Facing death

You rarely work on a Saturday, but sometimes you prefer it. Most of the administration, office staff and doctors aren’t there on the weekends, and it feels more relaxed and casual. You won’t have to compete with the doctor for a look at the chart, and the physical therapy department is closed. You figure that you’ll find most of your patients either in bed or in a wheelchair in their room.

As is your routine, you grab the charts of new patients from the nursing station, and begin flipping through the pages, making special note of the person’s age, sex and diagnoses. If there are patients with dementia, you put those charts aside. They will most likely require a phone call to the family so that you can get accurate information. As a social worker, you usually conduct a long psychosocial interview, and assist families and patients with discharge planning when needed.

One new admission catches your eye today. You’re always intrigued when there’s a relatively young patient. He’s 50, and you immediately wonder why he’s here. Stroke? Cancer? Infection? You turn to the History and Physical sent by the hospital. There should be some answers there. Yes, the H & P tells a part of the story. He is here because of an spinal abcsess. He had been admitted into the acute hospital because the neglected infection had gotten so bad that he could no longer walk. You also note that he has a long-standing heroin addiction. He was transferred to the nursing home yesterday to start a course of IV antibiotics.

Before you go into his room, you start talking to his nurse. You had noticed that there was a sign outside of his door that read “please see the nursing staff before entering this room” You figure that he has a staph infection, which is contagious, but want to be certain before going in. You take particular note when she says that he is HIV positive, and also has hepatitis C, and possibly B. You figure that this is most likely the result of shared needles. You begin to feel apprehensive about meeting this patient, so you mentally steel yourself before you go in. Heroin addict, HIV, hepatitis; you’re not sure who you’re dealing with here.

When you enter his room, you immediately notice how thin and pale he is, but you see that he had been a nice looking guy. In fact, his face still bares a boyish quality that you find appealing. His teeth look as though they have suffered obvious neglect, his hairline is receding, but his eyes are blue, clear and engaged. As you briefly scan his body, you notice tattoos that run the length of both of his arms. They are inelegant, almost ghoulish looking tattoos, and you wonder about their origin.

You sit down next to his bed and introduce yourself as his social worker, and begin with the usual questions—are you married, do you have children, are you close to them? He tells you in a soft-spoken voice that he married when he was a teenager—and that he is still with the same woman, and that they have 1 daughter, and a grandchild. This surprises you; you had assumed that with his history that he was either single or divorced. 32 years of marriage is impressive. He tells you that he is devoted to his wife---that she has been the glue in their marriage.

He begins to tell you about how he had 4 siblings, but that they had all passed away. Inside you cringe a little. How could he have lost all 4 of his brothers and sisters? Then he proceeds to tell you that his youngest brother had died just a few months ago. He weeps as he tells you about his brothers paranoid schizophrenia, his lack of social skills, and how when he was dying at the hospital he kept calling “mama, mama.” “Do you want to go be with mama?” he asked his dying brother. “Yes, yes” he answered in a small and desperate voice. You feel yourself welling up with tears as well, and you tell him that you lost a brother too. You see that he cares about his family, and he feels a great sense of loss that you immediately connect with. You scoot your chair closer to the bed. You want him to feel your concern; that you’re with him in that moment of despair.

You continue with more questions about his education and work history. He hadn’t graduated high school, and his work history was sketchy. He then admits that he had spent about 13 years in prison. “San Quentin?” you ask him. “Yeah”, he utters without hesitation. He tells you that he had hurt someone pretty badly. You have to ask the question, but are afraid of the answer. “Did you?” You can’t finish the question. “Yeah”, he answers flatly. He knows exactly what you are asking. He had murdered someone. You are repulsed and fascinated at the same time. You quickly run through the possibilities in your mind. Had he used a gun, a knife, or his bare hands? You have never knowingly met someone who has committed murder. You are 2 feet from his bed, and you suddenly wonder if you are in any kind of danger. You think better of it. He can’t walk—he is completely trapped in that hospital bed.

He goes on to explain that he used to beat people up when they owed money. You figure that he had been a drug dealer, but don’t bother asking that question. You have already learned more that you had initially bargained for. You have met a lot of people with varied personal histories in your work, but this was extraordinary. You only read about murderers in the newspaper, or hear about them on the nightly news.

You feel conflicted. He had just wept over his brother’s agonizing life and death, and you felt his sorrow. He had opened up and reached out to you, and now you feel like backing away from him. You’re seeing him through a different prism. In fact, you rise from your chair, holding his chart in front of you as if it would shield his reality from touching you.

You feel in control of the situation, and have successfully hidden your reaction to his revelation. You are in a position of authority, but you begin using words like “dude” and “man”. You slip into this persona easily---you think that if he believes that you’re “cool” and street-wise, that he will trust you. It makes you feel less vulnerable, and protects you from your own sense of disgust and horror over what he had done.

He tells you that when he was released from prison, he contacted the wife of the guy whose life he had taken. He asked her to forgive him, and he said that she did. He tells you that this wife said that he “probably deserved it”. You have a gut reaction to this, and wonder what kind of woman she must be. You wonder if you could forgive someone who had intentionally killed your husband. You doubt it.

He says that he lives with what he did every day, and that if he could take it back, he would. You feel skeptical. You’ve always wondered what kind of person could choose to take someone else’s life. It just doesn’t jive with your moral compass. He said that he “knew” that he was going to do it, that he “had” to do it, and you are filled with disbelief. Had to? Knew?

It’s emotionally incomprehensible to you, and suddenly you feel glad for having been raised in a small town with working class parents who instilled in you a sense of right and wrong. You’re relieved that you’re not the kind of woman who thought that her husband deserved to be murdered. You’re overcome by how lucky you are, when compared to that damaged soul lying in the bed in front of you.

Perhaps it’s his “karma” you muse, the fact that he is laying in that bed, helpless, full of infection and regrets. He’s vulnerable now. He is being murdered at his own hand---his past choices being the weapon that he wields.

Still, you think about how he had wept over the death of his brother. His grief was palpable---not merely for show. Through all of the deadly choices that he has made, he feels pain, loss, and even fear, and you can't deny that, or run away from it.

You return to his room a few days later and pull up a chair next to his bed. You extend your hand, and plainly ask “how are you feeling?”

He tilts his head slightly, perhaps surprised by your return, and replies, “You came back.”