Trauma Observation #8 The Wait And The Intifada Sunday, Nov 30 2008 

The waiting rooms at County are vast seas of suffering humanity. Row after row of uncomfortable chairs bolted to the ground are where they sit and wait, and wait, and wait. I asked the staff who have worked in the ER for years – the average wait is almost 10 hours. Sometimes less, although rarely, and often more. Like 13, 14. Is there any other area of life where people wait so long to get something? If you are sick or in pain you don’t have a choice, you have to wait. If aren’t insured you have no choice, you have to wait.  

Waiting that long is humiliating. Patients come up to the counter constantly and tell us how long they have been waiting and to find out how much longer they will have to wait. Many are in pain and ask for pain medication while they wait, but they never get it because the doctor has to see them first. I can’t even tell you how many times I have told patients I don’t know how long they will have to wait and that I’m sorry.

We get yelled at every shift by patients who are pissed off and in pain and tired of waiting. 

If patients want to see a social worker there is a sign-in sheet for them to put their name on at the counter in the ER. I check the sheet regularly. I go to the waiting area and yell out the persons name. Everyone snaps to attention when I do this. They are hoping it’s their turn to see the doctor. I feel embarrassed standing in front of everyone yelling out names. 

I yell out a patients last name, it’s sounds Arabic. He comes over and tells me he doesn’t need a social worker, he was able to find a phone and make a call. I just happen to be wearing a Palestinian scarf and he smiles broadly and says I like your scarf, I am Palestinian. Wonderful, I tell him I support the Palestinian struggle to return to their homeland.  He’s amazed and happy and says he hasn’t met many Americans that do. Whenever I’ve met Palestinians and they find out I’m on their side they react this way. The man and I agree this is because the United States government backs the State of Israel to the hilt and the media are utterly biased against the Palestinians. Arabs are demonized, always portrayed as terrorists and as the aggressors in the conflict between Israel and the Palestinians. The man says Israeli soldiers kill children and he has witnessed it many times. He’s from Ramallah. He told me the following story: a soldier shot a young boy, the bullet entered his mouth and exited thru the head. He carried the dying boy in his arms to a checkpoint and at first the Israeli soldiers wouldn’t let him through. He put the boy down and screamed go ahead, shoot me too, kill me. They let him through but it was too late. The boy died.

The man still had photos of his life in Palestine, of his house, before Al Nakbah. He remembers when the Zionist militia came to his village shooting and killing and his family fled for their lives. He participated in two intifadas and eventually made his way to the United States. He has relatives here. He called his wife over to meet me and introduced me as a person who supports the palestinians. She lived in Ramallah for 8 years. She said she hates the Israeli army, not jews. In fact, they had a family member who married a jew. We don’t like the Zionists they said. Me neither.

Trauma Observation #7 Bodies and Tequila Friday, Nov 28 2008 

My supervisor and I are sitting in her office and I meet the guy that manages the morgue. Creepy. He’s dressed in a sharp black suit, appropriate, I suppose. He asks my supervisor for some transportation forms. He’s got about 40 dead bodies that need to be moved to the morgue across the street. He’s going to have them transported by ambulance. Why not put the bodies on gurneys and move them that way I ask? It seems crazy to have an ambulance literally go from one side of the street to the other. He says by law they have to go by ambulance.

40 dead bodies that no one has claimed. They will be buried in paupers graves, unmarked.   

I get paged by the psychiatrist. He asks me to see a young Hispanic man who he says is an alcoholic. The shrink blithely asserts, if the patient doesn’t stop drinking he will die. Yeah right, heard that one before. It’s bullshit. Most people who drink heavily don’t die from drinking heavily because they stop drinking heavily. Only a tiny minority literally drink themselves to death.

I have so little respect left for psychiatrists. They have no interest in helping patients. Psychiatry sees patients as pathological and push pills for every problem. They especially hate working with alcohol and drug users. They don’t understand addiction as a biopsychosocial problem and instead, view it as a disease/pathology.  With this group of patients they have a strict division of labor. They do a brief, uncomprehensive assessment as quickly as they can and then page the social worker. We are supposed to help the patient get into treatment. The psychiatrists want nothing to do with this part, it’s beneath them. But you can’t separate the two. If you diagnosis an addiction you need to know what treatment is appropriate and what is available. Why bother talking to drug using patients if won’t get them into treatment?

