by Robert Lanz, LCSW
It’s unethical. It’s immoral. It’s illegal. It’s against hospital policy unless its cookies or flowers or some other useless stuff like that. We appreciate cookies and flowers, and if you’ve ever sent them to us, pardon any bad thoughts you might have about my even bringing it up, but this is the ER. We live on caffeine and chocolate and comfort food and there is always plenty around. We don’t need any more cookies, but thanks for thinking about us. That big box of crispy apples the cardiologists give to us every Christmas usually ends up at the homeless shelter after they sit around long enough for the fruit flies to find them. Jeez, you might ask, what’s wrong a little bribe for saving a life, anyway?
Well, the rules are there for a reason, created for someone who may not be as ethical as I am and needs some external guidance. But what’s a social worker to do when a couple of old gay guys from the west side who own a hip clothing store send me a shirt after I’ve given them some really good help?
Send it back? Give it to a homeless guy? No, I wear it proudly.
But that’s hardly the bribe I’m talking about. I’m talking dough now, not big dough and yes, I took it. And yes, it was one of the coolest moves I ever did in the hospital, and I seriously doubt if there are many social workers on earth who could have displayed the knowledge and aplomb to pull it off under the circumstances. Here’s the circumstances.
The paramedic radio sounded off—we were getting a hit and run with massive head injuries, just a few minutes from the hospital. We set up like always, got the CT ready and trauma tray ready, paged the trauma team, got the staff gloved and gowned, called the OR and reserved a room. As the social worker, I prepared to divert the friends and family to the quiet room where bad news is awaited. The patient arrived, young and beautiful, unconscious. Her boyfriend, who she was apparently with when she got hit, arrived shortly afterwards.
The boyfriend was a young, smart guy from a third world country, obviously educated, speaking fluent English. It was easy to tell that he had lived in the US for some time and most likely, gone to college here. He was easy to talk to despite the circumstances. He was amused that I was able to greet him in his own language, one that isn’t common in this part of the world. When more people arrived it was obvious that there was a lot of money involved with this family. Lots of money. I recognized the family name from my travels in Asia.
The patient had a terrible head injury and remained comatose. Everyone was in agreement that this would be a fatality, and that there would not be much the team could do for her. The CT scan confirmed what the clinical findings showed. We would not save this patient.
That was the medical thinking. It was time for some social work thinking.
It was late on a Thursday night, and the young and beautiful patient was admitted to the ICU upstairs, waiting to die. The trauma team handed her off to the surgical resident and got ready to go home. Then it was my turn. Luckily the chief intensive care doctor was a good friend of mine, so I could be direct.
“Uh, Dr. Edwards. You might want to stay more connected to this case and not pass it off to the resident.”
“Bob. You never say that, so something’s up that I don’t know about. This isn’t about medicine is it?”
“No. It’s not about medicine. It’s about perception. Its about third world wealth. It’s about a family so wealthy they can call the president of their country and he will call the president of our country and he will call the Surgeon General and the Surgeon General will call us. Probably not a good idea to have the Surgeon General calling the hospital and talking to the surgical resident instead of you.”
“You’re shitting me.”
“Nope. Not everyone in the third world is poor. The rich are super rich. Like the Rockefellers, guys like that.”
“I’ll go home and eat and come right back. Anyone calls I’m in the OR, okay? I’m supposed to be off call tonight.”
“Make an exception,” I added with the tone of authority docs generally don’t get from social workers.
Shortly thereafter, I was back in the ER and the call came in. It was an international long distance call from Singapore. A neurosurgeon was calling on behalf of the family, asking for me. It’s pretty rare for a surgeon to be calling the social worker. We’re low on the food chain, and usually doctors only talk to other doctors unless we have known them for a while. The neurosurgeon asked about the patient’s condition, and I was able to give him pretty specific details, enough that he understood the gravity of the situation instantly. He thanked me and I offered to have Dr. Edwards call him as soon as he was out of the OR. He declined, stating that he would relay my information to the family and would be flying in from Singapore in the morning. First class, I’m sure.
Lucky for me, I knew that one of the social workers upstairs was from a missionary family in the patient’s homeland, spoke the language and was familiar with the culture. It was easy to get him assigned to the case, even though ICU was not part of his normal duty area. So far, so good. If the patient was going to die surrounded by her family, it would be helpful if someone in ICU was familiar with their culture and spoke their language.
By the time I returned to work on Monday, I thought it would have been over, like most other cases. In and out. Here and gone. Youth snatched away. The kinds of things you don’t want to dwell on no matter how old you are, another tragic memory along the way. I had done what I needed to do and done it well, giving the family the respect they deserved and certainly were used to. I helped save the hospital from any embarrassment for not divulging what was truly involved in terms of politics and international relations. As I’ve stated before, when people ask what the social worker does in the ER, I reply “everything else.” This is part of the everything else. Nothing to do with medicine, but a lot to do with relationships.
Shortly after I started my shift I got a call from the ICU.
“Bob, they’re pulling the plug on that head injury from Thursday night. The family wants you to come up.”
Ouch. I had really been hoping that business would have been over with by the time my Monday afternoon shift started. The beginning of this tragedy had been pretty hard on me, and now I would have to participate in the end of it too. Not the way I wanted to start my week in the ER.
When I got up to the ICU, I saw some familiar faces along with some I didn’t recognize. It wasn’t hard to figure out who the mother was. Another family member I had spent time with moved to introduce us and as the mother approached she extended her hand to shake mine. Then the light bulb of thirty years of third world travel went off over my head just in time. I took her hands in mine and bowed slightly, offering condolences. Even the most astute of observers would never have noticed the little red envelope embossed with gold letters and the family crest passing from her hand to mine. It was as smooth a move as I ever made.
Later, Dr. Edwards told me how impressed the neurosurgeon from Singapore had been with the service I had provided and information I had shared. Luckily, he was in full agreement with Dr. Edwards about the extent of the injuries and futility of treatment. The family needed to hear that from him, their own guy, to know that everything had been done as it should have been done.
I didn’t tell the staff about the envelope. It wasn’t really a bribe. A bribe is what you do to get something done. A gratuity would be a better term. You get the gratuity for doing something extra, like a tip. And I suppose that I had done something extra. Fortunately, when it came to pitching and catching bribes and gratuities, I’d had plenty of experience, so there were no fumbles or embarrassments.
The next day I went upstairs and gave the money to my boss and explained what had happened.
“Good social work Bob. We’ll put the money into the general fund.”
It was good social work. Nothing that could be learned in grad school. Probably not approved by the National Association of Social Workers, but then, that’s true about a lot of the things I’ve done that still exemplifies “good social work”. I kept the empty red and gold envelope for myself. It went straight into my scrap book.