Trauma Observation #10 Phones and Phone Calls Wednesday, Dec 24 2008 

There is a phone on the counter in the ER. This is a very special phone. Patients use it to call social service agencies. All they have to do is pick up the phone, dial 2 numbers and they’re connected directly to the agency. There is a list of places to call with the numbers –  most are drug treatment programs and the Department of Human Services (DHS.) Every night patients use the phone to call DHS because they are homeless. DHS has a van that comes out and picks up our homeless patients and takes them to shelters around the city.

We social workers love this phone  because we don’t have to call and be on hold forever to make a referral. I can’t imagine what it was like before the special phone. Probably the patients would have used the phone in the social work office and there would have been a steady stream of traffic in and out.  No way! Or the  social worker would have had to make all the calls, not the best use of our time.

It’s a lesson in the effects of poverty to watch patients use the phone.  Because so many of them have lived on the streets for years, a phone can be a strange thing. It’s been a long time since they have seen or used one. They pick up the cradle and don’t quite know what to do. They aren’t used to navigating  voice menus that ask them to make choices, or how to leave a voice-mail which is kind of a moot point because there is no call back number. They aren’t used to being put on hold and waiting; they get frustrated. They put the phone down and seem perplexed. Usually I stand next to them in case they need help. With my patients that are severely mentally ill I make the call –  from my County-issued cell phone.   

The poor and the homeless are out of the communication loop. We live in a society obsessed with communication and connection – at all times – and yet we have a group of people who are utterly unconnected and out of touch.  The universe of cell phones,  Blackberries, iPod Touch, ipod phones, camera phones, web cameras, computers, laptops, Skype doesn’t exist for my patients. When they see these technological devices they are in awe in the way a country bumpkin sees the skyscrapers of Chicago for the first time.  

But there is something else about this phone – I never touch it. Unless I am cleaning it. No doubt the phone is coated with the germs of hundreds of hands, many of them homeless hands. It’s hard to be clean when you are homeless.  Those hands also belong to people who are sick. Sometimes patients try to hand me the phone especially when the DHS worker asks for my name and phone number. I quickly tell the patient the info and they tell the person on the other end of the line.  I write my name and number down on a piece of paper and tape it to the counter, too.  Never touch that phone if  you can help it! I try to clean it every shift. I go to phlebotomy and get a castile soap towelette and alcohol prep pads. I wash that phone down good, every part, the cradle, phone, and dial pad.

I remember during my orientation that the nurse epidemiologist stressed the importance of hand washing. The woman counseled: when you wash your hands sing happy birthday twice and that is enough time to remove all the germs.  At least 30 seconds, you have to scrub for at least 30 seconds. And you need to create suds. The suds make the surface of the hands slippery and the water makes the germs slide off. This is serious business. There are dispensers of hand sanitizer, soap, and lotion  all over the ER and hospital.

I’ve become a bit obsessive about the hand washing. County gave me OCD – obsessive compulsive disorder….

And thank the goddess of social work for that phone!

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Trauma Observation #9 Thanksgiving at County/Detox, Stabbing, Pencil Monday, Dec 8 2008 

I was working the holiday so I would miss my favorite meal of the year, roast turkey, mashed potatoes, squash, stuffing, and cranberry sauce.  But I was getting time and a half. That’s what you get when you’re in a union. Still, I needed some semblance of a Thanksgiving  dinner so I headed to the cafeteria.

County has the the worst cafeteria in the entire state! It’s a throwback to the 50’s; workers in white uniforms with silly hats and nets on their heads. All the food served is unhealthy, full of bad carbs, and boring.  Turkey tetrazine, reconstituted potato flakes, bland, canned mixed vegetables, gravy on everything. Yuck. I went anyway. I got slabs of turkey curled around mounds of dressing, gravy on top. Unbelievably there were no potatoes or cranberry sauce. Was I pissed!  And no credit or debit cards accepted.

Back in the ER a young man was waiting to talk to me. He was an intravenous heroin user from New York City. He had just enough money for a bus ticket to Chicago and so here he was in ER. He had used before he got on the bus but would need something in a few hours to stave off withdrawal. He told me he couldn’t get clean in NYC – too many people, places, and things. He thought Chicago would be a good town to get into drug treatment and that he was sick and tired of using. The man didn’t know anyone in the city or any treatment programs and was uninsured. He had $48 and some change.  I joked that he couldn’t have picked a worse day to get into treatment – Thanksgiving. No program would be taking new patients on a holiday. I made some calls, no luck. We discussed detox which I didn’t recommend. Anyone who has injected  heroin for a long time – he had been using for 4 years – won’t be able to detox and not use again. The recommended and most successful treatment is methadone or buprenorphine. He thought he could detox so I called a few more programs. There are two kinds of detox programs, ones for the insured and ones for the uninsured. For the poor and uninsured only non-medical detox is available. That means no medication to help with withdrawal symptoms. Cold turkey. It’s barbaric and serves as a disincentive to stopping drug use. The idea of going through the physical and mental anguish of withdrawal from opiates or alcohol without medicine and medical attention is about punishment. The drug user needs to be punished and taught a lesson while being detoxed. Let them shake, vomit, scream and moan in pain. They only did it to themselves. But if you have insurance and some money, there’s no punishment, you get the drugs to help ease you through the detox process.   

The war on drugs mentality pervades drug treatment – zero tolerance, abstinence, incarceration or treatment termination for relapse.  Detox without medication and medical supervision is criminal and shouldn’t be allowed by law. Our drug treatment system puts up barriers to getting into treatment. There is no treatment on demand and this is crucial. It’s about the stages of change. When a drug user says they want treatment we need to provide it right then and there because the person is in the action stage of change.  If the person has to wait for days or even  months which is the norm, they get demoralized, change their mind, and go back to using. Then the victim blaming starts, they didn’t really want treatment, they’re not ready… No, the blame belongs squarely on the drug treatment system.  

My patient didn’t think he could do a non-medical detox. In a few hours he’d be going into withdrawal. I knew what he would do, he did, too. He would find his way to the part of the city where the heroin is. Welcome to the Windy City of heroin.

I was paged to trauma to see a patient who was threatening to kill his girlfriend. She had stabbed him three times. The patient was a small man from Reno. He came to Chicago with a group of workers to set-up a convention in McCormick place. He was drinking with co-workers, they were all drunk and a woman, it turned out she wasn’t his girlfriend, stabbed him in the hands and chest. He was lucky to be alive. The man was furious and shouting, she almost killed me, I’m going to kill her.  He had a heavy, twangy accent. The police had already filed a report.  I had a duty to warn this woman. But there was no way I could contact her, she had a cell phone and the man didn’t have the number. Or did he and he didn’t want me to warn her? Finally after much conversation filled with expletives he calmed down. Now he just wanted her to go to prison for attempted murder. The police came back and the patient filed charges against the assailant.  

Another page, this time to pediatric trauma. I hate the peds calls. They always want me to investigate parents for abuse and neglect. Every time an injured child comes into the ER they automatically call social work and often Child Protective Services (CPS.) It’ s wrong. They don’t make these calls at other hospital ER’s, like Northwestern and Rush. Definitely not in wealthy suburbs.  Kids have accidents all the time.  But at County, every parent who brings in an injured child is suspect.

I read the admitting note in the chart and the patient was a year old. According to the mother, her son was pulling himself up using a table. He grabbed a pencil that was on top of it and then fell on it. It lodged in his neck. Mom left the pencil in the baby’s neck and called an ambulance. What am I supposed to ask this mom? I left the referral for the social worker on the day shift.