By: Robert Lanz, LCSW, MFT
In every crisis lies the seed of both danger and opportunity. This is a frequently quoted proverb based on the Chinese character for “crisis,” which contains the symbols for both “danger” and “opportunity.” Urgency brings out the survival instinct in us and forces us to think in ways to which we aren’t accustomed. Crisis management is a very large part of hospital social work, particularly in the E.R., where we’re often presented with one crisis after another. I learned early in my career how to alter my thought process to fit the demands of the moment, and to value critical thinking above almost all other tools. In doing so, I frequently found myself on the precipice of danger, but I was also presented with opportunities.
When I started as a hospital social worker in the early ’80s, there was no Internet. Only a handful of geeks had computers, and the closest thing to a cell phone was a CB radio.
The social work department on the first floor was heavily female. My boss was a woman, her boss was a woman, and all of the managers in the department were women. There was one other guy—an older man in his fifties—who worked part-time in the E.R., but I rarely saw him. I did, however, read some of his charting, which I found to be unimpressive. I had worked previously as a probation officer in Juvenile Hall, where all of my documentation was likely to end up being read in court, so I had learned to write with precision and clarity. The writing had to make sense and be easily understood. Over time, I worked to radically change the charting format in the E.R., but that came later. This story took place at the beginning of my employment there.
Shortly after I started working at the hospital, the other male social worker left. I became the only guy in a social work department of thirty-six women. But I worked the night shift in the E.R., a kind of rugged, masculine job. Upstairs, if something like the death of a child occurred and a social worker needed to vent, get advice, or even cry openly, there was plenty of support from co-workers. At night in the E.R., the lone wolf social worker was the only non-medical employee on the shift except for the secretaries and housekeeping staff.
In those days, most of the doctors were—like me—white, male, and middle-aged, so that’s who I tended to hang out with. I was welcomed into the docs’ social circle, but there were still some obvious professional barriers to full acceptance. I recognized early on that at some point, I would have to show what I was made of to earn their respect. I would need to display the right stuff, using a term popular at the time, and that’s what this story is about—having and showing the right stuff. Opportunity from crisis.
I’ve always been something of a jock. I ski and surf, and I’ve studied martial arts. I worked in jails, and I’m not afraid of physical confrontations. I’m comfortable with guns, and for a time, raced cars after figuring out how much pain could be involved in racing motorcycles. I’m into guy stuff. But in the E.R., that only gets you into the boys’ locker room; it doesn’t put you into the starting lineup. For that, you have to do something to move things forward—something brave, maybe. Something smart. Something creative that no one else has thought of—but most importantly, something that works.
Let me emphasize again that on the night shift, you are on your own. You can’t ask another social worker for help. There are no hallway consultations on difficult issues, and if you need a good cry, well, get over it. And it isn’t just hospital resources that are scarce at night—it’s everything. If I had to call Adult Protective Services, they would tell me to hospitalize the patient and they would send a case worker out in the morning. Calls to Child Protective Services go through to an office on the fifth floor of a building twenty miles away. It’s good to have friends on the local police force, because you can’t call 911 from the E.R. You have to call the station and hope to hell the person who answers remembers who you are.
Even the Greek embassy is closed at night. I found this out when a Greek fisherman ended up in the E.R., brought in by paramedics who had responded to a call about a man lying on the sidewalk at a bus stop. The Greek fisherman spoke no English and had no phone numbers in his wallet. The office at a wharf in San Pedro where fishermen of all nationalities worked wasn’t answering my calls, and neither was the Greek embassy.
The E.R. staff started all the usual tests, but were flying blind because the patient couldn’t give them a medical history or even any basic information, such as what hurt, when it had started hurting, or the quantity and quality of the pain he was experiencing. When a patient is as sick as the Greek fisherman, you don’t want to be guessing, so the doctors did a lot of blood work and waited. They couldn’t even give him the pain medication he so obviously needed, because he couldn’t tell them about any allergies he might have. It would be hours before the lab results were in. It was time for the Right Stuff.
“Hey, Bob,” one of the E.R. docs said. “Can you try and find out something about this guy? Maybe who he’s connected to? He doesn’t speak any English. He’s got a Greek passport on him, but not much else.”
We now had a social work issue. The patient was in the E.R., and all the medical stuff was being done—tests, monitoring, observation—but he wasn’t getting any better. This is when I had a revelation concerning my job description. The social worker, between doing all the other typical social work tasks, does Everything Else. Once I grasped that concept, my role became clear.
It was all low-tech back then. Telephones had wires, and although there were ways to connect several parties simultaneously, a three-way conference call was a big deal. First, I positioned the phone in the Greek patient’s room near his bed. Second, I made sure that the reluctant attending physician could get the other phone in the room to reach the patient’s bed, too. Third, I got out the Yellow Pages and turned to the section on restaurants.
“Hello, House of Ouzo,” a man answered.
“Is this an authentic Greek restaurant?” I asked.
“Yes, it is.”
“Do you speak Greek?”
“No. Sorry, I don’t.”
“How about your authentic Greek chef? Does he speak Greek?”
“Yes, sir. The chef is from Greece.”
“Great. Can you help me out here?”
The Right Stuff is only right when it works. Lucky for me, the Greek chef was able to communicate with the Greek fisherman, as well as with the doctor, who made his diagnosis based on translations relayed by a bilingual moussaka cook. He quickly overcame his skepticism and the awkwardness of the situation and was able to treat what was ailing the patient. Someone from the restaurant arrived and picked the fisherman up when we discharged him. Maybe it was the chef himself. I don’t know, because I was somewhere else doing everything else. I got back in time to grab the last of a plate of stuffed grape leaves and to catch part of a conversation between two of the E.R. docs about “that new social worker.”
So my Everything Else list started with Greek restaurants, with the Right Stuff, and with the seeds of opportunity. Some of my most enjoyable moments on the job came from compiling that list over the years. It explains why every E.R. should have a social worker on staff 24 hours a day. Everything Else is a really long list.
Robert Lanz, LCSW, MFT, received his MSW from Fresno State University and his bachelor’s in sociology from Cal State University. He spent five years doing family therapy in juvenile hall in LA County, followed by thirty years at Huntington Memorial Hospital in Pasadena, CA, working the night shift in the E.R. Currently retired, he is now President/Chairman of the Board of Giving Music, A Music Charity at www.givingmusic.org. His blog, My Life in the ER, can be found at http://robertjlanz.wordpress.com/.
This article appeared in THE NEW SOCIAL WORKER magazine, Summer 2013, Vol. 20, No. 3. All rights reserved. Copyright 2013 White Hat Communications.