Trauma Observation #20: Easter in the ER – 16 hours Monday, Apr 13 2009 

How crazy am I? I agreed to work the morning and evening shift: 16 hours in the ER.

8am  A knock on the social work office door. 2 women in the hallway. The back story: They brought their sister here from East St. Louis. The patient has ovarian cancer and the doctor said she has less than 6 months to live. The sisters don’t believe it and want another opinion. They tell me the sister is uninsured and ask can she get a medical card in Illinois. What will be the discharge plan? Are there resources? I answer the questions.

I check the computer for the medical story. The patient is 41 and has advanced cervical cancer, not ovarian. No woman should get cervical cancer in the United States, a simple pap test and death is avoided. This diagnosis always astounds me. Only poor, uninsured women get cervical CA. The cancer has metastasized. Surgery is not an option. Maybe chemo. Not good.

8:30 Call from Blue Team. They have a guy with head and body lice and are going to shower him. His clothes have to be thrown out. Can I find some clothes for him?

9:00 My co-worker working up on the units wants to buy me a cup of tea. We go to the cafeteria and drink tea and chat.

9:42 Call from trauma ICU. A patient is going to have a peg placed and will be ready to be transferred to Oak Forest Hospital early next week. The team wants to make sure he can still go to Oak Forest. I offer to leave a voice mail for the social worker on that unit. I check the patient’s medical record to see if she has seen him. 33 year-old man. Multiple gun shots to the head. He never regained consciousness. Gray matter was extruding from the brain.

 The resident’s note:

Intubated no sedation, no eye opening, pupils 4mm not reactive, doll’s eye sign absent, weak gag present to deep oropharyngeal stimulus, no spontaneous movement, no movement to noxious stimulus, overall prognosis is poor.

The social worker’s note:

SW met with patient’s sister to provide emotional support. The sister stated her brother would want to stay on earth, even if in a nursing home in his present condition.

11:34 Page from labor and delivery. A patient’s baby died. No money for a funeral or burial. Staff ask me to come to the unit and talk with mom and dad.

11:45 Call from trauma. The nurse asks me to meet with a patient who is an alcoholic and give him a “pep talk.” I meet with him and he tells me he’s a Viet Nam veteran. He started drinking heavily when he was over there because he was afraid much of the time. When he returned to Chicago the fear didn’t end. In the past, the patient received treatment for alcohol abuse at the VA. He tells me he’s going to go back for more treatment. Great idea I say. One day at a time.

1:pm  Saw a patient who needed transportation home. He was assaulted by fists in the face and by a brick that was smashed in his left eye. He had surgery on the eye and was wearing a fox shield (fancy word for an eye patch.) He looked like a pirate.   

2:30 Peds trauma resident calls. An iron gate fell on a child, breaking his clavicle. Per the peds protocol that says every injured child must be seen by social work, I am asked to come and interview patient and family. Except not right now because the child’s mother has just passed out. They’re going to work her up.

3:30 I have the office door open and I hear a loud, raging argument emanating from around the corner in the ER waiting area. A woman is shouting, “Fuck-you, go ahead and try to arrest me, I’ll fuckin’ have you arrested What he be saying to me? Fuck you.” It went on like that for about 5 minutes.

3:45 My co-worker comes down to my office for a break and we swap patient stories. She’s catching hell up on the units, I’m catching it in the ER.

5:30 Domestic violence victim, 32 years old, with 2 children in the big, big city of Chicago from a small, small town in rural Illinois. I went into the exam room and the kids are out of control and mom was screaming at them to sit still. One is 8, the other 10 and they have both been diagnosed with Attention Deficit Hyperactivity Disorder (ADHD.) They can’t sit still because they are not medicated. Mom bursts into tears and chokes out, “I can’t do this.”  There isn’t another person in the entire hospital that is more stressed out than she is at this moment. The room is so full of tension if feels like it could blow up. For about 30 seconds I just stand there in stunned silence trying to think of something to say. 

It’s impossible to have an uninterrupted conversation. She grabs the children roughly by the arms and legs, yells at them again and forces them to sit on the floor. They immediately start moving the minute she turns her attention back to me. They touch everything in the exam room. Again, she breaks down into tears. Even a 2 parent family would have difficulty controlling these children. I recommend she ignore some of their behavior and tell her she that she is going to get through this; it’s only temporary. I also suggest she always bring things –  electronic games, books, crayons and paper  – to keep the kids occupied whenever they go anywhere. 

Next stop is the peds ER to see a pediatrician/psychiatrist so the kids can get their medication. In that ER there is a special enclosed waiting area for children filled with books, games and a TV. I know mom will finally get a break from the 2 little ADD maniacs.

They are going to a domestic violence shelter tonight; they’ve already been in 2 other ones. I tell mom to have the nurse page me when the kids are finished with the doctor and I will call the Department of Human Services (DHS) for them.  

6:30 I walk back to my office through the red team. Behind a curtain a patient is throwing up as loud as a bomb and with great difficulty. He starts coughing out chunks of something. No one moves to help him. The sound is so disgusting I sprint out of out of the room as fast as I can.

7:15 I duck into the chapel for a moment of silence. I stare up at the lighted circle on the ceiling.

8:00 I’m out at the vital signs desk seeing patients when a heavyset young woman starts going off, complaining about having to wait over 4 hours. She starts shouting, “Fuck y’all, I’m leaving.” She points to my co-worker behind the counter and calls her a fat bitch. The patient is escalating and telling everyone in the waiting area to go fuck themselves. The police officers just stand back and watch her. She yells at her friend to get up, it’s time to go. She keeps repeating as she walks out, “Fuck y’all, I’m leaving, fuck y’all.”

