by Robert Lanz, LCSW
Old guys shouldn’t take call. It took me a long time to learn that and that just shows a certain level of lameness on my part. Working on the night shift is hard enough on your sleep rhythms and coming back at 3 a.m. after finally dozing off doesn’t help any. The experts say you should get eight solid hours of sleep each night. Yeah sure! They say you should go to bed at the same time every night. Uh huh! Spend some time relaxing before trying to go to sleep. That’s a good idea. You shouldn’t do anything but sleep and have sex in your bed. Sure thing. After a night shift in the ER sex is the last thing on my mind. And I guarantee, if for some twisted reason it did get on my mind and I woke my wife up to tell her about it I’d get so damaged I couldn’t even have sex with myself.
But this isn’t a story about sex or me or even sleep. It’s a story about redemption, among other things. I’ll start by saying that it is easy to forget your patients after you have finished with them. I won’t say there aren’t some you would remember. They are called frequent flyers and most are difficult patients and therefore difficult to forget. An average patient would go more like this.
I’m on call, it’s an hour before sun up and I am actually sleeping soundly and then the beeper goes off in the living room. The beeper is in the living room because since the first day I carried it the screeching sound wakes me so horrifically that by the time I get to it and turn it off I already have an adrenaline headache. Hardly the way to drive back to the hospital and deal with some trauma patient’s family.
With the beeper in the living room it takes a little time for me to hear it because I spent too much time listening to loud rock and roll in my youth and my hearing isn’t so good. My wife is a light sleeper with keen hearing and a not so gentle elbow wakes me to the point that I finally hear the beeper too. Nudged into the insanity of a guy my age sleeping next to a perfectly good woman I get out of bed and think who would be so crazy as to do what I am doing, heading to the hospital to enter into an emotionally painful event of some kind.
Anyway, all this is going to make a point soon so bear with me. I get to the hospital and find an attractive woman about thirty-five waiting for me. She is already at the hospital because the Highway Patrol has already called her and told her that her mother has rolled her car on the freeway and doesn’t look good. No one ever said why she was driving alone at that time of day and I guess it doesn’t matter. To ask the question is to imply there might be a right or wrong answer and there is enough wrong already. We talk a little and I go to the trauma room to see what is happening.
The patient is intubated, a large tube into her trachea to help her breath. Seldom a good sign. I notice the cardiac monitor doesn’t look good either and when I make eye contact with one of the trauma residents he comes over to bring me up to speed. He thinks she most likely had a heart attack or pulmonary embolism and then crashed. Her injuries aren’t too bad and don’t account for her deteriorating vital signs. No one seems to think she will live.
When I return to the quiet room where the daughter is, I keep good eye contact and she is perceptive enough to know that, despite her hopes, the news isn’t good. I explain what we are doing and tell her that her mom is not stable and her condition is grave. The daughter cries a little but starts to already accept the news she knows is coming.
“She just got back from Australia yesterday. She wanted to drive up to Santa Barbara from San Diego to see my sister. Probably wanted to get an early start.”
Bingo. Old lady. Long flight. Blood clot. Pulmonary embolism.
This is information that might be helpful to the trauma team who is working on a patient that probably needs a cardiologist or a regular ER doc rather than a trauma surgeon. When I get to the room I see the patient has flat lined and hear the all too familiar, “Let’s call it. Time out, 05:27.
I tell the resident about the trip from Australia and he just nods.
“Want me to talk to the family?”
“If you want to. Or I can do it.”
Protocol is flexible at this time of day. I get to go home and go back to sleep until my body wakes me. He has to go back to the resident’s quarters and get up in two hours and start rounds.
“Could you do this one for me Bob?”
Part of the resident’s training is to learn how to give bad news and I’m one of the guys who teaches the class. I’m also the guy who prefers to do it myself because most docs just aren’t very good at it. People say that surgeons are particularly inept at it. I wouldn’t argue that point-but I wouldn’t make it either.
