TRAUMA OBSERVATION #14 HOT AND COLD Sunday, Jan 25 2009 

It appears that two things bring people into the ER in the winter: burns and hypothermia. On one night I had two children who had been scalded by hot soup and two that had hypothermia of the feet and hands.

1. The “Soup Kids.” Hot, steaming bowls of delicious soup define winter. They warm us up inside. They are nourishing and good not dangerous and life threatening. That is until the soup spills. The resident said a child had pulled a bowl of hot soup off the counter and it splashed all over his face and neck. Second degree burns.  He wanted me to talk to the family to find out how it happened. And to suss out if there was abuse and neglect. The other soup kid spilled the hot liquid on his neck and chest. Second degree burns. It has to be a parents’ worst nightmare come true. 

The whole premise of these social work consults is wrong. Children have accidents. Even the most vigilant parent can’t prevent all accidents. If the doctor talks to the parent and child and the injury is consistent with the story, don’t call me. Doctors know so much more about injuries, if they were intentional or perpetrated, it’s kind of a CSI thing. My getting involved ups the ante, the stress, the anger. Social workers are still viewed as snatching children out of homes. But Child Protective Services (CPS) rarely takes children away from parents. The goal is to keep them together and provide services. Lucky for me I got the calls so late in the shift I left it for the social worker on the next one.

2 kids out in the cold.

It’s been really cold out. Kids play outside in the snow and ice. It’s fun, until the feet and fingers get numb, attacked by frost. I went to see the first kid with hypothermia. I walked in the room and he was surrounded by 4 African American women of all generations and all dressed to the nines. They were wearing large hats. Mom, aunties and grandma were all over the kid. The love and concern radiated around the room. I asked a few questions and got out of that room fast.  Second cold kid was a disaster. His clothes were dirty, he smelled, couldn’t sit still or focus, and his mom had that glazed, lost look in her eyes that is a dead ringer for mental illness. Parents with hyper-active kids need a break. Send them outside to play. But when the temperatures dip below freezing, like 20 below, that’s not an option. This kid was outside without heavy boots or gloves. The boots leaked. I saw them, the leather was water stained and ripped away in several pieces. It reminded me of Van Gogh’s painting of a pair of beat up shoes.  His feet were a sickly shade of gray. His mother, upon questioning, confessed that she had no money, had lost her job a couple months ago, and had moved in with her sister. She didn’t want to be there, they didn’t get along, but she had no choice. Winter jackets, boots, hats, and gloves cost money. Mom said she was going to go to a second hand shop and purchase those items. We have clothes in the hospital for adult patients but not children. I wished that I had a $100 gift certificate to a clothing store to give to her.

It still shocks me that in this country clothes to protect against the elements are hard to come by.

The back story to almost every child neglect case is poverty. But it is the parents that get blamed, not the economic system that produces the deprivation. So what am I supposed to do? Call CPS and report mom for neglect, for not having bought sturdy winter boots,  heavy mittens, and telling the kid who is driving her crazy to come in from the cold? Once again I escape the CPS dilemma. The patient was admitted and it would be the inpatient social workers problem.

RESIDENT POEM

distal aspect of cuboid

dorsally subluxed

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Trauma Observation #13 County Chapel/Hell’s Angel Wednesday, Jan 7 2009 

There is a chapel at County and a woman who is a minister-of-sorts. She comes into the ER waiting room in a short, white lab coat to announce prayer services and would anyone like to attend? Most times none of the patients go. This woman is so mean, so holier-than-thou, brash and bullying. She exudes a By god I’m going make you suffer, save you from Satan, and then put you in your goddamn place you homeless, drug-addicted, insane, sinning, shivering piece of shit attitude. It’s no wonder no one goes to the chapel and listens to her spit fire. She is a silver-haired, stern, sadistic Hell’s Angel.

No doubt the tone and timbre of her voice triggers PTSD in some  patients.

