by Robert Lanz, LCSW
think this story, as most of my stories, presents the socio-moral-ethical dilemma of how much you should do for a patient. In other words, how much of other peoples money should you spend to save the potentially un-saveable? How much is that life worth in hospital dollars? Or think of it this way: how much of your own money would you put up to save a dying stranger if the hospital could not allot the funds to do so? (Is it even ethical for a medical pr0fessional in the ER to spend their own money in this circumstance?)
It’s easier to answer these cosmic questions during the day when its light out, and there are a lot more resources available than there is at three in the morning. And at three in the morning, this is not an uncommon social work issue to solve. So what would you do when the system you work for presents this kind of dilemma, it’s three hours past the end of your shift, and you’re tired and alone with this problem?
The world of social work is full of difficulties and compromises: no-win situations that tax us all, literally and figuratively. But a good social worker is always up to the challenge. A SW just has to develop a style that works for them, one they are comfortable with. The range of options during interventions is limited only by your creativity-and sometimes your willingness to spend your own money. Of course that is why you need to develop a good reputation and good resources with the police and/or what ever agency can help, including tow truck drivers and cooks in local restaurants.
Everybody wants to be a regular guy. Maybe we wouldn’t have good SW interventions if everybody was just “regular.” Just ask Larry.
A person who will never get his life together, Larry was one of the regular “visitors” to the ER. Long before this particular night, Larry got drunk and got into a car driven by a guy who wound up driving it into a wall at a hundred miles an hour. The driver died instantly but incredibly, Larry lived. But Larry was left with a twisted brain and a very twisted body. Some people who knew him probably think he would have been better off dying that night. I guess it’s a bad thing to be judgmental and it always says a lot about the person doing the judging but I never met anyone who thought Larry achieved anything by surviving the accident. No one can really tell by the way Larry acts whether or not he even prefers being alive. I say that with some compassion.
Larry was now relegated to the streets for the most part. But even street people kept away from mentally addled and physically twisted Larry — even if he bought them alcohol. Twisted and broken as he was, Larry could have been at home as just another denizen in the streets of Calcutta, India, but his presence on the streets where my hospital is always raised an eyebrow. Most people prefer to look right through Larry as if he didn’t exist. It’s just more comfortable than looking at him and being reminded how bad things can turn out in a brief and careless moment.
As a result, Larry remained alone, just another perpetual goof on the street, acting out and stumbling around in the only manner his twisted body would allow him to. One day, a person who could not bear to simply stare right through him called 911. But this time, Larry wasn’t acting out because he was drunk. On this night he was having seizures from alcohol withdrawal. When I came across him in the ER, his state of mind and body were such that I could not tell whether he was brought here because he had too much alcohol or not enough. Pretty extreme.
Someone in Larry’s state does not evoke too much empathy among seasoned ER professionals. It’s not like anyone was unprofessional toward him, but their medical interventions were generally very brief and understandably lacked much personal connection. But Larry was still human. Social Work was invented for guys like him.
It seems logical that someone like Larry would develop a psychological mechanism to keep the pain of constant rejection from beating on what was left of his consciousness. I was never sure if Larry was able to do that. I tried several times to connect with him by being polite, offering food, fresh clothes and cab rides home from the ER. While Larry didn’t mind his clothes being dirty and mismatched, he loved anything resembling food. But no matter how much food I gave him he still couldn’t remember where he lived. Other than giving Larry sustenance, my interventions hardly proved profound. But I just didn’t want to give up on him. There was just something behind those sunken eyes and rotting teeth that I sensed wanted my tending and it’s my job to tend to those kinds of requests. So, despite the temptation to just get him out the door and back to wherever he was yesterday, I again asked Larry where he lived. Suddenly, Larry began a conversation with me. He replied, “With Mike”. Turns out Larry has lived with “Mike” for 20 years. He does not know Mike’s last name, nor his phone number. All he was able to tell me about Mike brought him out here from Las Vegas.
I checked Mike’s address off Larry’s chart and called adult protective services. Who is Mike anyway? Is Mike investing Larry’s money in mutual funds and offering protection like he should? Or did Mike kidnap Larry from a hospital in Vegas to use him as a supplemental security income money machine? Believe it or not, this happens — a lot. Whether or not adult protective services would be able to figure it out, I knew Larry needed someone to watch out for him for more than the few minutes we could spare in the ER.
A few weeks later, Larry was back with us after passing out in a park. He looked his usual self, no better nor worse than last time. When he sobered enough to talk to I referred back to our previous conversation, and asked him if the Adult Protective Services social workers had been out to see him. He didn’t remember. Then he asked if I would get something to eat for us both. He never did that before. Was the person inside that broken mind and body seeking a connection with me? We had a quick ER sack lunch and I sent him “home”.
A month later, he was brought into the ER again, this time covered in blood. No one, not even Larry, knew why. We cleaned him up. Stitched up the wounds and then he asked, “Can I get something to eat?” Once again, I was surprised at Larry’s ability to suddenly carry on a conversation.
What the hell. “Sure, let’s go up to the cafeteria. And it’s on me.”
In another extraordinary conversation, I finally got a chance to know Larry a little better. He could only remember a few things about his life. He was utterly without manners as he ate, often laughing about it. Oddly, he ate rather slowly for a hungry person. My sense was he was enjoying our time together and wanted to stretch it out so I indulged him, and did a lot of curious guessing about his life. What I did understand about Larry is that no matter how he appeared on the outside, he still was a guy on the inside and wanted to be treated like one. Not special, not different — just treated like you’d treat anyone else. It was that simple. I don’t know why it took me so long for me to figure it out.
When I finally got him outside the ER and we were standing in front waiting for the cab I called for him, I came up with a question I was hoping would elicit an interesting answer. I asked, “What’s the best topless bar in Vegas?”
Larry looked at me and started to laugh. He laughed so hard that he shook from side to side and then fell over, landing on his face and undoing all our handiwork. I grabbed a wheelchair and brought him back into the suture room.
“Jeez Bob, what happened to this guy? It took an hour to sew him up and now look at him.”
“I don’t know what happened” I fudged. “He just sort of fell over. His balance is never very good. He’s at his baseline.”
Larry laughed the entire time he was being stitched. He was still laughing half an hour later when the taxi came. I put him in his cab and he yelled to me out the window as he drove away: “Hey Bob, I don’t remember the name of the bar, but I remember those boobs!”
Larry is a regular guy after all.