ICU

I was doing some banking for a client when a man leaning unsteadily on a cane with a half dozen hospital bracelets flopping loosely on his thin wrist came in. He got within two feet of the tellers and shouted “I need money!” The staff clearly knew him and a banker got up from her desk, came over and asked him how much he wanted. “$500!” he shouted and a teller started assisting him. “I need more money!” he shouted. “this is a bank!” “I told you to bring me your address,” the teller said calmly. “The Travel Inn,” he said. I know that’s a shelter, but the bank staff didn’t, it’s not the world they inhabit, and there was some confusion. The staff treated him respectfully, but the security guard was hovering way too close. While I was at the bank, I missed a call from the ICU. I called them back as soon as I got to the office. “He was being intermittently non-compliant on the floor,” said the ICU doc of my Very Sick client, “then his blood pressure dropped and his mental status was altered so we brought him back to the ICU.” I brace myself for what’s coming. “He has a new blood infection, a different bacteria,” says the doctor, “but we know what it is, and we have him on the right antibiotics.” This is promising, but then he says, “because of all the stress on his body, his heart is pumping even less efficiently than before. It’s called cardiogenic shock.” I blink back the tears so I can see the notes I’m scribbling in the margins of my to-do list. “How is his mental status? Is he still altered?” I ask. The doctor pauses. “He was having trouble breathing….” “So you intubated him?” I ask. “Yes,” he says, and I am pissed that they didn’t ask me. I would have said no. Intubation when someone is in this state rarely accomplishes anything and it’s hard to get someone off life support once they’re on. I think the doctor senses that I am not happy about this, because he hurriedly adds “we’re going to try extubating him tomorrow. Also, he is very anemic.” “That has been going on for years,” I tell him. “I need your permission for a transfusion,” he says. I agree. Since he’s already on life support, they might as well do what they can. I ask if he can have visitors. The doctor seems pleasantly surprised. “Of course,” he says. There’s another protest this evening about the woman murdered by ICE, but I am going to head to the hospital. The next call is from the Criminal Justice Agency, the people who interview people who have been arrested and are being held pending arraignment to make recommendations about bail. I haven’t seen the client he mentions in months, she is banned from our program for trying to hit someone with a chair. I hate to ban anyone, especially someone who is really struggling, but we cannot have violence in the space. “She was arrested and she gave this number as someone who could verify her information.” I tell him I don’t know how much I can verify since I haven’t seen her in so long, but I answer what I can. I hang up and think about how alone in the world you have to be for the only person whose number you can give is someone you haven’t seen in months. It’s an unusually mild night and my mind is bubbling at a full boil, in danger of spilling over, so I walk from 41st down to 34th to catch the crosstown bus to NYU. The streets are crowded with pedestrians out enjoying the break from NYC January hibernation. Outside an expensive restaurant, I pass a man in a wheelchair with a sheet over his head, trying to sleep. Homelessness bothers me in general, but the fact that our society leaves elderly and disabled ppl out on the street makes me furious. Half a block further, I pass a BRC homeless outreach van, parked and empty. In the next block, two more. I consider the large amounts NYC spends on homeless outreach and how ineffective it is. Waiting for the elevator at the hospital, I notice a woman standing near me. Across the front of her cream colored sweatshirt is the word “comply”. That’s the last thing we need right now I think. I get to the client’s room just as the nurses are switching over. They are both young and friendly. He is lying in the bed, sedated and surrounded by more equipment and IV meds than I have ever seen, even with other people in the ICU. One pole is so heavily laden with 8 IV pumps and at least 12 bags of medication that it looks like one of those overdecorated Christmas trees where you cannot fit even one more ornament. They say that unconscious people can sometimes hear so I talk to him. I start with the gossip from work, that Dilo was away but he is back and he says the client still owes him a hug, a longstanding joke between them. I tell him the church just hired Robin to work Wednesdays doing security for the migrant program to make sure ICE doesn’t get in. I consider his situation for a minute, all the tubes going every which way. “They’re going to try to extubate you tomorrow,” I tell him. “If you want to live you’re going to have to really fight. But I know you’re tired and you would hate this so if you want to go, that’s ok, too. I wish I could wind time all the back I say to before you were abused at the boys’ home, wipe away all the trauma that led you to the decisions that landed you here.” The night nurse comes in and starts checking and flushing all his lines. “This must be a lot to keep track of,” I say. She pauses , her eyes flickering over it all , “it is ,” she says “but especially when you first get a patient and you are seeing where everything is. After that you get a groove going.” “You get oriented ,”I say and she nods. I think about when I get a new client and start collecting all the pieces of their story and it’s not all that different. It gets to be 8pm, so I say goodnight and tell Jonathan I will let his mother know I saw him. I also tell him I will ask Rev Micah to pray for him since I know he believes which I do as soon as I get to the lobby. Micah texts back “prayers absolutely coming.” I text his mother, too. Before I leave the hospital, I get a message. It’s a from a blind trans client who says “I got it! I signed the lease for my apartment!!” A bright spot on a dark day.