Pathology

 

by Robert Lanz, LCSW

People have often asked me, “What was the worst thing that ever happened to you in the ER?” (I take that to mean, ”  thus far.”) My answer: “There is no worst thing; the worser thing is always coming.”

But one of the worst things that did so far happen, happened the night I had a fight with our hospital’s pathologist. The pathologist works in a icebox-like laboratory next to the morgue. Day or night doesn’t matter to him: no windows, nor sunlight. He never sees a living patient. He never deals with loved ones of dead patients. He never speaks to the social worker. This social worker had no experience or friends or any resources available to him to smooth out a bad connection with a pathologist, when such smoothing needed to be done.  Not good.

If the pathologist doctor was adept at or slightly more desirous of interacting with the living, he likely would have gone into another specialty. I could even understand urology or proctology. At least those guys make visits to the ER.

It’s important for medical specialists who only occasionally consult in the ER to see how social workers interact with patients, their families and the ER physicians. Social workers then become “people” to them. If the social worker has to have an interaction on another of their visits at least they know they can utilize these social worker “people” if they need them.

Every ER social worker has tales of working alone on the night shift, having to be dragged upstairs to deal with deaths in the ICU, angry parents in pediatrics and mentally ill alcoholics demanding to be signed out against medical advice — all at the same time, of course.  I was unique in that I knew of no other ER social worker, who had pissed-off the hospital autopsy doc, at least to the extent I did.

There are twenty social workers “upstairs” (the part of the hospital where patients who are admitted reside — the ‘nemesis zone,’ which I have talked about in previous stories.) With so many social workers up there during the day, it’s rare for the social worker down in the ER to be called upstairs to help. But the ER social worker at night is the only social worker in the hospital and it is common when there is a crisis to get a request  from upstairs: “Bob, can you come up?”

Downstairs, where the patients I have already started to evaluate or began an intervention with, will now have to wait until I come back from an emotionally and time consuming situation waiting for me in one of the wards upstairs. Being pulled upstairs when I am still needed downstairs in the ER is a challenging, time consuming tug of war that always put a drag on my ability to take care of my “downstairs” clients.

Tonight, a new grandmother was upstairs visiting her daughter’s very premature baby. The baby was still-born, weighing under the requisite five hundred grams to even meet the criteria to be issued a birth certificate. The still-born was sent off downstairs to the pathologist. In this situation, a still-born is not wrapped in a towel and placed in a morgue drawer like a larger dead infant would. That would be an easy fix. Security would open the door to the morgue and I could show the body. Instead, what is referred to as pre-term tissue is placed in a specimen jar and sent to the pathologist for whatever analysis he’s going to perform down there in his lab. Whatever it is, I’m sure it has rarely ever included a visit to the ’tissue’ from a  grieving grandmother accompanied by a meddling social worker. I guess the pathologist didn’t read the current social work literature, so I imagine he didn’t quite get how important viewing the remains is to the grieving process (regardless of the condition of the remains.). And this grieving grandmother wanted to view those remains. Who am I to deny her closure?

The remains in this instance, were in a jar on a shelf in a lab, a lab neither the grandmother, nor I,  had ever witnessed the inside of. A mother making such a request may have had more emotional or legal or policy energy behind her to pull it off. But such an unusual request by a grandmother was a stretch.  I worried the pathologist might hide behind hospital policies and procedures and keep us out of his private space. The insistent grandmother raised the issue to one of the nurses. The nurse punted to the charge nurse. The charge nurse punted to the night supervising nurse who served as the hospital administrator on this particular shift. Fortunately, the night supervising nurse and I had a lot of ER mileage together with a lot of mutual respect. Grandma was insisting she had a right to view the remains. But the remains weren’t in a space I had access to. The space in question was the lab, access to which can only be had with permission of the pathologist. Being it was almost eleven at night, the pathologist had gone home hours ago and was probably in bed.

Yep, he was  asleep when the hospital operator called and got him on the phone. I told him of grandma’s request. In no uncertain terms, he told me that it might be a good idea if I went back to social work school if I thought that grandma seeing the macerated remains of her still-born grandchild was a good idea. Click. That from a guy who worked in a room with no windows.

Macerated. Hmmm.  More dilemma. Should I try to de-tune that word and explain to grandma why the pathologist is reluctant to have her view the remains? I tried my usual soft version of the truth, deflecting her ire towards hospital protocol instead of me.  “You tell that pathologist I’m tough and I can take it. And tell him I insist on seeing my grandchild!”

I had the hospital operator dial him again.”Uh. Doc, the grandmother here says she insists. She says she wants me to view the remains first, and if I think her viewing them will be too gruesome, she will trust my judgment.”

“Jesus Christ! Tell security to open my lab and let you in! The jar is labeled. Anything goes wrong, it’s on you. Don’t wake me up again!” Click.

Whew. He didn’t did ask for my name.

I went in. It was the middle of the night. It was quiet. It was dark. I groped around for the light switch and finally, I found it and the room lit up brightly: everything was either medical-green or stainless steel. I saw saw lots and lots of jars on metal shelves lining the walls and I did the best I could to avoid looking too closely at the contents. When I found the appropriately labeled jar containing the grandchild, the remains didn’t look too macerated at all. Just very small.

I brought grandma in. She had her closure.

As she was leaving the hospital, grandma thanked me and apologized for pitting me against the pathologist.

I never heard from or spoke to that pathologist again. For all I know, he’s still down there in that lab.   Maybe one of these days, I’ll take a look. Maybe try to friend up a little. Do a little social work.

Dividing line

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About robertjlanz

Author and health care professional.
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