by Robert J. Lanz, LCSW
Despite my sometimes unorthodox interventions, my outcomes were such that it was rare that I got complaints from staff or patients. Oh, sometimes the staff would think that I took too long with dispositions, or that I was too generous with the taxi vouchers—simple things like that. But no one has ever registered a complaint about my clinical skills. We deal with so many different types of issues in the ER, many of them not medical, that virtually every intervention presents an opportunity for grievances. Since the social worker is on the front line for all the non-medical issues, I consider myself lucky that there haven’t been frequent complaints related to many of the things I have done or said over the years. Hey, the free clothes were too small. Hey, he wouldn’t sign for my pain medications. Hey, the social worker was rude to me and told me not to come back to his ER, that kind of stuff.
I would have thought that sooner or later, someone would have found a reason and the time to send a letter to the administration when they believed I’d done something out of line. There may even have been several times when it would have been appropriate for people to think they had a right to complain, and I would have been more than happy to address their issues and apologize if I thought I was wrong. The truth is, if I thought I was wrong, I wouldn’t have done it in the first place, but my perceptions may be different from those of someone who was angry or drunk or grieving or somehow on emotional edge.
I understood that and tried not to push people too hard when they were near the edge. I frequently used my own time and money, as any good social worker would do, to try to keep people from the edge when for some reason the system was unable to provide all the things the person may have needed. This was especially true on the night shift, when pharmacies are closed, or it was raining and cold, or it was too dangerous for a patient to take the bus. Situations like these, which I managed to make better. Situations that never got mentioned in thank you letters to the administration or mentioned in the annual evaluation, because no one knew about them except the patient and maybe the nurses. The nurses were good about supporting me on these issues, but it wasn’t the nurses who did my evaluations or signed my paychecks. As far as they were concerned, anything they got from me was a bonus.
Most of the nurses had worked previously in other ERs where there wasn’t a social worker, and any help from us was especially appreciated. Some of the nurses probably thought I spoiled certain chronic patients. They were right. I did spoil them. The alternative was to let them develop into patients who were willing to fake illness to get drugs or food or warm clothes, so spoiling them was cheaper, faster and far less stressful.
I wish that I had the time and patience to be more of a Dutch uncle sometimes. That was partly the case in another life, when I did therapy in juvenile hall and was able to lock up my clients and force them to listen to me and make the appropriate adjustments to their behavior when they had been rude or hostile. Believe this, there were lots of times when I wished I still had that probation officer’s badge and control.
Anyway, I’m getting off track. This is a story about someone trying to get even for a slight they received and services they thought I should have provided but didn’t. They may have been right, and if I expected better behavior from my patients, then I guess they had a right to expect good behavior from me. I’m human and there are limitations. I’m generally pretty aware of where mine are.
Some situations are inherently fraught with difficulty, and any complication that develops can be used against me, even if it isn’t my fault. A good example is when there is a death in the trauma center, it almost always becomes a coroner’s case. Someone has to sign the death certificate, and since most traumas involve some sort of legal morass, no one in the ER Trauma center complains about turfing these things to the coroner.
That doesn’t mean it won’t be a problem for us. That doesn’t mean I won’t get caught in the middle between the police, many of whom I have known for years, and the families of coroner’s cases who I don’t know at all.
A typical situation goes like this: Some young man between sixteen and twenty-five gets shot. He is not an innocent bystander on his way to sports fame, musical millions or college honors. More likely he is in a gang, which, now that I think of it, may seem like a sport to him just like football, in which the goal is to gain or defend turf, to score points by taking out an opponent. There may even be some pre-game tailgating type of behavior along with a post-game wrap-up, if you survive the game. Maybe later, in prison, the gang equivalent of the Hall of Fame, the “sports heroes” are held in high esteem. Kind of an OJ goes gangbanging thing. There I go, digressing again.
The typical young male victim is out late, not having the burden of school or work the following morning to consider. His clothes and his tattoos scream out, “I’m in a gang and what of it?” The guy who shoots him looks and dresses a lot like him, and is most likely from the same ethnic background. In most cases, the victim and victimizer could easily change places.
For most of us, and I’ll include myself in this group, it’s pretty hard to work up a lot of empathy for these guys. Pretty hard to get all shook up and think, “there, but for the grace of God, go I”, like we might when there is a car crash or a tragic fall from a roof. But it was my job to interact with the police, the coroner and the family, so I was not allowed to consider the normal things a bystander might be thinking.
This was the hard part. I never had any real problems with the police, never had any real problems with the coroner, either. I had a lot of problems with the families of victims.
My initial reaction to the families was one of empathy, regardless of the circumstance of the death, or life, of the victim. No matter that the victim may have been engaged in the sport of violence, he still had parents and siblings and friends who loved him and thought he was a great guy. It wasn’t my job to point out the obvious—that would have been insensitive.
In the normal course of events, even before the death pronouncement, I would secure the family in a private room, provide water and coffee, tissues, phone access and translation if needed. I would also be the conduit for any medical information about what the trauma team was doing to try and save a life and how we were progressing with our interventions.
The family always had a lot of questions about what happened, how serious it was and what the likely outcome might have been. As I shuttled back and forth between the family and the trauma bay, the news continued to get worse, and finally we would tell the family that the patient had died. Not “passed on”. Not “expired”. Died. He’s dead. The we involved may have been the police and me, the doctor and me and maybe all of us. Sometimes I preferred to do it on my own. Sometimes it was good that there was a cop in the room, because the way people handle bad news can be violent and I would rather not have to bear the brunt of that violence alone.