One evening she came into the waiting room, made the announcement and started making a mini, motivational speech. A patient who was mentally ill happened to be snapping gum really loudly while hell’s angel was preaching. The gum kept snapping. The minister got angry and started yelling at the patient to stop snapping gum. The gum kept snapping. Then the minister yelled at the police officer who is stationed in the waiting room to make the patient stop snapping her gum and start respecting her. No one disrespects Hell’s Angel!

A different minister came into the waiting room the next day. He politely asked the police officer if he could announce that a chapel service was about to begin. The officer said yes, but just an announcement.  Mr. Minister went into the waiting area and started to preach among the rows of sinners, er, patients. Hell fired and brimstone they had to get their sick and sinning souls to Stroger’s chapel to get some salvation! Then Mr. Policeman intervened and told preacher-man to get out of the ER. Preacher-man protested. Mr. Policeman got right up in his face and called him a hypocrite, a liar and cussed at him. I was loving it! Raging Mr. Policeman threw down on preacher-man bad and they walked down the hallway away from the ER arguing in loud tones. The last thing I heard preacher-man say was, “Have a blessed day.”

Trauma Observation #12 Xmas in the ER Wednesday, Jan 7 2009 

I wanted the Christmas eve night shift to be like one of the Christmas episodes of the long running series ER. That famous series of course is based on County’s ER. I wanted my  ER, the real ER, to be beautifully lit with strings of blinking blue lights and a tree with presents  under it and lot’s of  decorations scattered around. I wanted to see glass block walls that create wavy shadows and light that the show prominently features; there are no glass block walls at the real County. I wanted to hear in my head all the great music the series wove into each episode. I wanted something really important and profound to happen:  Clooney and Hathaway share a passionate kiss and have sex standing up in a closet,  Mark Green doesn’t die in Hawaii, or I get invited to a holiday party at the Drake Hotel by Dr. Carter and his rich family.    

Instead the drab and harshly lit ER was full of homeless men and women. I know a couple of them now and greet them like old friends. Christmas eve doesn’t feel like Christmas eve in the ER because homeless patients aren’t trying to get home to spend the holiday with family or friends. It’s a terrible holiday because it excludes them. Their families have rejected them or vice versa. So there are no presents, no great meal and cocktails, no parties, no “great to see you, how ya been?”   

I decide to give away all the food in the refrigerator that I can. I give some patients two sandwiches a juice and a milk. There are a couple of Styrofoam trays with hot food and I hand them out, too. I brought a box of chocolates and offer patients one.

At one point a bunch of young people come into the ER waiting room with a box of presents. The security guard/police officer announces to everyone waiting that there are presents for their children if they have children. They’ll need to prove it somehow. Several patients get up to claim a present.  

Patients are asking me for clothes, boots, shoes, underwear, hats, scarves, and gloves. It’s freezing out, below zero with the wind chill. We have a few boxes of clothes  up on the 7th floor. I go up to the floor and there isn’t much, a few women’s sweaters and one coat. I grab the coat, it’s from the Gap and in great condition. It’s last year’s must-have Gap blue P-coat. I give it to my patient who basically has no teeth, splotches on his cheeks and a squashed flat nose. He looks great in the coat! I can see how if he was cleaned up a bit, got some teeth, psych meds, and some stability in his life he would be oddly attractive.

I get a call about a patient that has sobered up and needs a shelter. I meet with the man and he still looks and acts intoxicated. He’s been in trauma obs for almost 2 days. He has a bulbous, red nose like Rudolph the Red Nosed Reindeer.  He has great difficulty answering questions, remembering what I say to him. I suspect Wernicke-Korsakoff’s Syndrome. This chronic brain syndrome is a result of thiamin deficiency. It’s most striking feature is a dementia characterized by permanent, short-term memory loss coupled with the telling of “fanciful” tales in an effort to fill in blanks in the memory, confabulation, really. The patient tells me he is going to the firehouse to pick up his medication. I couldn’t suppress a laugh at that one.

