I was in an ER, with a patient who was confused and had a giant lump on his beautifully wrinkled face. All he could say was "billy club." He said that every time, even when we'd seen that it was other clients who'd beaten him, not the cops. He just had it in his mind that every time he was hurt, it was the police's fault. Maybe they symbolized the institutions he'd learned to fear, the structures that kept him hurting. Maybe he really hated the cops. Maybe he just liked the way the words sounded. "Billy club." It is kind of fun to say.
Staff at the shelter where he stayed were worried about him. He'd come in badly beaten every week, clutching his bank card, no money. "Billy club," he'd say. "He gets taken advantage of," they told me. "He's so confused and disoriented, and it's getting worse. He can't survive on the streets." Tiny and old, he looked awful. This time, the tennis ball over his eye was bleeding into his mouth. He kept arguing with staff, convinced that he had lost his bank card despite them showing him they had it, forgetting that he had just given them a bag with his medications and worrying that he had dropped it.
He reminded me of one of my first patients out of nursing school, a frail elderly man who'd broken a hip. Dementia took what had clearly once been a sharp scientific mind, and although his jokes were witty, they were out of place. He would look down, confused about why he was bleeding, only for me to remind him that he'd fallen just a moment earlier. He was in hospital because he so clearly could not take care of himself, and was on the waitlist for long term care. He'd been formed, meaning he lacked capacity to make his own decisions. He was well cared for, and the times that he wanted to leave, he was bribed back into his chair with promises of applesauce and extra pudding. Sweet, and heartbreaking.
Similar, but not the same. That patient came from the upper echelon of society, and received the best care possible. This one didn't.
I knew it was time to go to the hospital as soon as I saw his face in the shelter. I was worried that his skull was fractured, or that he was bleeding into his brain, or that his eye was damaged. I was worried that if we didn't take him in, I'd find him dead on a mat in a few hours. The alcohol I could smell on him made it worse - it put him at a higher risk of bleeding. His way of coping with the trauma wasn't working - it was time to try mine. The only problem was, he wouldn't go.
Bribery. It works. Don't knock it.
A couple of cartons of promised cigarettes later, his caseworker wheeled him over to her van. He wouldn't agree to EMS, so we drove him to the hospital with the shortest wait time. It was the emptiest I'd ever seen an emergency room - the nurses were chatting, the trauma bays were empty, and the waiting room had only one other patient. All good news for my patient, or so I hoped.
Despite the friendliness of the nurses, and the efficiency of the physician, my patient found himself sleeping on a mat that night, discharged to the streets once more. Medical jargon and legalese permeated the answers to my persistent questions of why. "Capacity assessment in the community," "no formal dementia diagnosis yet," and "inappropriate candidate for a psych consult" combined with "not actively suicidal or homicidal," sending my patient into a free-fall deep into the cracks of a system designed to care for those whose votes count. In the end, I was told: "If he wants to leave, that's his choice." There was nothing I could say to convince them to keep him in hospital.
And so, another systemic vortex was made clear. The only way to know if he was capable of making good choices is if he would "choose" to allow somebody to assess his capacity. Even if he made that choice, it would have to go along with the "choice" to not drink, the "choice" to show up for the appointments, and the "choice" to pay thousands of dollars for a private capacity assessment (as the publicly funded group was not taking on any new patients). This is what was expected from a confused little old man who says "billy club" when he gets beaten up for his social services money.
He's representative of so many more that democracy has failed. We say that we protect the rights of the minority, but when it comes down to our health care dollars, we'd rather they be spent on our grandparents than on some street drunk. Understandable, but is it right? This question is especially for all of us who are Christians, who preach equality of worth and care for the poor. These gaps in the system are carefully placed - they only affect those without a voice, and you don't see them unless you're near somebody who falls in.
Honestly, that day was just another day for me. Stories like this one are so common that I could tell you ten right off the top of my head, much less if I stopped to try and remember more.
I write these stories because I think people need to know. Well that, and I have the gift of being loudmouthed and I figure I may as well use it for good. I also write so that I make people uncomfortable enough to ask "Is she telling the truth? Does this stuff really happen?" But be careful - if you start asking and you find out the truth, you might just have to act. It's probably better to just click back to Facebook and see what song was playing the day you were born. I mean, what can one person do, anyways?
“Which of these three do you think was a neighbor to the man who fell into the hands of robbers?” The expert in the law replied, “The one who had mercy on him.” Jesus told him, “Go and do likewise." (Luke 10: 36-37)