A Slippery Seat

Emergency departments often attract people who have nowhere else to go. If you think about it, homeless people retain a certain amount of anonymity in large, busy places like hospitals. There, they can be in out of the weather. They have access to restrooms. They can easily charge their cell phones and electric wheelchairs. If they don’t cause trouble, they are often allowed to sit and rest in waiting rooms. This is a regular thing, but huge problems come up when certain homeless people refuse to leave and can’t be thrown out.

Mr. L— was a homeless man who weighed in at over four hundred pounds. He had serious medical problems and had been admitted to the hospital many times for treatment. When it came time to discharge him, social workers usually tried to transfer him to a long-term care facility. In trying to do this, they faced two challenges. First, Mr. L— refused to cooperate because he didn’t want to spend his disability income on nursing home care. He chose to keep his money for other purposes. Once, when he was admitted to the hospital, he had over $10,000 in cash stuffed in various places on his person and in his belongings. Secondly, even if
Mr. L— agreed, many local nursing homes wouldn’t take him based on their past experience with his nasty, unpleasant behavior. So, when it came time for him to be discharged from the hospital, he would usually motor his over-sized electric wheelchair across the street to the bus stop in front of McDonalds and set up housekeeping.

Early one rainy day, we found Mr. L— in the main hallway of the hospital, right behind the emergency department. He had been there all night. The top part of his body was precariously perched on the edge of his huge wheelchair but the lower part of his body was actually on the floor. To keep himself from sliding all the way to the ground, he had hooked his arm around the armrest of the chair. The reason he had trouble staying in the chair was that it was slippery from his urine and feces.

Most of Mr. L—‘s abdomen and groin were exposed as his pants were sagging down and his shirt was pulled up. He had placed one of his dirty shoes on the window ledge next to the wheelchair. It was being used to hold a plastic bottle that was half-full of urine. Urine and feces dripped down the wall from the shoe to the floor and pooled under the wheelchair. It was quite a sight for the day shift staff that passed by him on their way to work… and the smell was horrendous. Patients, visitors and staff complained he made the air smell so bad they felt like they were going to vomit.

Asking Mr. L— to leave was not really an option because he was not capable of doing so. Yet, he was not cooperative with any efforts to help him. He wouldn’t let himself down onto the floor, but couldn’t get back up into the chair. He constantly complained about being in pain. Yet, he threatened anyone who approached, trying to help him. So, there he was.

Someone from hospital administration finally made the decision to force him to move out of the public area. A team of twenty staff members was assembled. It included 5 medical assistants, 6 nurses, 2 doctors, the shift supervisor, 2 emergency department technicians, 2 security officers and 2 physical therapy staff members. Three administrators stood by directing the effort.

A plan was laid out to get Mr. L— down onto the floor, wash him up and get him back into his wheelchair.

A crane was borrowed from an inpatient unit. Partitions were set up around him to provide some privacy. When he was forced to let go of the wheelchair, he slipped entirely onto the floor. The team of staff rolled him from side to side to cut off his clothes. It then took 30 sheets, 20 blankets, 30 towels and 30 disposable pads to clean and dry him. Twenty packets of antibiotic ointment were used to cover his skin, which was raw and irritated from being in constant contact with his excrement. Over-sized hospital clothes were pulled onto him. His wheelchair was also cleaned. Then, the sling from the crane was laboriously worked under him so he could be safely lifted back into his chair. Once back in his chair, it was impossible to remove the sling from under him. So there it stayed– at a cost of $300 to replace.

It took all morning to get Mr. L— cleaned up. Once he was reseated, he was wheeled to a hallway out of the main thoroughfare. He refused recommendations to sign in as patient and receive medical care. The Sherriff’s deputy, who was called in, said it was not an option to arrest him for trespassing, saying that the jail staff would refuse to accept him into jail because of his many problems. No one had any idea what to do with him, so there he sat. I don’t know what happened after that.

On my way to work the next day, I saw him back at the bus stop across the street from the hospital. From time to time over the next few weeks, a Good Samaritan would call 911 to get him help. Paramedics who responded to the situation told me he always refused care. He lived at the bus stop for several weeks, and then he was never seen again.

I checked vital statistics online and found he died soon after that event, though the details of his demise are unknown to me.