Trauma Tango - Tom Messmer

A tale of toil from a San Francisco hospital social worker.

“The apocalypse has been announced so many times that it cannot occur. And even if it did it would be hard to distinguish it from the everyday fate already reserved for individual and community alike.”
Raoul Vaneigem, The Movement of the Free Spirit

“They hang the man and flog the woman
who steal the goose from off the common
But let the greater villain loose
who steals the common from the goose”

English folk poem, 17th century

1. I’m outside waiting for an ambulance to bring in another trauma. It’s one of those foggy-yet-sunny, surreal San Francisco afternoons that occur in the fall, which is actually somehow our summer. I noticed a few pigeons congregating to my left and as I glanced over I realized to my horror that they were all happily dining on human blood and tissue from an ambulance backboard.
2. The budget crisis in San Francisco has become truly dire, and according to the folks who calculate such things, sacrifices are in order. What amounts to a 7.5% pay decrease is proposed for many who work for the city in such job capacities as health aides, janitors, groundskeepers, and, in my case, social workers. The union puts this proposal to a vote and it narrowly passes. For some reason the union was unprepared to propose any alternative to this pay cut for the lowest-paid workers in the city. And the membership was frightened by the prospect of layoffs: many have recently bought homes in the Bay Area and are deeply in debt. Still, many are pissed about this, particularly since a large pay increase simultaneously came through for the city supervisors.
3. A man jumped off a freeway overpass and fell 740 feet onto the roadway. He was quite dead, but they attempted to revive him as a matter of course. I walked into the trauma room after they officially pronounced him dead, the floor was covered with blood and bloody footprints, he was partially covered with a sheet. Medical staff stood about quietly filling out paperwork. For some reason someone was pumping music throughout the hospital’s PA system and the Temptations’ “Ain’t Too Proud to Beg” was blaring in the room. I went back into the room a few minutes later and they were playing Aretha’s “Natural Woman” and a nurse was actually singing and dancing to the music.
4. The pay decrease got to me, and I thought to myself, “Someone ought to do something.” Then it occurred to me that this in of itself isn’t a particularly helpful sentiment. Terry Pratchett quipped that this thought is never followed up with the rider “and that someone is me.” I’d been reading Saul Alinsky for some odd reason and I decide I want to rile people up, so I distribute flyers and petitions slamming the union for not fighting, and demanding action. I get a bunch of signatures and people call the Union griping, so they contact me and set up a meeting about what to do.
5. A homeless Haight Street kid maybe 17 years old is brought in by the police. His friends were worried about him because he had what looked like burns all over his body. The police didn’t like the way he looked so they brought him down. He has a pretty high fever and he tells me he thinks he fell asleep in the sun or something. The docs are puzzled and wonder if maybe a speed lab blew up on him. I talk with him a while and he tells me he ran away from home, which was a trailer park somewhere in the Midwest. He has one of those squatter symbols badly tattooed on his arm. He’s quite frightened and tells me he really wants to get into a drug treatment program so I agree to help him once he’s better. I take my half-hour regulation dinner and when I come back the room he is in is packed with doctors and he has a breathing tube in. They don’t know what’s wrong with him but it appears he is suffering from some sort of systemic sepsis. He dies that night of complications from necrotizing fasciitis, aka “flesh-eating bacteria”, which he got from a dirty needle.
6. I meet with the rep and some other activists on the very day Schwarzenegger is elected governor. They all have stunned, tired expressions on their faces and have been precinct-walking and rushing from meeting to meeting for years, probably. With a sinking heart I imagine myself clutching a tattered datebook, or even a palm pilot packed full of meetings and rallies, public forums, and phone banking. This is unattractive to me in the extreme and I decide to play music and spend time with my fiancé instead.
7. I receive a subpoena from a lawyer about a case I worked on in which a 2-year-old Latino child was injured in her apartment in the Mission district. The family is suing the landlord and the landlord’s lawyer tells me that the kid is really OK and that the family is trying to take advantage of his client, an “honest, hard-working landlord” who happens to live in the wealthy Marina district. I tell him that I can’t recall a single fact from the case, but that I’ve lived in those Mission tenements and that none of my landlords tended to the buildings very well. For some reason they don’t call me to testify.