8:30 DV mom and ADD kids are finally all medicated and ready to go. I bring them to my office and call DHS to pick them up. The kids start to have at it in the office: slamming down the keys on the computer keyboard, pressing the buttons on the copy machine, diving under the desks, spinning like a top in the chairs. Mom yells to stop. They don’t. They knock over the trash bucket and she bursts in to tears. Then I say in a stern voice, “You have to stop and you have to calm down, your mother is crying and upset, you have to listen to her, you are hurting her feelings.”  They stop and apologize to her. Is that some social work or what? We gather up their things and walk toward the waiting area for families. I leave them there and trudge back to my office with foreboding and relief.

9:00 – 10:00 Write notes on patients in electronic medical record. Eat leftovers for dinner. Surf internet. I read online that 3 of the Somali pirates holding the captain of a cargo ship hostage are shot in the head by snipers and killed.    

11:00 Home, helluva Easter in the ER.

Trauma Observation #19 Still Life: Newborn and leg-cuff Saturday, Apr 11 2009 

I got a page to talk to a young woman who had given birth to a baby a few days ago and now had to go back to prison. The nurse told me everything was ready for discharge except who would be coming to get the newborn. I looked in the patient’s medical record and found the number for her boyfriend, the father of the baby. I called and a woman answered. She said he wasn’t home and she didn’t know when he would be back. She thought he might be out buying cigarettes. Hmm, out buying cigarettes and his newborn is waiting to be picked up…. In any case, she said her son wouldn’t be able to come and get the baby for 2 days because he had to work.  Oh really, you think we’re running a newborn hotel at Stroger hospital, I wanted to say?

I got on the elevator and headed to OB/GYN to see the mom. I hate these cases because the criminal injustice system always wins. Young, drug addicted mothers will be punished.   

It was around 8:30 pm. At night the halls in the wards appear to be extra long, the lights too bright, and there is few staff around. It’s creepy in the way that horror and psycho movies depict hospitals. I’m afraid that some maniac will grab me from behind and drag me into a dark room and rape and stab me to death. No one will hear my screams….

I talk briefly with the patient’s nurse and she gives me a heads up that mom is angry and uncooperative. In front of the patient’s  room are 2 police officers from the Department of Corrections (DOC) talking  loudly, laughing, and eating  greasy bags of Burger King french fries.

I walk into the patient’s room and the newborn son is lying on her chest. He’s in delta sleep and doesn’t move. I sit at the end of the bed in a chair and see her leg is locked to the bed by a metal leg-cuff. Then I glance over at baby and see the plastic cuff on his impossibly tiny, chicken-wing leg. It has a light that blinks green. One cuff imprisons, the other secures.

Mom starts crying – tears spill down her blue patient gown. Her red-rimmed eyes have only seen 22 years of life and I know instinctively it’s been a hellish and mostly unhappy 22 years. She said her boyfriend is trying to find childcare, but because the baby was born a few weeks early, nothing is in place. Mom said dad definitely wanted to take the baby home, but really, it didn’t look that way at all. He hadn’t even been to the hospital to visit the infant. 

Mom reveals that she has another child, a three year old living with her boyfriend’s mother (the woman I had already spoken to.) She starts to tell me her story and it’s impossible to follow. So many patients are incapable of telling in chronological order and with clarity, what the issue is. We call them “poor historians.”  It’s equal parts not remembering, lying, and clumsily weaving together a tale to include important details and leaving out important details. Moments of shame, embarrassment, humiliation and sometimes flashes of anger accompany the account. Then she quietly mentions the crack. She was pregnant, using crack and left the treatment program. She reveals the police arrested her for “child endangerment,” meaning, I think, her using crack was putting her child at risk. Oh shit, here we go, this has Child Protective Services (CPS) written all over it. The story got so convoluted and crazy I gave up and decided to just focus on what was going to happen within the next couple of minutes: the baby was going to be taken away from her by the nurse with back up from the DOC police officers and then she was going back to prison.  

There is a phone next to the bed and I suggest she call dad. She dials the number, someone picks up and then hangs up. She calls again, same thing happens. I call the number using my hospital issue cell phone and boyfriend’s mom answers. I ask her again is anyone coming to get this baby and if so, they have to meet with me and the doctor. She said he’s not coming to the hospital and not only that, she doesn’t believe the child is her son’s. She spews out, “That woman has sex with a lot men, she’s a slut.” Grandmother is not willing to take care of another child, especially if it’s not her blood. Okay. I couldn’t believe I was having this conversation with this woman in front of the woman who just had a baby and was crying her eyes out. I didn’t tell the patient everything that was said –  that would have sent her over the edge – only that grandma wasn’t willing to take care of another child. More 22 year-old tears.

Newborn wakes up. He is an Anne Geddes photo. He is wrinkly, crinkly, all creases and criminally cute and I want to hold and squeeze him. I almost ask but in the nick of time realize every moment mom has with her son in her arms is precious.

I tell her that if dad doesn’t come to pick up the baby we will have to call CPS and they’ll take temporary custody. She starts crying and howling, no she blurts out, that’s not going to happen! She shouts that her son is not going into foster care, she knows how horrible that is, she was a foster child. Mom states she was abused in her foster home. And there it is, the cycle completed. I try to assure her that the case worker will come to the prison to talk with her and help her keep and parent this child. She’s having none of it and I realize nothing I can say will assuage or erase the fear she has that her son will end up like her.

As I leave the unit, I see there are 2 more officers from the DOC – that makes 4. They are snapping on latex gloves and moving down the hallway like a pack of animals, toward the patient’s room.