by Robert Lanz, LCSW
Sometimes I wished I worked at a bakery like when I lived in Park City. After that last doughnut came out of the cooker and those final brownies were wrapped, I changed into my ski gear and went and had fun. I never dreamed about cookies or apple fritters. I never gave a thought to the sour dough bread on the shelves I had helped prepare. Not a thought about the bakery until I passed it on the way home to catch a nap before returning at two in the morning. Never a thought.
I should have known not to bring a patient home with me. I should have known to not be influenced by a woman who was weak and under the control of alcohol. I should have just left her there in the ER and ignored my feelings and gone on home alone like I always do. It’s not good practice to let things like that happen and a person with half a brain could see doing such an act would only lead to problems, sometimes big problems…sleepless nights, guilt, embarrassment. There are a lot of reasons not to fall into the trap some patients seem to set. They can find your weakness, drive a wedge into your soul and make you think thoughts you don’t want to think, say things you don’t want to say and do things you don’t want to do. I should have known after fifteen years it would only lead to grief and I did it anyway. In the morning I was sorry.
Rose is seventy-eight years old and she drinks. She drinks way too much and has for a number of years. She is getting worse and a few days ago she decided to leave the safety of her retirement community because they wouldn’t permit her excessive drunkenness. She hit the streets with about a thousand bucks and like Nick Cage in Leaving Las Vegas she seemed hell bent to finish herself off before she ran out of money. She had a good start the day she ended up in the ER, smelling like a diaper pail and looking like she had been on the streets a lot longer than the three days she had been. Her hair was matted, her face was dirty and my eyes watered from the acrid ammonia smell of the urine that soaked her clothes. I was ready to hate her, for having left safety and moved to danger at her age, letting the alcohol do the thinking for her, and I guess, the acting. She was found down in the street, unable to get up, clutching a half empty bottle of vodka. The paramedics told me she had a lot of money on her and that she was homeless. That’s a rare combination; especially at the end of the month when funds get a little thin while the drinkers wait for their “disability” pay. Rose was going to be an enigma. I knew that from the start. I didn’t have any idea I would take her home.
She had no family, no friends, no place to stay and she thought she lived someplace she didn’t. She had no keys in her purse so I knew she had no residence. She still had her money despite her obvious intoxication so I figured she must be pretty smart to fight off or fool the predators that would be more than happy to beat, rob and rape her when she passed out in the bushes.
She wasn’t crazy enough to lock up unless she wanted to be and she didn’t. She wasn’t gravely disabled enough yet but she was going in that direction full speed ahead which is truly a scary idea at her age. She wasn’t suicidal or homicidal in the sense that I could have the police put her away for a few days. She wasn’t quite bad enough yet to take away her rights. Not yet. I knew she was destined for worse things but there was nothing I could do about it. It was getting on to midnight and it was cold outside but Rose had sobered to the point of being legal again and she wanted to take a cab to the home she no longer had. She was holding enough money to go in search of it though and I knew that’s what she would do.
I called the psychiatrist on call on the off chance that he would get out of bed, drive across town and fudge the rules a little to declare Rose gravely disabled so we could lock her up and detox her. He was angered at the idea. I thought maybe we could call her regular doctor and see if she would admit Rose for detox but Rose didn’t want to hear any of this and the ER physicians didn’t want to wake another doctor for an alcoholic who didn’t want to stop being one. By now, it was pretty clear that the only person who gave a damn about Rose was me. In the big picture, that would probably give a normal person a clue they needed to reevaluate their position.
“I can’t let this patient go out. She’ll die in the cold or get killed and robbed. I’m not letting this patient go so she can die on my shift,” I yelled out in a crowd, hoping that one of the docs or the charge nurse would offer some suggestion. One did.
“When’s your shift over?” I was asked.
They had made up their mind to send Rose out into the night and given all that she had done with her life, especially over the last few days she probably deserved whatever fate she got. But not on my shift.
“It’s over right now, I’m out of here.”
“And so is she” I heard as I went to lock up my office.
Rose took a cab to nowhere but in my heart I brought her home and put her to bed where she kept me up all night with nightmares of old women that looked like my mother and grandmother being raped and murdered in the street.
The feelings haunted me the next day and the next night Rose was there again to keep me from a peaceful sleep. I knew we had done wrong to let her go but there was nothing else we could do. That didn’t matter. I knew I would see Rose again and it would be bad.
After an anxious and sleepless weekend when I came back to work three days later, Rose showed up with the paramedics. Found down again intoxicated. The secretary pulled out an old chart from the previous day when she had left following another drunken visit to the ER but at least this time she didn’t get sent out into the night. What she did get was a two thousand dollar workup; CT scan, blood work, the works. She had a broken nose and enough abrasions on her face to make everybody uncomfortable but not uncomfortable enough. The psychiatric nurse that evaluated her at four a.m. didn’t think she was crazy enough, disabled enough or self destructive enough to be locked up. Maybe when he went home he had nightmares too.
Anyway, tonight Rose didn’t smell any better than she had the previous visits. Her clothes had been changed and already were as dirty as her old ones. Her blood alcohol was three times legally drunk and she could still walk. But despite all this, when I walked into the room her face lit up and she said, like we were old friends,
“Hi there Bob, remember me?”
“Yeah I do, Rose. You caused me to lose a lot of sleep”.
She cried and asked what she should do.
“Get off the streets, get off the alcohol. Get a life. Grow up. Go to detox. Go to meetings. Move into a safe place”.
“OK, I will.”
It took about three hours to battle my way through the nightmare of insurance companies, admissions clerks, accepting physicians and transportation but the arrangements were finally made. The ambulance came to take Rose to the detox center. As she was being rolled out the door she turned to me and asked,
“If I do all those other things will you do one thing for me?”
“Probably” I answered.
“Take me to dinner when I’m sober”.
‘I’d be honored,” I replied.
And this time, I won’t be taking you home…