I meet the man in the hallway and say hola. I had a feeling he didn’t speak much English even though the psychiatrist said he did. That’s another reason he turfed the patient, he didn’t want to get an interpreter. He didn’t spend any time with the patient, couldn’t communicate with him, and yet made the dire pronouncement that the patient was going to die if he didn’t stop drinking. Wow, medical school really paid off, you’re clinical skills are brillant, doctor….

The patient is still drunk, not drunk enough that he can’t talk or think, but the alcohol coming off his breath is powerful. He’s short, clothes are dirty, he’s 22. He smiles a lot. I ask a bunch of questions and he tells me his mother is a Christian and they don’t get along. I ask about his father, he says he died. And then he starts to cry, but he stops himself and says estoy bien, I’m okay, and I say no you’re not. The tears well up in his eyes again and he wipes them away and pushes the pain back down. He can’t go there. Alcohol is an interesting drug – it medicates the pain but it also disinhibits enough to let the pain out. Crying in your beer sums up the idea.

He drinks tequila and says can down two large bottles in one night. His girlfriend is a heavy drinker, too. He shares that she gets “caliente” (sexually turned on) when they are drunk.

He works 7 days a week in construction and goes to work even if he has a hangover.

I happen to love tequila. It has a narcotizing quality that is totally amazing. Two margaritas are therapy for me. Crying into a cactus-stemmed glass of lime green liquid.

The guy likes to drink and fight. He’s definitely 22. He’s in the precontemplation stage of change so nagging, threatening, or scaring won’t work and actually, it never does. I tell him I have some free advice if he wants it, he says he does. I recommend he talk to someone about why he cries when he thinks about his father. And I suggest that 1 or 2 nights during the week he do something else after work besides drinking. And por favor, use a condom. But it’s his life, his body and he can do whatever he chooses.

Trauma Observation #6 The Addict and the Artist Thursday, Nov 27 2008 

A very pregnant woman needs transportation to go home. She gave me an address and I checked the computer and decided to look at the discharge note. She was living at a drug treatment facility and had used heroin about a month before. 

I asked about the treatment program and if she wanted to go back. She said no. Mom was nervous and twitchy. Her eyes darted off in different directions which made me dizzy. What’s the program and the staff like? I always ask this question because I want to know how drug users are treated. She didn’t like it was all she would say. She was in the methadone program for pregnant women an didn’t want to be taking methadone because she believed when the baby was born they would take it away from her. I told her infants aren’t taken away for that reason and methadone for pregnant women is indicated for pregnant drug users, is safe, and is the most effective treatment for heroin addiction. She seemed skeptical.

I called the transportation company SCR. She asked how long it would take because her daughter was coming to the ER and she didn’t want to see her.

Oops, in walks the daughter with her boyfriend. The daughter is obese and wearing a brand new, brown leather bomber jacket with round patches that say things I can’t understand. She asks what’s going on. Mom is really nervous now. They want her to go back to the treatment center, she refuses. We are in the hallway having this conversation and as I listen I get the back story. Mom has been using for 16 years and relapsed many times, she has 3 other children, all were born drug addicted and taken away by DCFS. Including the daughter standing right in front of me. Wow! They are trying to convince her to go back to the program. They tell her they love and care about her and the baby but she needs to be in drug treatment.

 I take the daughter aside. I tell her if mom really doesn’t want to be in treatment trying to convince her probably won’t work. She starts crying. She plans on taking care of the baby when it is born. It will be her sister.  

I realize what the patient is doing. Over the years I have met women with drug addictions that have one child after another. DCFS always takes custody. The cycle continues. They believe they will get it right with the next baby. Get off drugs, get housing, a job, get stable. And crucially, give and get love from a tiny infant. A new baby is hope, a fresh start. 

