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
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.