When I go back to the quiet room the daughter knows what’s coming so my job isn’t so hard. As I’ve said before, you never know what a person’s reaction will be but I had the feeling that she wouldn’t attack me with a chair or throw up on my shirt or blame us or any of those other less than functional reactions. She cried quietly and then told a few stories about her mom. Pretty normal grieving. I asked if she wanted to contact anyone but she said she didn’t have anyone. I felt sorry for that for a couple of reasons. First, it was sad to think at the moment of the death of your mother you would have to bear the burden of the death alone. Second because she was bearing the burden of the death alone I couldn’t hand her off to someone else and go home myself. Much as I wanted sleep, it was more important to help her get focused enough to get home safely, however long that took. It was about an hour and I got stuck in morning traffic and did what the sleep experts say not to do. Don’t wake up and turn the light on as that tells your body it is daytime and it will want to stay awake.
Well it was daytime and the sun was up and I was very awake. Awake and sad. I gave up a lot that night and I just wanted to be home in bed. I slid in next to my wife’s warm body, fired up one of my neurobiology learning CD’s and laid my head over my pillow speaker. I have no idea what the end of that boring CD sounds like. I have never finished it despite trying for a year.
The next day when I got to work I took report from the daytime social worker and was up to speed. She had taken care of all but one of the patients, a woman in room 8 who was having a stress reaction.
I grabbed the chart and walked into the room and thought the patient looked familiar. I looked at the name on the chart and didn’t recognize it. I could see she recognized me so I had the good sense to let her start speaking first.
“Oh Bob. You’re still here.”
“Not still. I went home and got some sleep. How abut you?”
“Not so good.”
I went through the grief drill and got her hooked up with some counseling and some meds so she could get some sleep. Hard to believe that after spending that time with her just twelve hours previously I didn’t remember who she was.
Everybody has their own style of social work to deal with these issues and mine is to give it all when the person is with me and then not give anything when they are gone. Let it in. Let it through. Let it go. Works for me.
Now I’ll get to my point. Remember the story about the guy who got shot in his penis just after getting out of jail? I was torn between telling anyone that story and not telling anyone that story. The intervention trail I took wasn’t exactly out of the Crisis Intervention class I had in grad school. It probably would get a little heat from the ethics board at the National Association of Social Workers organization. But I did what I did and it seemed to work at the time. Still. I always wondered if I did the best thing. I also feared getting caught and having to defend myself to someone who isn’t as, let’s say flexible or creative or spontaneous and not say professional or some such word, as I am. Five years later I still let that one get to me. It didn’t go in and out and be gone. It just went in.
Later on that night I was walking down the hall. It was busy as always and all the rooms were full and the hall beds that we aren’t supposed to use were getting filled up. I make it a point not to have eye contact with people in the hall as they often ask me questions I can’t answer or make requests that I can’t fill or maybe even vent about something that I couldn’t control. I have the ability to ignore people under those circumstances pretty well so I was surprised when I heard someone call out to me.
“Hey there Mr. Social Worker.”
I turned and saw a black guy about thirty with an older woman, probably his mother. I hate to get caught forgetting people, like the lady with the dead mother and have learned to not give myself away unnecessarily.
“Do you remember me?”
“I remember your face.” Non-committal won’t get me in trouble.
“You came and talked to me a few years ago. I was on the back of a motorcycle and got shot.” The Dick Shot. Now I remembered.
“Oh yeah. I remember. How’s it going?”
“It’s going good. I’m living in Iowa with my auntie. Got a job. Going to school.
And all my parts work.”
“Well that’s good news” I said.
Working parts. A job. School. Just like I said.
“You’re a funny dude man. But you were right. I took your advice. You were right for sure.”
That’s a face I won’t forget. It was a face that had been haunting me for years and now it won’t. He’ll never know how happy I was to see him. And next time I will know him for sure. For five years I had paid some heavy dues for that night. He had been paying since too. And it all worked out…