There is another dynamic at work. Being pregnant brings attention, concern, and a role, a job. Something to do, to focus on. These woman have one identity, addict – being pregnant and mothering brings another identity. It’s one that society respects and reveres. But not if you’re pregnant and using drugs. That’s the part these women forget. Pregnant women who use drugs are despised. They are considered to be child abusers. Then they get the opposite of what they crave: punishment, incarceration, coercive treatment, kid taken away, and doctors, nurses, social workers, family and friends, judging them harshly and telling them what to do. Or else!   

There was no question this baby was going to be taken away from the mother and she knew it.

The driver from SCR arrives to pick up the patient. For a few minutes we all argue about where mom will go. I change the address on the form 3 times. Finally it’s agreed mom will go back to the drug treatment program.

I saw a man dressed all in black, Johnny Cash-like, with a Stetson hat walk into the waiting room. I recognized him immediately. It’s Marcos Raya, one of my favorite artists. He’s in my waiting room! I’ve seen dozens of his paintings and found art objections. I’ve seen his shows at the Cultural Center and at galleries. His work is weird, engaging, full of pain and mystery. And women’s assess. He went through a phase and was painting los traseros de mujeres. Not my favorite paintings. I read interviews with him and he used to be a heavy drinker, but doesn’t drink at all now.  He’s been down there with the booze, gone to places most of us will never go. The paintings are extracts of those places. I see Raya driving around the hood in his vintage, scrappy Jaguar convertible and drinking coffee at the Jumping Bean.  I had to introduce myself and have a chat but there were several patients I had to see first. No problem, he wasn’t going anywhere, he’d be waiting for hours to see a doctor. I saw that he was with a woman. They sat together and he had his arm around her.

I’m back at the counter in the ER and I spy Raya. He’s standing by himself near the front entrance. I walk over and say you’re Marcos Raya. He says yes, I’ve seen you around haven’t I? Yes I say, I live in Pilsen. I tell him I love his work and he thanks me. He’s shy, humble. He asks me if I can change a $20, he needs change for the parking meter. I don’t have a nickel. Will they ticket me he asks? Mosdef. How long will I have to wait?  Hours. His friend who needs to see a doctor is an artist, too. Artists are never insured. He asks me how long I’ve been working in the ER. A couple of months and it gets pretty crazy. Raya’s done crazy and then he asks, you see a lot of alcoholics? Yes I reply.

I told him I’ve been looking for his studio and can’t find it. I know it’s on Halsted, but where? Right across from the Skylark Lounge. He hands me his card and shares that he is working on a self-portrait. He tells me to come by anytime. Dream come true, Marcos Raya telling me I can come by his studio anytime….

Trauma Observation #5 The Border Crossed Us/Un Mundo Sin Fronteras Sunday, Nov 23 2008 

I was walking out to the ER waiting room to check if there were any patients to see and I could hear one of the techs saying to a man in a power wheelchair, I can’t help you, you have to wait to see the social worker. I said brightly, here’s the social worker. She said great, you are here, this patient has a problem and only speaks Spanish. I said I speak Spanish and she said I love you.

I relish any opportunity to speak Spanish. The man in the wheelchair was from Mexico. He told me his story.  The state of Jalisco was where he was born. He crossed the border through the mountains and had an accident. He hurt his back and hips but made it to Los Angeles. Somehow he hooked up with a church. He got a power wheelchair, no mean feat because they costs thousands of dollars. He used it mostly when he traveled from place to place. Once he got where he was going he could walk slowly and with difficulty. The church paid for a ticket for him to come to Chicago. He came in a wheelchair accessible van. The man was coming to Chicago to live with someone. He didn’t know the person and then he lost the address to the house and had no phone number. This all sounded too weird. He showed me a paper with the name of a man who was affiliated with a church in Pilsen. I called the number but no one answered which wasn’t surprising because it was 10:45pm. I asked what his plan was. He had a flyer for cheap rooms in Pilsen. Tonight he would go to a shelter and the next day rent a room with the help of the church. Okay. I called 311 for the man. I explained that DHS would come and take him to a shelter. He said thank you.

