by Robert Lanz, LCSW
There are some guys on the trauma team that are more or less outliers, some of them so far out that most of us don’t even think of them as part of the team. In fact, they are so far out they probably don’t think of themselves as being part of the team either and that may be the bad part for these guys. If you have to suffer the trauma of being on the trauma team then you ought to know it. You ought to have some defenses built into your day like the rest of us. You ought to have a debriefing support group or something like we do.
The cops do it. So do the paramedics and firemen. The doctors and nurses and the rest of the staff, even down to the janitors and secretaries, do it because we all know they are part of our team and we watch out for each other. We are all an obvious part of the team that deals with the treacherous outcomes of mistakes, bad luck and lame decisions that bring people to the ER.
Those guys who drive the tow trucks are sort of victims themselves, having to clean up after the paramedics have left the scene of terrible accidents or even having to watch while the patient is extracted from a crushed vehicle. One time they even called the paramedics when they found a severed finger in a car they were towing and didn’t know what to do with it. With all the other trauma, the cut off finger was overlooked, a reminder, for the moment, the driver is part of the team, even if unwillingly.
Let me digress for a few moments. Although it wasn’t in the policy and procedures manual and most folks didn’t think it was necessary and some folks even thought it was an invasion of privacy, none of that mattered much to me. One of my professors taught me to always consider the possibilities of the unseen victim. Lucky for me I had a good relationship with the cops who came to the ER. Over time they began to understand when I asked questions about an accident they were investigating they knew I wasn’t just indulging in some voyeuristic fantasy.
For me, the unseen victim was the guy who survived the accident unscathed, often the guy who was the innocent one in the tangle of metal and asphalt. If he wasn’t injured and he wasn’t at fault, the cops just took a statement and maybe helped him call a friend to get home while his car was towed away. Hey, how could he be a victim? He didn’t get hurt and he didn’t get busted and the other guy got squashed and taken to the trauma center . He goes home seemingly safe. But I know that a lot of them aren’t safe. They’ve just been in a life and death situation and not addressing that is incomplete medicine.
The literature on traumatic stress reaction shows you don’t have to be the actual victim to end up traumatized. You just need to be close to the action to suffer it’s traumatic effects. Two issues come into play. The closer you are to the center of the violent act, the more it will effect you and the more closely you are connected to the victim, the more it will effect you. Bad luck for a lot of guys is that they are almost never emotionally connected to the other guy and despite being in the actual center of the trauma, they get overlooked, kind of like the finger left behind and found by the tow truck guy. Pretty minor it would seem, compared to everything else.
Imagine, if you can, that you are the guy that finds the finger or you’re the guy that’s been in an accident with the death of a stranger and no one gives any thought to what that may do to you emotionally. You don’t go to the ER so none of us see that death stare look in your eyes or that nervous tremor. No one died in your car or no one died at your house so the police chaplain doesn’t come out to see how you are doing. Nope. This is emotional aftermath that you will have to deal with on your own. Unless, the social worker in the ER who has the good relationship with the cops asks for your phone number and the cops, who have learned a little about that clinical judgement thing, don’t have to think twice about giving out that confidential information. They know if it gets back to their watch commander or the chief that they shared confidential information they can say,
“Hey, Bob the social worker told us why he wanted it and we thought it was a pretty good reason and you would too if you talked to him, do you want his number?”
Lucky for me a lot of the watch commanders used to be street cops and I knew them too and we had history. Enough history that no further questions were necessary.
So, at first, it probably seems strange for the unhurt guy to get a phone call from the ER social worker who wonders how he is doing. Since most people don’t even know there is a social worker in the ER and are clueless about what we do until we do it, I usually opened with an introduction that included that I had spoken with the police officer and he thought I should call and see how you were doing. Then I would listen for answers that would guide my intervention. It’s that clinical judgement thing again. Being able to pitch a perfect stranger about mental health issues is a difficult skill set to acquire. Thoughtfulness and practice I guess.
