by Robert J. Lanz LCSW
There are a lot of people who walk or stagger into the ER when they probably should have called an ambulance but didn’t for one reason or another. Then there are people who call 911 at the first sneeze or twitch and probably don’t need to see a doctor at all, especially not one in an emergency room. It is also not uncommon to have patients come through the ambulance doors looking pretty healthy and joking with the paramedics, so the ER visit seems like just another social occasion with the ambulance being the icing on the very expensive cake.
So I didn’t consider it strange when a middle-aged guy rolled in with the paramedics and who, aside from his pale, pasty complexion, didn’t look all that bad. His wife showed up a few minutes later appearing less anxious than a wife should be when her husband has to be taken to the ER in the middle of the night in an ambulance. I noticed she seemed almost to float into the ER unencumbered by worry, wearing a shapeless, off-white dress with a red heart embroidered on the back. I don’t usually notice details so seemingly insignificant, but on that night I did.
Unknowingly, she passed by the resuscitation room where a two year old baby was fighting to stay alive, and we were doing everything in our power to help him win that fight. Sadly, it looked as if wasn’t going to be enough. The pediatric emergency team was there, the ER physician was there, the respiratory therapist was there, the nurse with an infant son of his own was there, all working to save the baby long past the point where their efforts could have any effect. Worst of all, the mother was there too, standing right outside the door, watching her child slip away. She could see that everything we tried wasn’t working. She could see the looks on the faces of everyone in the room signifying failure. She could see the desperation and dejection in my eyes. But despite being right outside the resuscitation room, the young mother didn’t hear the clatter of life-saving equipment or the concerned yet professional voices of the ER staff who were working their hardest to save the child. She couldn’t even hear the rattle, hum and multi-lingual hospital babble going on around them, because she was deaf.
As soon as I recognized her impairment, I knew that right then, despite being unable to hear, she knew that bad news would be coming soon. From the minute she came in the door I had been writing down questions I usually posed orally.
“Had the baby been sick?” “Did the baby choke?” “Is there anyone I can call?” Please, is there anyone I can call? Is there anyone anywhere who can rescue me from this nightmare of a dying child with a deaf mother? As social workers and mental health professionals, we are trained in the art of conversation. We ask questions and listen to the answers—not just the words, but the inflections, the hesitations and so many other little audible clues that can communicate as much as the words themselves. All of my ear training and listening skills were useless in this pen and yellow legal pad version of a conversation.
I also had three suicidal patients waiting to see me, and I was feeling a little overwhelmed. Weren’t there enough problems already without adding a social worker who felt as helpless as the mother did?
As the code blue progressed, my notes to the mother were shorter and increasingly more hopeless—as hopeless as the last few efforts to save a young life we already knew was lost. Those futile efforts were performed as much for the staff with children of their own as they were for the patient. Those last looks at the monitor were for the doctors who had to know that they did everything they could. Those final chest compressions and IV medications were also for the death review committees and lawyers who like to second guess what everyone does, so now everyone in the ER goes above and beyond, even when the patient is beyond needing our care. In the end, we make the extra efforts for so many reasons, but when a child dies, we all become patients and need to be cared for in some way.
As the mother read my notes (notes that just kept bearing more bad news), she cried and stared hopelessly. She looked at me, the only person who wasn’t working on the baby, as if expecting me to be able to do something. My job was to help her and it didn’t seem as if I was doing that. Help her do what? Accept the impending death of her child? Overcome whatever guilt she might be feeling? Understand the randomness of life? It was one of the most helpless situations I’d ever been in, writing tragic notes to a suffering mother, painting an increasingly ugly outcome without being able to adequately express any emotional connection. I wanted to tear the yellow paper into shreds and somehow find a way to enter my patients’ silent world.
“Maybe I can help.” It was the serene woman with the heart embroidered on her dress. She had appeared next to me with a gentleness that immediately brought back some of the hope I had lost. “I teach sign language,” she said. Perhaps an angel had arrived.
Sign language. I explained what was happening with the baby and gave her the opportunity to avoid getting involved in what would surely be a long and complicated ordeal. I couldn’t ask a stranger to help deal with a problem of this magnitude without being fully aware of all of the repercussions. And if I did ask her to help, I knew I would have to debrief her when the mother had gone to help get her head right again so she could go and tend to the things that were truly her things. Her offer was generous, perhaps too generous. She didn’t know what she was about to get into.
Or maybe she did.
I told her that the baby was close to dying and we would be telling the mother soon and there was no way to know what her reaction might be. That was a truth I hated to share. There is no way to know what will happen at the moment when the news is final and all hope is gone. I didn’t want the angel to sign herself into a situation she couldn’t sign out of.
But I did. The woman said that she understood and we took the mother down to my office. It was a long walk down a lonely hallway and the mother had to know what was coming. She looked at the other woman knowingly and said a few things with her hands that even a non-signer could read. Then she began to cry silently. The angel signed and the mom knew for sure it was over. The baby wasn’t coming home. We had run out of things to try. We lost again.
For the next half-hour there was the usual self-blaming, the hysteria, the questioning, the guilt. The angel translated back and forth, and pretty soon was able to function in my role without problems. In time, things settled down, as they always do, and the mother asked to see the baby. She wanted to take the angel with her, and why wouldn’t she? She was helping her through her worst moment, giving unconditional love and support at a time it would never be needed more.
In an hour, it was over. Except that it’s never really over. Not for the stunned mother, who had contacted her mother and then went home with their grief. It’s never over for us, either. None of us ever gets over it, we all just get used to it.
Later, I saw the angel sitting outside her husband’s room while he was getting his blood drawn. I wanted to thank her and make sure she was okay, so that she wouldn’t have to take too much home with her like I knew the rest of us would.
“Are you all right?” I asked.
“Oh yes,” she said with a sad smile. “I hope they will be. And you?”
The kindness of strangers again. It’s always such a surprise.
“Thanks so much for your help,” I offered. “We couldn’t have done this without you.”
The words just sort of hung in the air. It could have been an uncomfortable silence but it wasn’t and the moment passed. I knew I had to ask.
“How did you come to learn sign language?”
She looked right into my eyes before answering. We shared another silent moment without discomfort.
“Four years ago I was in a job I hated, battling my way up the corporate ladder. One night, I found myself in an emergency room just like this one waiting to hear if my son’s meningitis would do permanent damage to him. I had time to think about my future and I realized how foolish I was wasting my life on something so insignificant as the career path I had chosen. I decided to do something meaningful so I went back to school and learned how to sign. Now I teach fifth graders.”
“And what happened to your son?”
“He’s fine. Totally healthy. And my husband is healthy as a horse too. He never gets sick. Now I know why God made him faint tonight. I was needed here.”
The embroidered heart should have been a clue. Four years ago, on the night she thought she might need an angel, one apparently showed up and changed her life. I guess it made an impression and so she decided to become one herself. Tonight she completed the circle and she was at peace.
There are times when no one can prevent death, not doctors and not even angels. But there will always be the living to attend to. Sometimes the work of angels is to help us go on with our own lives the best we can.