, so it doesn’t bother them, but you and I are. This should bother us, because these regulars are usually the most difficult patients who show up at the worst possible times and take up the most resources. They are frequently rude and demanding, and think it’s perfectly all right to call an ambulance when a cab would do just as well. Of course, a cab would cost them five to ten dollars. Better to call an ambulance that costs someone else about three-hundred and eighty.
Every Emergency Room has a collection of these kinds of patients, and ER workers around the world dislike them but take good care of them anyway, because even though they don’t take good care of themselves, their diseases are treatable. Then there are the other regulars. They’re fond of ambulances too. They generally don’t have real medical problems, although they might have real medical symptoms, such as being high from taking too many drugs or being drunk from consuming too much alcohol. Some of them might be experiencing yet another anxiety attack or are feeling suicidal. Some have been beaten up for the tenth time or, my all time favorite, some have shit their pants. I’m not making this up. People call the paramedics after shitting their pants, and if they do it more than a few times, they become regulars. These are not the kind of regulars we like. (There’s a “code” for everything in a hospital—“Code Red” for fire, “Code Blue” for heart attack etc.) The regulars who shit their pants are “Code Browns”(the worst code of all). We reach a point where we no longer feel sorry for this type of regular, at least I believed we do until my first Code Brown died.
At one time, Mary had been a pretty good-looking young woman. But she was the most self-destructive person I had ever met, and over the years, that self-destructiveness took a heavy toll on her body, prematurely aging her to the degree that a new admitting secretary might think that Mary’s birth date was incorrect when charting her in. We saved her life when someone shot her in the chest for reasons that were never clear. We saved her again when she had a blood alcohol level inconsistent with life, along with twenty Valiums as a backer. We spent hours X-raying her when she had been beaten mercilessly after getting drunk and having sex with six guys who were as sick as she was. We sutured her head and face so many times from assaults and drunken falls she could be described as “Frankensteinian”. Yet, she had staying power that defied all odds.
On two separate occasions while caring for her, I thought I detected a twinkle in her eyes, and realized she was flirting with me on some primitive level. Another night, while being sewn up to repair a brick to the face injury, she looked into my eyes and told me she loved me and that I was the only person who had ever cared for her. Then her false teeth fell out and she got embarrassed and turned away.
She was a regular, and because of that, I thought she would always come back. We all thought she would survive anything, because it seemed like she had already survived everything. I was wrong about that. One night, a paramedic told me he had gone on a call and found Mary curled up in the bathroom of an abandoned house. She had been dead for days, cold and alone, the needle still hanging from her arm. She had finally killed her pain.
I didn’t realize just how much the regulars like Mary meant to me over the years until my first one was gone. I went home and thought about the strange relationship that had developed over the course of late night admissions, drunken confessions, and the incredible pain we observed but could only imagine experiencing. Between the beatings, the OD’s, the stomach pumpings, the frequent faller program, the nights sobering up in one of our beds and even the “Code Browns”, we did spend a lot of time together. I had seen Mary at her absolute worst and because of it, at times, she had seen me at my absolute best. No matter how pitiful people are, no matter what they’ve done with their lives, if they bring out the best in you, you always remember that about them—the good part.
And if you are somewhere reading this Mary, I’d like to say “thanks” and tell you that I think about you often. I’ll always miss you. I hope you are finally feeling better.