8. I’m speaking to a homeless man who is what is referred to as a “frequent flyer”. He is in the ER at least 3 times a week, mostly for alcohol intoxication or being the victim of an assault. Between the alcohol and blunt head trauma he has become profoundly demented, and his mental capacity is about that of a ten year old, with a short-term memory that lasts 5 minutes. If I find him a shelter bed and ask him to wait for the van to come pick him up and bring him down there he will either a) wander off and get drunk; b) go back to the triage window and re-register, forgetting that he’s already been seen (interestingly, if a shift has changed recently, oftentimes the triage nurses won’t notice that he’s left the hospital); or c) sit in the chair all night staring at the television. There is not one, or two, but a dozen or more people like this who come to the ER regularly.
9. One of my favorite websites is called The Commoner (http://www.commoner.org.uk), a commie website which recently featured a discussion of the ancient notion of “The Commons.” It occurs to me that health and caring for others’ bodies must be part of this. If it isn’t, what could be? The Commons are simply those things that ought not to be part of the marketplace. In the United States in 2004 this concept is viewed by some as close to treason, and by most with suspicion. We seem to have learned our lessons well, though if I suggest to one of the hospital police officers that his job may some day be privatized, indeed that it almost certainly will be, he scoffs. Could the sort of sentimentality Americans reserve for police and fire fighters be enough to stave off another Enclosure, or will we return to the days where the rich have private security and fire fighters and everyone else has what they happen to be able to pay for? Will the poor have to rely on bucket brigades?
10. A rapacious local “public” university that is also somehow a famous private research hospital system is increasingly involved in the operations of the hospital where I work. One proposal calls for a relocation of the entire hospital to the area that included Mission Rock, a former hellhole of a homeless shelter where murder, extortion, drug dealing, and pimping were everyday occurrences. It is common knowledge that the move is being driven in part by top-tier physicians who complain of parking problems at the current facility. This hospital has recently proposed a new initiative in their world-famous cardiology program in which wealthy donors could gain “enhanced access” to same-day appointments, house calls(!), a special hotline, even physicians’ private pager numbers in case of emergency. These donors include the elite of our society, CEOs of major corporations, national political figures, the usual suspects. This boutique medical system may be the wave of the future, despite local outcry, even from the physicians forced to play a part in it.
11. I’m waiting at the ambulance bay for another trauma to come in. As the ambulance pulls up and the EMTs open the door I find myself looking into the eyes of a dead black teenager from some particularly violent local projects. He has a bullet hole directly in the middle of his forehead. I can feel myself about to faint as my stomach is empty and the shock hits me hard. I grab something quick to eat and wait for the crowd of family and friends to arrive. As a social worker I earn my pay by somehow offering comfort and assistance in situations exactly like this. But what can one say? I do a lot of listening and nodding; sometimes I’ve broken down and cried with people, not your stereotypical civil servant response. I’m paid to maintain a human presence in the midst of real horror. I ask myself what kind of system we have created that requires us to pay someone to remain human.
12. I’m walking through the ER on my rounds and realize that just about every bed is occupied by someone who has actually been admitted to the hospital but is simply parked in the ER waiting for a bed to become available upstairs. There are so many sick people out in the community not getting regular medical care that many come to the ER as a last resort, and when they do they are often very ill and in need of hospitalization. Many of these folks are there with such preventable diseases as diabetes and heart and lung diseases from smoking. The deep love affair our society has with privatization, and the equally deep denial that the market’s hand is neither invisible nor particularly benign, are nowhere more obvious than in an emergency room in the year 2004.
13. Despite my ambivalence towards the union, I’ll do what I can to help when the fight comes, if for nothing other than solidarity with the people I work with everyday who tend to the sick, the crazy, the suicides, the junkies and drunks, and the ever-growing numbers of those who are working but uninsured that wind up jammed into the waiting room, staring up with glazed, sick expressions at reality programs on the ceiling-mounted television.