Then he asked if I could help him plug in the battery on his power chair – he had already spied an electrical outlet in the waiting room. We went to the back of the room and I plugged the cord into the outlet. The battery, which was low on power, started charging. It would be fully charged by the time the DHS van arrived, it takes hours and hours, sometimes all day for them to pick up homeless patients.

He told me he had not eaten all day, tengo hambre, he said. No problem I said, let me go check the refrigerator. It was his lucky night, tons of sandwiches, juice, and milk. I took him 2 sandwiches, a carton of milk, and 2 juice cups. He thanked me for the food. I told him he was really courageous. He didn’t know 1 person in the United States, he was disabled and yet made it halfway across the country in a power wheelchair on the kindness of strangers. 

It was now 11pm. I said hasta luego, cuidate mucho.

Trauma Observation #4 It’s a Small World After All Sunday, Nov 23 2008 

I park my bike and enter the hospital through the parking lot. The first thing I see is a sign announcing LUNG CANCER AWARENESS MONTH. Great. My mother died of lung cancer, 3 packs of cigarettes a day for 50 years.

The pager goes off. I need to order an ambulance for an elderly woman to go home. I head back to the trauma area to leave the paperwork on the chart and I see a young man sitting on the edge of an elderly woman’s gurney. I go over and introduce myself. He’s the son. The patient has advanced Alzheimer’s. She is a beautiful and wizened old woman who used to be a farmer in Nigeria. She has that vacant expression that is the hallmark of Alzheimer’s disease. She has constrictures in her arms and legs and is curled up in a fetal ball. She only speaks Ebo. I ask the son how it is going at home. It’s hard he says, he is the sole caregiver. There are other siblings, but they live in faraway states. He has been with his mother 24/7 for 3 years. He doesn’t get good sleep because she wakes up at night literally drowning in secretions and he has to suction her. I can see he is approaching “caregiver burnout.” There is a lot written about caregiver burnout and how to prevent it, but as a society we are not preventing it because that would take money. The state/federal governments don’t allocate much money to help families take care of loved ones. The Family Leave and Medical Act is a joke. It’s unpaid and most people can’t afford to take it. The United States has the stingiest social welfare policy of any country in the developed world.

There was money though, to put a feeding tube into this patients body. Feeding tubes in patients with dementia are cruel and unusual punishment. They only prolong the inevitable. When a patient with dementia no longer desires to eat they are telling us something. And once the tube goes in, it’s difficult to take it out. To take it out means the person will die. Doctors don’t want patients to die. Doctors often don’t tell the family they don’t have to put in a feeding tube to avoid a difficult discussion about the end of life. It’s about quality of life. I asked the young man about his mother’s quality of life. He wasn’t sure. Sometimes she recognized him and said a few words. Most of the time she was mute. The goal of the family was to get her healthy enough to fly to Nigeria to see extended family and to die. I asked him how they were going to pay for it. He didn’t know. I looked at his mother’s eyes again, she was gone, she was already home, back in Nigeria.    

Cell phone rang. I could see from the caller ID that it was an extension from inside the hospital ER, but it was a patient. I wondered how he got the number. He was shouting into the phone that he was laying on a gurney in the hallway in his own urine and he was in pain. Could I do anything to help him? I asked him where his nurse was. He yelled loudly, she won’t help me, she doesn’t help me, can you come over here and help me! I told him I couldn’t and to talk to his nurse.

I go to use a bathroom near the social work office. I open the door and a woman is vomiting into the sink. I open the door to a stall and the smell of feces is overwhelming. I dash out the door holding my breath.