Anyway, what usually happens is that the person rambles a little, then gets more focus, re-frames things a bit then listens to my pitch about normal reactions and what to watch out for and he thanks me for calling. I give him my number and tell him a SW will answer 24/7 if he has any questions. Sometimes the normals move into ‘uncomfortables’ over time and I want us to be there just in case. This usually works pretty well and the unseen victim realizes he has been seen and tended to and now knows part of why there is a SW in the ER all the time.
That’s why I started calling the tow truck driver guys. If the cops mentioned that the accident was horrendous or that there was a death or the tow truck guy had to hang out while the paramedics did an extraction or something happened like that finger incident I’d make the call. Most of the time they seemed OK and found it interesting that I would even call and check on them. Most of the time they had found their own way to dodge that emotional bullet. At least I hope they did. Kind of hard to tell on the phone and they were a tough crowd, at least on the surface, so maybe they were OK and calling them was just overkill on my part-oops, I probably could have been more sensitive in the way I put that.
So, one night I had a special request for the tow truck guys. One of my regular homeless alcoholics, living on the street in his electric wheel chair had been brought in, again, when he misjudged a curb while going about as fast as a guy could go in an electric wheelchair. He did the perfect face plant, also again. He either thought he was going to zip up that ramp and struck the curb instead or he thought he was going to zip down that ramp and went off the curb instead. Didn’t matter much I guess. A drunken face plant is a drunken face plant regardless of the actual mechanism of the injury. Didn’t matter much to me, again.
What did matter to me was that last time the homeless drinker in the chair came into the ER with a face plant, again, was that after he sobered up enough to get going he had nowhere to go or any way to even get to nowhere because his chair was lost in the shuffle. Cops didn’t have it. Paramedics never saw it. Maybe it was still back at the crash site. Maybe someone stole it, urine stench and all. Anything can happen in the street. Luckily for me, after four hours of phone calls I finally got a family member to drive thirty miles at midnight with an old chair he had in the garage and take the homeless guy out of our hair. I thought it was particularly skillful of me to offer gas money when the family member said he didn’t have any. Twenty bucks of my own dough and worth every penny. Still I didn’t want to go through that again. The twenty bucks was the easiest part and I’d probably not be able to spring that trap another time.
So I started again with hope and a prayer. I called the paramedics to check on the chair. They thought the cops had it. I doubted that as the chair weighs a couple of hundred pounds and it was unlikely they would have thrown it in the trunk of the police car. I was right. The cops had called the tow truck to haul it away. Great. I knew where the chair was and I’d have to get the chair to get rid of the patient and all I had to decide was how much of my own money I would be willing to spend to make this movie end well. Like a lot of things it always comes down to the two currencies in life. Time and Money. How much time would I spend to avoid spending my money. How much money would I spend to save some time. Should I start trying to get his family again or just whip out my credit card and pay the tow guy to get the chair back? The cops thought it would be about a hundred bucks. Man I was stuck. No money from the hospital, so I’d be on the phone for hours again or use up half a nights pay to avoid the aggravation. Time/Money. Money/Time.
I called the tow company to see how much it was going to cost. Time won out over money.
Well, they had his chair and it was $160 to get it back. The guy heard me groan.
“Dude. There’s nothing I can do.”
“Yeah, I know. I just gotta get this patient home.”
“You calling from the ER?”
“Yeah. I am.”
“Is that social worker guy down there tonight?”
Before I could tell him who I was, he hung up. I called back but didn’t get an answer. Damn. Time/Money. I started calling his family again.
Fifteen minutes later the secretary called me up to the front. She told me there was a guy out there from the tow company and he wanted to see the social worker guy.
I walked out and there was a giant flatbed tow truck with an electric wheelchair strapped down, dead center, just like a crushed car would be. When I approached, the driver asked,
“Are you Bob, the social worker?”
“Yes, I am.”
“I brought the chair.”
He tilted the flatbed and winched the chair down to where I was waiting.
“No charge” he said. “I owe you. Last year you called to see how I was doing after a big crash on the freeway. I was OK but I appreciate you thinking about me.”
And then he drove off.
I took the time and didn’t have to spend the money. Works for me….