Rescue

Yesterday, my Very Sick client was really struggling. Since he had been picked up by an ambulance at his apartment, he was at Bronxcare, the nearest hospital. Like many hospitals in the Bronx, Bronxcare is short on resources. Unlike NYU, where there is one social worker for every floor, when you call the social work office there you get a recording that instructs you to leave a message which will be returned in 24-48 hours. Staffing shortages mean long waits for pain and diarrhea meds, or to be cleaned up after an episode of fecal incontinence. Overworked staff mean less patience for our client's challenging behaviors, and a tendency to respond to him with anger, which only makes his behavior worse. It also means that attending to details like his skin gets overlooked. "I'm white like a ghost," he said, referring to his very dry skin. We have known each other for a long time and I know what will make him laugh. "So am I," I say and he starts cracking up. By afternoon, he was frantic about getting out of there. "They're going to kill me here," and with a D in safety from NYS, he may be right. I call the transfer office at NYU but they tell me the Bronxcare doc has to initiate it. The client gives me the doctor's name, Kumar and I call the switchboard, who transfer me to the floor where nobody answers. At that point, the client starts yelling that he needs his doctor. This does not get the desired response, so he decides to start getting out of bed, setting off his bed alarm. This brings a nurse quickly, but instead of getting his doctor, she takes away his call bell. "Hey, what are you doing?" he yells. "You wrapped this around your neck before," she tells him, also taking the TV remote. Now there's chaos. In the middle of all this Jeff, apparently coming to the same conclusion I have that they can't provide what our client needs, texts that he will come with his car after work to get him out of there. The client will sign out against medical advice, then Jeff will bring him to the NYU ER to be admitted from there. This is going to have to be a late evening escapade because Jeff can't get there from work until 10pm. "Tell him I have no pants," says the client. "I don't have a shirt,either." "EMS brought you to the hospital naked?" I ask. "Yeah," he says. "Tell him I need my coat and my walker." He tells the staff the plan, and they are a little skeptical that anyone will show up, but basically amenable. By the time Jeff collects the stuff and shows up at the hospital, the shift has changed, and the doctor on duty is really uncooperative. "I don't have your poxy paperwork," she says. "That's because it's on file at NYU," I tell her "but this is not a proxy matter anyway, he is capable of consent." she hems and haws, makes excuses about safety, about him needing dialysis. I point out that he is not going home, which would be unsafe, but to a hospital, where they can provide dialysis. Then she says, "I have spoken to his mother before, I know who she is, if she agrees he can go." He's a grown man, but we call his mother, who has her own issues with that hospital and readily agrees. Finally, he gets out of there and into Jeff's car. At the NYU ER, Jeff, who knows the things that tend to upset him, gets him into a gown and fresh socks, and piles on three blankets. "They'll get me cleaned up here," he tells me sleepily. "I have to do the laundry now or I will have nothing to wear to work tomorrow," I tell him and he laughs and gets off the phone. It's 11pm and I am the only one in Stephen's building down in the basement doing laundry. I watch the suds pour down the glass door and think about how fucked up it is that access to quality health care depends on where you happen to be.