An elderly man with a foot fracture needed a wheelchair. He was in the ER with his wife who was wearing a beautiful purple sari. He introduced himself and told me the doctor said I could help him get a wheelchair. He wasn’t insured so I told him he would have to pay for it. He said he didn’t have the money. He was a proud man and said he had never applied to any public assistance program. He worked his whole life until he got sick and then broke his foot. He and his wife moved to Chicago to be with their children when he retired. The man was an engineer, originally from Pakistan, and worked for oil companies in the Middle East. He was kicking it in Dubai when no one knew the place in the desert existed. He made $8000 a month. Now he was poor. I made a wisecrack about Bush, the war, and oil. He smiled broadly and said yes, he used to work with Mr. Cheney’s partners at Haliburton. We ripped on Cheney for a few minutes. It felt surreal to be having this conversation in the hallway in the ER that was busy and full of people walking by. He said the United States leads the world but not in health care and that was a shame. He told me I was a good social worker because I listened to him. He asked what ethnicity I was and I told him Irish on my father’s side and German on my mother’s. But I don’t feel Irish or German. I told him I love Indian food and try to get to Devon Avenue as much as I can. He told me the best Indian food was at his house and invited me to come for a meal. I asked if he cooked and he said no, his wife did, and her food was outstanding. She smiled shyly when he said this. He wanted to give me his phone number but I told him I couldn’t accept it. That thing about professionals and patients. He said he understood and thanked me profusely for taking the time to listen to him.

My plea to the government: Nationalize the corporations that make wheelchairs. Free wheelchairs for every person that needs one! Wheelchairs are a human right!

Pager is going off again. The resident explains she has a 15-year-old male who was tasered by the police. They tasered him in the back as he was running away. The shock of the taser made him fall forward and crash on his face. He had facial fractures and an eye injury. Was there anything I could do for this kid? Yeah, I’ll call the Office of Professional Standards (OPS) and help him file a complaint of police brutality against the cop who tasered him, I told her. I didn’t say that. Instead I told her there was nothing I could do. The security cops at County were guarding him and as soon as he was discharged he was going to jail to await arraignment. Besides the brutality of the assault on this young man, I thought, this is how they waste the health care resources of the county. Because those fat cops spend their time at Dunkin Donuts chowing down dozens of donuts and sit on their fat asses for hours in squad cars in hidden locations doing nothing, they are incapable of chasing suspects and apprehending them. So they use tasers and guns because they can’t run. And the person gets injured. I looked in the 15-year-old’s chart and he had all kinds of scans, medications by IV, and was seen by opthamology, neurologists, neurosurgeons, etc. All of that pain and suffering could have been avoided. But that’s what the police are all about  – inflicting pain and suffering on young black males.   

                                                                              ************

Sometimes what the residents write in the chart sounds like a poem:

In blue hallway on a stretcher, comfortable

very thin/cachectic, poor oral hygiene

pale, long conjunctiva, unicteric sclera

temporal wasting

no spider angiomata

                                                                               ************

I swipe out and as I’m tiredly trudging down the long hallway a group of Indian women who work in the hospital are leaving, too. They’re all carrying insulated food bags in bright colors. I marvel at their long, black, shiny hair that’s pulled back into pony tails. They are laughing and speaking either Hindu or Urdu. I walk with them and we say goodnight. I turn the corner at the end of the hall and there are a bunch of Philipino workers whose shift has ended. They are speaking Tagalog and are headed to the parking garage. We say goodnight to one another. 

The last thing I see as I exit the hospital is that damn sign for lung cancer awareness month. I don’t want to think about lung cancer.

As I ride my bike home along Taylor Street in the crisp night air, I see groups of smokers shivering and huddled together on the sidewalks, outside of bars.

Trauma Observation #3 Turkey Sandwich Friday, Nov 14 2008 

The social worker on the prior shift updates me on cases that she didn’t have time to get to. She said there was a homeless woman in a power wheelchair who had been in the ER all day. I was warned that the patient might try to pull me in and have me running around like crazy, trying to find a place for her to go. My co-worker also warned me that the patient might ask for something to eat. Personally she didn’t like to give food out to patients because she wanted them to feel some “discomfort,” and not hang around the ER.  She also thought if she gave one patient a sandwich everyone would want one and well, we can’t feed everyone. In her opinion it was “enabling” patients.

