by Robert Lanz LCSW
When I go to see a patient with my demographic background and a serious medical condition, like any normal guy I become acutely aware of my own angst about these things. Having survived motorcycles, surfing, backcountry skiing, off-road racing, extensive third world travel adventures and being a roadie in a sixties rock band, I thought that with age I would just go gently into the night and die as an old man in my own bed.
The good part about aging, at least medically, is that many devastating illnesses tend to cluster in the under-fifty age group, especially those out-of-nowhere neurological disorders that sneak in and cripple you through no fault of your own. With these issues behind you along with the wayward testerone based decisions of youth, it is a relief almost to have finally arrived at a place with some degree of safety.
However, always lurking are the degenerative diseases of aging: heart problems, lung disorders, kidney disease, cancer, Parkinson’s, more cancer, dementia and all those other things that take quality away from the quantity of life there is left to otherwise enjoy. So even with some of the dangers behind us, oldsters have an equally apprehensive view of the future, which promises, at the very least, death.
When such issues present themselves in the form of a patient who, most likely, is, or should be dealing with them, the ER social worker sees a natural intervention opportunity. Perhaps the intervention will be a simple walk through where all is normal, or it might be a major intervention because the patient is in denial. Luckily, my ER culture was such that the social worker could do “independent case finding”, which essentially meant we could see any patient we wanted to for any reason we thought was clinically appropriate. The ER docs were more curious than upset about us coming into their own clinical space. Good social work often has that effect.
The night was slow enough that I could actually cruise the charts for possible interventions or even some simple public relations work, giving the staff another opportunity to see what a clinical social worker does and how we do it. In the future, this knowledge might enable the staff to know when to refer patients to us.
That night I noticed a guy about my age-fifty four, a little young to end up on a monitor in the cardiac room, so I read his chart.
Chest pain and anxiety. Blood pressure medications and anti-rejection medications. Heart transplant about four months prior. Divorced, teenaged kids living somewhere else, no visitors, suffering alone. Scared me just to think about it and I surmised he felt the same way, so I went into his room and struck up a conversation.
“That whole heart transplant thing seems so scary,” I offered.
“It was. I was on the transplant list but running out of time. My cardiologist was getting concerned about my spot on the list and thought I was coming perilously close to passing on. I didn’t realize how close it was until he noted that there was a three-day weekend coming up and maybe someone else’s bad luck would be my salvation. Sure enough, Sunday night my beeper went off and it was the hospital telling me to come right down; they would be ready to do surgery in two hours. My broken heart almost stopped. Six hours later I was waking up in the recovery room with a new one. A seventeen year old girl in a car crash and a bad head injury saved my life but she lost her own.”
“Somebody watching over you.”
“I guess. I’m just glad it happened. Not that way of course.”
“Does it feel different having a young female heart?”
“Man, I don’t know. I was so close, so desperate I would have taken any heart. I’m just happy to have it but I’m not happy about how I got it.”
The nurse came in and started disconnecting his IV, his pulse oximeter and EKG leads and told him we had called his cardiologist and that the cardiologist was OK with him going home. She added that our doc would be in to speak with him before he left and that he’d probably want have a follow up with the cardiologist in a couple of days.
More than a drive-by, less than an intervention. Just a good story, some relief for the patient and some for the aging social worker. All bad things don’t end too soon. Maybe I will die an old guy sleeping in my own bed at home…