by Robert J. Lanz, LCSW
When you read up on these things, the experts say it’s bad to start your work day at full speed, that you should get a cup of coffee, ease into the day slowly, feeling your way around a little until your mind and body are ready to go at the same pace. Or, you could just get smacked by some large hard object and get thrown off a cliff. Then your mind and body, with all its survival chemicals pumping, would be going at the same speed in no time at all. You don’t actually have to be thrown off the cliff to get your mind and body going that speed, that’s just a metaphor. All you have to do is be close enough to someone who has been tossed or knocked or spun into the danger zone as their emotional residue sucks you into the vortex, too. When you work in a trauma center there is a possibility of that happening every day. Actually, that assessment is far too conservative. There is a strong probability of that happening every day.
The night shift, my shift, started at 4:00PM and ended when it was over, whatever time that was. If it had been a busy day for her, the day shift social worker acted as if she was the happiest person on earth when she saw me walk in at 4:00. If there had been a trauma within the last hour she’d be more than happy to let me take over, especially if she hadn’t actually made face to face contact with the patient or family yet.
So, at 4:00 PM, on a day like any other day, I arrived at work and started to put my things away, and the day social worker went through the routine of telling me what a horrendous shift it had been. She told me about the terrible close calls she’d had, the ridiculous drunks she had dealt with (and who were now my problem), the crazy, needy patients who were almost impossible to get rid of. Then as she was ready to leave, she turned and mentioned casually, almost as an afterthought, “Oh, yeah. The trauma victim’s family just got here. They’re in the conference room, don’t know anything yet. The patient’s an old guy, got in a TC, took out a couple of parked cars. He was stable last I checked, but he has a pacemaker and takes a lot of meds so who knows what’ll happen. I’m out of here. See you tomorrow.”
I finished putting my stuff away and walked out onto the unit where, as usual, things were working at warp speed. Maybe the experts who concluded that starting your shift too fast had been studying the trauma center as the worst example of workplace stress. Maybe whoever designed the world and the people in it hadn’t read the expert’s study and just went ahead and sort of threw things out there and let them fall as they may. Goofballs and good guys. Responsibles and irresponsibles. Rich and poor. Walking and driving. All together trying to get along and get home safely, mostly clueless about what havoc they would be experiencing and probably even worse, what havoc they would be causing.
“Hey Bob,” someone yelled through the maelstrom that is emergency room life, “that trauma went south in CT. The docs are looking for you.”
The last part couldn’t possibly be good news. The only reason the docs would be looking for me is to get me to do something they didn’t want to do. More than likely that would mean dealing with a death. They had to notify the family or they had to tell me to notify the family. It was up to me to find them wherever it is that doctors hide when they need to escape from the pain of their losses.
If I was going to deliver death news, and that was a pretty sure bet at this point, I needed to find out what happened. The last report stated that the patient had been stable and now that was no longer true. There are few things more grueling that starting your shift with a death.
The patient was in his seventies and had a pacemaker. Witnesses told the police that they saw his car drift suddenly out or his lane, striking a couple of cars and crashing into a light pole at about 40 miles per hour. The crash caused internal bleeding and despite our transfusions and interventions, the patient died. And now it was my turn to talk to the family, who were all waiting and hoping to hear otherwise.
Anyone who doesn’t hate walking into a roomful of anxious family members to tell them their loved one died has some serious mental problems. A social worker who can’t do it probably should find another line of work in some other kind of place, but one who doesn’t want to do it is probably mentally healthy and will be able to get through the task without great difficulty, even if it is the first patient of the day.
It was as bad as I expected it to be. A daughter and a son-in-law and three teenage grandsons all looking at me with those pleading eyes, begging me to lie, if only for a moment. Another minute, please, another minute before you take away my dad. Another minute before you take away my father-in-law and put my wife is such pain. Just one minute before you take away our Grandpa. Please. Just one more minute, Bob. Can’t you leave and come back later? Can you give us a little more time?
“I wish we had better news but we don’t. He had too many injuries and we couldn’t save him. He died.”
They all cried, of course, and they talked about how hard it was to believe he had died, since they had just talked to him that morning. It was all so fresh and painful, anguish invading the room like a fog hanging over us all, ghostlike. Finally, signaling the rest of the group to prepare for the next step, the daughter asked if they could see him, and I told them they could, leaving ahead of them to make sure he was presentable. In their minds, he was just the same as he was the last time they saw him. It was my job to try to get him back to looking the way they remembered him as best I could.