I want to help this guy get into treatment so I bring him to the social work office. I call a couple of places but no one will take him because he doesn’t have his seizure medication. He can’t get his prescription until tomorrow but he never takes the medicine because he’s drinking most of the time. The patient doesn’t like to mix prescription drugs and alcohol, that’s both good and bad. So no treatment program. He asks me to call his father to see if he can stay with him tonight. He gives me the number, it’s been disconnected. He says it can’t be disconnected and I try again. It’s disconnected and the patient just sits there in sad, disbelieving silence.

I ride my bike home in the freezing cold. I love the holiday lights that shine and blink along Taylor Street. I get in and make myself a pomegranate martini with fresh mint. The red juice with flecks of green looks festive in the clear martini glass and the vodka tastes clean and smooth.

Call me the grinch, but I hate Christmas.

Trauma Observation #11 Phone Calls Home/Heartless Friday, Jan 2 2009 

Almost every shift a patient asks me if they can use the phone. It’s always incredible to me that there are people in this world that don’t even have money to use a pay phone let alone own a cell phone. The inability of the poor and the penniless to do something as simple as make and receive phone calls becomes one more barrier to getting housing, social services, and medical care. Sometimes I let the person use the phone in the social work office and sometimes I call for them using the ER cell phone. I learn a lot about my patients by calling  family members. Often a dark side they don’t share with me.

Many of my homeless patients ask me to call family to see if they can stay with them. Home and family is everything, no matter how dysfunctional it is. The family: the heart of a heartless world but for my patients the heart has been ripped out. There’s no home, only homelessness.

One young man seriously, dangerously mentally ill and homeless asked me to call his mother and ask  if he could come back home.  He was a scrawny, white man. Early twenties. He was malnourished, dirty clothes, hair greasy and matted. Front teeth were missing. I got his mother on the phone and she said no way, he couldn’t live there anymore. She was recovering from heart surgery, had a ton of other health problems and he was stressing her out too much. He was unplugging phones, climbing out windows, threatening her and generally acting bizarre. She also shared with me that she thought her son was gay. Mom said the medication he took wasn’t working and he shouldn’t be on any at all. She called psychiatrists a bunch of horses asses. She said she loved her son very much but just couldn’t handle having him in her home. Then she started to cry and sobbed, “I’m not a bad mother.”  The patient asked if he could talk to her – he was crestfallen when he heard he couldn’t go home.  Normally I would say no, it’s that thing about the germs and I was afraid he might run off with the phone. It costs $700. But I said yes this time. He got on the phone and launched into an ugly, loud argument. After about two minutes I said conversations over and took the phone from him.  I could see why she couldn’t have him at home.

Another patient, a young, black, woman with bi-polar disorder,  asked me to call her family to see if they would let her come home.  She was unusual in that she was wearing stylish, clean, designer clothes, had flashy jewelry and was carrying two huge, heavy duffel bags. She had a maniacal laugh that punctuated most thoughts and wouldn’t stop talking unless interrupted.  Definitely in the manic phase. I don’t think anything I said sunk in. I called her mother who flat out refused to let her come home and hung up on me. Then I called an aunt and she agreed to let her stay for one night  but she couldn’t be drunk. I assured her that the patient was not drunk and had been in the ER for almost 24 hours. I called for a medicar to take her to the aunts house.

I called a patient’s ex-girlfriend to see if he could stay with her instead of going to a shelter. She started throwing down on me: “I’m so sick of that man, I want him outta my life, why he callin’ me, he ain’t caused me nothing but misery and he ain’t staying here.” Then I asked if she had the number for his parole officer, she yelled, “He don’t know the number to his parole officer, he a grown man?!”  She said hold on, slammed the phone down and went to look for the number. The ex gave it to me and said, “Tell that fool don’t  never to call me again.” I relayed that message to the patient.