I hate that attitude. That mean-spirited attitude is common in social work today. Social workers have run out of compassion and empathy for patients. They are bothered by those who ask for help, for resources. Social workers behave as if the resources were coming out of their pockets and paychecks and look for ways to deny patients. Some flat out refuse to help. But that is what social work is all about; helping people in need and giving them services and resources. Yes, enabling them! The backdrop for this utter lack of empathy is the destruction of the social safety net in this country. Resources to assist patients have been cut to the bone. All sorts of programs have been cut or eliminated; transportation assistance, homeless shelters, drug treatment programs, food pantries, counseling services, domestic violence shelters, affordable housing.  Social workers are only as good as the resources they have at their disposal. Compounding the problem is social work positions have been eliminated and caseloads increased. This accelerates burnout and “compassion fatigue.” The crisis puts us in the position of trying to figure out who is “deserving” and who is not. It sets social workers against patients and leads to classic blaming the victim.  You know it’s bad when a social worker in an ER that is full of poor, oppressed, addicted, hungry and homeless patients believes that giving food to a patient who says they are hungry is “enabling.”

When I met the patient in the ER indeed she had been in there all day and was hungry. Was there any food? I told her I would look after I took care of a few other patients. About a half hour later I checked the refrigerator and found a turkey sandwich and a box of apple juice. I went back to the ER and the patient was gone. I took the food back to my office, put it in the refrigerator, and hoped she would come back.  

The phone rang. The woman on the other end was wailing, crying, and screaming over and over again, I’m going crazy, I’m going crazy, I’m going crazy, no, no, no. I calmly asked for her name. Then I asked, What’s wrong, why are you going crazy?  What ensued was a rambling monologue punctuated by more wailing and crying, interspersed with allegations that her priest had molested her. She called him a faggot and a cocksucker and then apologized to me for using profanity. It was difficult to follow her high pressure, non squitur speech. But it always got back to the church and the abuse she had suffered at the hands of the priest.

Then I got a call from OB. The doctor wanted me to talk to a patient who gave birth two days before. Her urine tox was positive for cannabinoids; marijuana. The newborn did not test positive. Why are they even tox screening pregnant women? It’s bullshit and racist. They don’t do that at hospitals where white women give birth. I’m not making this up. Google Lynn Paltrow’s work. She is a lawyer who has defended pregnant, drug-using women.  I went to the patient’s room and her mother was there. I didn’t want to talk about drug use in front of her so I asked her to step out of the room for a minute. She and her daugher exchanged a knowing look and the patient explained, My momma knows everything I do, you can say it. So I asked. She said she had been smoking marijuana because she had no appetite. She didn’t believe her drug use was an issue, neither did her mother, and stopping wasn’t a problem. Okay. I view casual smoking of marijuana like the social use of alcohol, but marijuana has one big advantage over alcohol;  it makes the user mellow, calm, happy. Happy mommy, happy baby.

I run down to the cafeteria to get something to eat and I see the patient in the wheelchair waiting in line to pay for a tray heaped with food. 

10:30pm and all of a sudden there are a ton of homeless, drug users asking for assistance. I want to go home at 11pm but now that’s not going to be impossible. One man wants inpatient drug treatment. I love working with drug users so I spend some quality time with him. He’s homeless. This is the worst thing to be if you want to quit drugs. The mean streets of Chicago make it inordinately difficult to stop. Continuing to use becomes a way to cope with the violence and alientation of being on the streets. The homeless are victims of police brutality, theft, rape, assault. Vulnerable can’t begin to describe the reality of the homeless. To survive my patient had been prostituting himself to men and women and dumpster diving. He had been robbed the night before, someone pointed a gun in his face and stole his backpack that contained his medication for depression. He used to have a life. He worked at a social service agency, had a girlfriend and then she gave birth to twins who were premature and almost died. He took off time to stay at the hospital and got fired for missing work. Couldn’t pay the bills. Problems with the girlfriend and being a father of 2 sick newborns. He got stressed and depressed and started spiraling down. Started drinking and drugging. Found out he was HIV positive. Got more stressed and depressed and drank, drugged, and prostituted some more. Six years out on the streets. Several admissions for inpatient drug treatment and then put back out on the streets. He used to have a life. He called and was able to get into drug treatment the next day. They wouldn’t let him come to the program until he had his depression medication so I asked the doctor to write him a prescription. I gave him a transit card to get to Walgreens. The pharmacy at Stroger closes at 7pm which is ridiculous. Tons of patients need medication at all hours of the night and many don’t have insurance to pay for it so County is the only place they can get a prescription filled. It should be open 24/7 like Walgreens and Osco. Luckily my guy has Public Aid.  I tell him as he leaves that he can get better, he can stop drinking and drugging. That he can get his life back. Take it one day at a time. He thanks me profusely. But I haven’t done anything.