The rest of the night was a blur, and I was glad for that. I’d always thought that if a guy had to start the day telling a family they have lost the person they love most in the world that the guy should have the rest of the night off. A lot of people in my business feel that way, except, of course, the people that pay me to do this stuff, but who are never there when I have to do it.
When my shift was finally over I went home and fell into a fitful sleep, filled with crying kids and dying grandpas running through my head and trampling over my heart, pulling my soul from its hiding place and lighting it on fire.
“The night started off bad and went downhill.” I told my friend Lori, the day shift SW, as I put my stuff away at the beginning of my shift. She gave me her report about all the leftovers I would have to deal with: The crazy guy in Room 5 waiting for a locked bed in the psych unit. The drunk guy in 3 who had been there all day with a blood alcohol level inconsistent with life. The old guy who fell down and was waiting for a cab voucher to get him home safely. The woman in Room 1 who was beaten by her husband, again, and was waiting for the cops. Just your average day in the ER.
A hard knock on the door got my attention. I’d been there all of five minutes and already had dealt with several difficult dispositions. What could be so serious that someone was banging on my door? At least no one was dying, according to the charts and reports, so how bad could it be?
Some questions should never be asked, and this was one of them.
“Hey Bob, that old dude in Room Eight, Bed Four just coded and his family is here.”
How bad could it be? I was about to find out as another elderly man began slipping away right at the start of my shift.
I walked over to see how the code was going, brushing past the woman who came in with the patient. She looked about the right age to be the patient’s daughter and I was already starting to rehearse my lines. “I’m sorry. We did everything we could and we couldn’t save him. He died.”
But we hadn’t given up yet. We put the tube down his throat and hooked him up to the respirator, shocked him three times, gave him enough rounds of CPR to crack a couple of ribs and injected sufficient cardiac medicine in his IV to get a heartbeat going in a dead person. And it worked. He kept a pulse for a few minutes and we started making arrangements for him to go upstairs to ICU. If he was going to die, let him do it on someone else’s unit, I couldn’t start my shift that way again today.
I went to tell the daughter waiting anxiously by the door, a well-dressed woman who had just been joined by a harried-looking man. He looked familiar but I couldn’t quite place him. He obviously had no problem placing me.
“Do you believe this Bob?” he said. “Yesterday my father-in-law and today my dad.”
My knees buckled. My forehead broke out in a cold sweat and my eyes naturally angled for the door. His wife would be here, too, along with his sons, the patient’s grandsons.
The ER doctor came to me and asked if I would talk to the family about making the patient a “No Code”. That essentially means that if he were to start dying again, we would just let him pass peacefully. No heroics. No machines. No more broken ribs, just a peaceful passing. At his age and with his medical condition, it would have been the right thing to do. Under other circumstances I would have readily agreed, but there was a limit to what I was willing to endure. And there was also a limit to what I was willing to let the families I work with endure, even if it would cost a lot of money to arrive at the same conclusion. I was at that limit. So were they.
“No. I know this family and they might be willing to let him die tomorrow but they can’t let him die today. Get him upstairs any way you can, but he can’t die tonight. Don’t even tell the family he might.”
When I went to the waiting room and found the daughter-in-law and the three grandchildren, I knew I had done the right thing.
They looked at me again with those pleading eyes. The tears were already there, eager to start flowing again. Maybe I should have another type of job in some other kind of place, I thought. Someplace like the Alaskan oil fields—ice and tundra, wind and sleet, sub-zero weather all the time. Something easier.
“Your grandfather will be going upstairs soon. He’s unconscious right now, but I want you to talk to him as if he can hear you. Sometimes people who are unconscious can still hear. I’m sure he wants to hear you talk to him.”
I heard my own voice as if someone else was doing the talking. It couldn’t be me. It couldn’t be possible for this to happen. I was in a daze, a functional daze, but a daze nonetheless.
I’m sure you need this, guys—a chance today for some last goodbyes. I’m sure I need to know you did it, so I can start to feel whole again. I’m sure I need to know it isn’t possible for three young men, who looked and acted like they never did anything bad to anyone, to suffer such punishment, to lose two grandfathers in two days.
And I’m really sure the experts who write about these things don’t think that is a good idea to have to endure so much such pain in so short a time period. I’m no expert, but neither do I.