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.