I’m standing at the counter and a young man, very dark complexion with patches of red and white skin comes up to me. One side of his face appears lopsided and swollen. He opens his mouth to speak and he’s missing lots of teeth. I can’t understand him at first. Then he says he wants to go to a shelter, that he’s homeless and could I help him. I agree to call DHS for him. I want to cry. I don’t at that moment but I am as I write this. I can see from his face and his eyes that he lives in a world of pain, of little kindness. What kind of a world do we live in that would degrade a man to this point?

I see the woman in the wheelchair and want to run back to the office and get the turkey sandwich. I don’t care that she bought food. I want to show her that I got her something to eat, that I care that she told me she was hungry.  But a patient suddenly comes up to me and starts talking. He’s angry and frustrated.

He’s big and tall and tells me he wants to go live in a nursing home. He’s homeless, too. He starts talking about things that happened in the past but it’s all jumbled up. He’s trying to get medical records, social security, birth certificates, and on and on. No one his helping him, including me. All I can do is get him into a shelter. He wants to see a doctor but the people in admitting refuse to register him saying that there is nothing medically wrong with him. The patient is just homeless and wants to hang out in the ER waiting area the staff person tells me.  

Now it’s 11:20 and I’m about to go. The lady in the wheelchair is gone again. Damn I wanted to give her that sandwich! I start to walk back to my office and a young, scrawny, white guy with rotten black stubs for teeth asks me if I can get him something to eat, he’s been waiting for hours and is hungry. I say sure, I got a turkey sandwich, I’ll be right back. I grab the sandwich and the apple juice and go back and give it to him. He thanks me profusely. But I haven’t done anything.

Trauma Observation #2 Domestic Violence Monday, Nov 3 2008 

The shift last night in the ER started with a bang. But the first thing I did was check on my patient whose head met the concrete the night before. He survived the surgery and was now in Neuro-ICU. Whew! But still the worst may be yet to come. Sometimes patients with traumatic brain injury, it’s better for them to have died at the scene.  When they came out of the fog of the deliberately induced coma, they are never the same. If they are quads forget it. If the brain has regressed so far back, to infancy, forget it. Adult diapers, drool, bland diet, bed sores. Harsh, I know, but for me, it’s about quality of life.  

The case that freaked me out the most was the woman who was a victim of domestic violence. I’ve seen lots of women over the years who have been battered. The cycle theory of violence is one of the most important contributions to how we understand domestic violence and I used it to help assess where the woman was in the cycle. The phone rang in the social work office – I could see by the caller  ID that it was from inside the hospital.  The voice at the other end was speaking in a low, panicked voice. I could hear a child whining in the background. The patient said she got her husband to bring her to the ER by feigning an asmtha attack. She planned not to go back home with him now that she had gotten out. The woman stated, “He’s getting violent on me and I’m not going back.” She put the phone down and shouted something at her kid. I asked her where she was in the hospital and she replied in the lobby by the giftshop. The husband was in the trauma waiting area. I told her I would come over immediately. I grabbed my stuff and fairly sprinted down the long hallway. I saw the woman by the house phone, she was struggling to get her child fastened into the stroller. He was screaming and she was screaming back. As I approached she pulled his pants down, he was wearing a diaper, and spanked him hard on the butt and legs, then pulled his pants back up. I was appalled at the the brutality and said, “You can’t hit your child.” She replied, “Don’t tell me I can’t hit my child.” I said it again and at this point the security officer came over and told her to chill out. Then she said, “He’s not going to hit me.” So the reason she was hitting her 3-year-old son was because he hit her. And her husband was hitting her. Hitting is for everyone. Finally she got him locked down in the stroller and raced to the exit. I knew she felt humiliated. I just stood there saying to myself, what the hell just happened? I was supposed to talk to her about getting out of her violent home and help her get into a shelter. The opportunity was completely lost because now I was the judgemental social worker from hell. 