Of course, the family would be devastated. They would almost always cry. Sometimes they’d throw themselves on the floor and wail. Sometimes they’d throw chairs and punch walls, kick tables over, blame, curse and threaten. Sometimes the friends would leave and go looking for some payback. And everyone wanted to see the body. They were clueless that he may have been covered with blood, missing parts of his flesh, filled with tubes and in some occasions, cut open enough that one of the surgeons could get his hand directly on the heart and try squeezing it as a last ditch effort to move some remaining blood around. Everyone wanted to see the body. Always. Every time. Hmm, what could go wrong with that?
If your son fell out of a tree on his job as a tree trimmer, it’s a coroner’s case, but viewing the body wouldn’t be a problem. If there was a traffic accident without suspicious circumstances, it’s a coroner’s case and again, viewing would not be a problem.
But if the victim was shot or stabbed or beaten to death, the coroner and the police would consider the body relevant evidence, and therefore, no one would be allowed to touch the body. There would be a cop there, a street cop in uniform who would actually sit outside the room and not let anyone but staff go in and out. He’d know that we were not going to touch the body and if we did, it would be well documented. To him and the law, the body would have the same relevance as a kilo of cocaine or the possible murder weapon. The cop would not give anyone the victim’s phone or necklace or clothes or anything else, and he sure as hell wasn’t going to let the family in to touch and hug the victim. That would be contaminating the evidence.
In a coroner’s case, at the moment of death, that patient is no longer a “patient” in our hospital. No matter that his body is there, and even though we bear a certain responsibility for it, it is officially a coroner’s case. The social worker remains involved, because the family is still in the secure room waiting to see the body. It is one of those terrible situations in which I would have had a tremendous amount of responsibility and no power at all. I wanted to help the family with their grief and allow them a chance to say goodbye. I wished that they could have held their son and hugged him and cried over him and said their necessary farewells. Didn’t happen. If I asked the cop if the family could visit, he would always say no. He would remind me that it wasn’t his call, either. Viewing would depend on the Robbery/Homicide detectives (the cops in suits) and they were not present at the hospital, but at the scene of the crime. Thanks to cell phones, I could usually call them and tell them my situation. Not that it did me much good, but at least I could tell the family that I tried.
Because we frequently worked together, the cops were nice about my calls, and sometimes empathetic to the situation, at least to my part in it. But empathy, while helpful to social workers, is not helpful to cops in these circumstances. They may be empathetic, as I said, but that’s why there are strict rules of evidence, so someone doesn’t let their feelings override their judgment and compromise the evidence. Remember that OJ thing? I can see it now-the courtroom is packed, the cop is on the stand and a Johnny Cochran-type attorney is defending a man accused of murder. He approaches the cop and asks,
“So, officer. Is it your practice to let a victim’s friends and family have access to evidence in a murder case?”
“But you let four people go up into a room alone with the evidence. They touched the evidence, they hugged the evidence, they kissed the evidence. They contaminated the evidence with their DNA and perhaps removed or manipulated some part of the evidence that might demonstrate the innocence of my client, is that right?”
Whoops. That’s why empathy was off the table. No visitors. Of course the cop didn’t have to tell the family that, I did. Then I’d have to explain that it is the police that make these decisions, not me. Then I’d have to explain that the officer at the door doesn’t have any say in the matter. Then I’d have to explain that it is the decision of the detectives and that those detectives aren’t present. Then I’d have to explain that I have no way of knowing when the detectives will arrive at the ER, or if they will allow the family to view the body when they finally do arrive. They might. Depends on the detectives and the families. This may go on for hours. Sometimes it goes on long past the time when I stopped getting paid to be there, and when I should have been home in bed, leaving these problems for the nursing staff. But I didn’t do that. I finished what I started even if it was to my detriment. That’s empathy, I guess.
Once, at four in the morning, a family threatened, cajoled, yelled, screamed, tossed chairs, threw some pretty spicy epithets my way, and even accused me of unethical conduct because I wouldn’t let them see the body of their murdered child. And I was on my own time when this took place. After taking this beating for a couple of hours, I finally lost my cool. I could no longer bite my tongue and my empathy had long since left the room. Try as I could to get it back, I couldn’t, and my ability to even fake empathy finally wore out. The accusations and implications finally got to me.
“You can’t see the body because the body is evidence. Your son is evidence. No one can touch the evidence. No one can kiss the evidence. No one can hug the evidence, like I know you will do. And there is nothing I can do about it. He’s evidence and I have no control over evidence.”
I had been nice and empathetic for almost six hours, four of those uncompensated. I should have been home in bed for those hours. But nice hadn’t worked with that family. My empathy, and it was initially genuine, never got any traction with them. The longer I tried, the angrier they got. I understand that. I’d had it happen before and I got through it. But this time, it just went on for too long and became far too personal, and I lost it.
I explained all of this to my boss when the complaint letter arrived a few of weeks later. “The social Worker was very insensitive the night my son died in the ER.”
I thought, maybe next time I won’t even try. I’ll make the family show me first that they deserved my efforts and my empathy. And if they don’t, then I’m going home to bed. If they think that I’m insensitive. let them try dealing with the charge nurse next time.
She’ll be insensitive from the get go, especially if family members are rude to her. No second chances. No extra mile. Complaint letters would just roll off her back with the knowledge that it is all but impossible to replace a good night shift charge nurse. Maybe that’s why we finally got twenty-four hour social work coverage in the ER. So we can have some empathy all the time…no matter what.