The Cycle Theory of Violence teaches that when battered women ask for help to leave their partners that is the golden moment. It’s a window of opportunity to get free of the violence. It means they have thought through the pros and cons and are ready to take action.  But the system for helping battered women is not ready with the resources at this critical moment. I went back to my office and hoped she would call me again. I called the Domestic Violence Hotline to see if there was an opening for her. The woman said no, there was no shelter available and to call back in a couple of hours. This is almost always the case – women cannot get into a shelter immediately. So they go back home and the cycle begins again. And then society blames women for not leaving the men who abuse them.

In the United States there are more animal shelters than shelters for battered women.

The drivers for the Department of Human Services arrived to take the homeless to shelters. I chatted with the woman, she was from Russia. She asked me where I was from and I said here, the United States. She said, oh, you look so European. The other DHS worker told me he feels like they are just a taxi service, taking the same people to shelters night after night. Nothings changes he said. What has to change I asked him? We need more subsidized housing he replied. I asked do you think if Obama is president things will get better? No, he said, all politicians are crooks.   

Towards the end of the evening I was sitting at the desk in the ER with the worker who takes vital signs. She said I had missed the action earlier. She was taking a patient’s blood pressure and suddenly the patient whispered, “I’m going,” and then fell out and went into cardiac arrest. She started CPR and the trauma team in the back ran up to the front and took over. They continued giving the patient CPR until they got up to the Cardiac-ICU. It was a total ER moment. I was bummed that I missed it.

Trauma Observation #1 Real Time in the ER at Cook County Hospital Sunday, Nov 2 2008 

I’m a social worker and I’ve been covering the ER at Cook County Hospital, the 3 to 11 shift, for about a month.

The amount of people who come in with GSW, that’s short for gun shot wound, is astonishing. They’re almost exclusively young, black men. One patient had 8 bullets shot into his legs, calves, and feet. A 14-year-old on the pediatric unit I assessed had been shot in the leg. I read in his chart that he had been shot in the other leg 5 months ago. That’s what we call a “2-fer,” or double trouble.  Last night a 16 year old that was shot in the chest was admitted.  The bullet was still lodged inside. I introduced myself to him and his family. One relative said to me, “Those mutha fuckas’ shot my nephew.”      

Around 8pm I got a page from a clerk in trauma. She said a 21-year-old man had come into the ER by ambulance. He was in a motorcycle accident and had a massive, life-threatening head injury. They checked his wallet but only found an address, no phone number. He lived in Cicero and she asked me to call the police in the town and ask them to go to the patent’s house to inform his family of what happened. I called the Cicero police and they agreed to go. 5 minutes later she called me back and said the family was in the ER talking with the doctor. I put a note into the chart and I read one by the neurosurgeon. They had scanned the patient’s brain and  pressure was building up quickly, so he would have to have a craniotomy. A couple minutes later I was back in the trauma area when the family came in. The women were crying, the men were stoic but stunned into disbelief. They were asking questions, would he be okay, would he wake up? And I thought – what they couldn’t know now was the minute their son’s cranium hit the asphalt his life was forever changed. He will never, ever be the same again. His brain was swelling, destroying itself and taking down memory, language, the ability to feel true emotion, achieve an erection, drink a beer, live independently. If he was lucky and a mircle of science was available that night, his brain might recover enough so that he could live a semblance of a normal life with minimal disability.  He might live to say, “I’m never getting on a “crotch rocket” again.”    

The only thing that was getting me through this night was the thought of the pomegranate martini with fresh mint that I was going to shake and sip when I got home…