A middle-aged woman was discharged from the hospital after a three-day stay for treatment of injuries suffered in a car crash. Less than twelve hours later, she was back in our emergency room.
She told me her son took her to a motel room and told her they would spend three days watching TV there until they could get into “the condo.” After settling into the motel, the son left to go out for something and did not return. In trying to get to the toilet alone, she ended up on the floor and was unable to get up. So, she called the ambulance, which brought her back to the hospital.
I clarified she was there only because of not being able to care for herself and not for any new medical problem. I told her we would make her comfortable on a gurney in the hallway until morning when someone from social services could see what might be done to help her.
Feeling comfortable with that plan, I placed her at the bottom of my priority list. Normally, I would have given her little attention for the rest of the shift.
Some time later, I went into a room and smelled cigarette smoke. I asked the people on one side of the room if they had been smoking, which they credibly denied. The other lady in the room was a severely demented nursing home patient who would not be able to smoke if she wanted to. Where was that smoke coming from?
As I walked back into the hall, I noticed an orange Bic lighter on the sheet next to the lady from the motel. I approached her and asked if she had been smoking. Slowly and dramatically, she pulled her hand out from where it had been hiding between the bed and the wall. In it was a lit cigarette. Mind you, this is in California where you basically can’t smoke in any public building. On top of that, this is a hospital! And right in the center of the emergency department! We occasionally catch someone smoking in the restroom, but I have never seen anyone brazen enough to smoke right in front of us.
Anger and indignation welled up inside me. I have never been good at hiding my feelings and in this case, I did not even try. I felt it important that the lady know I was completely disgusted. I said something snotty as I took the cigarette away from her, doused it with water and threw it into the trash.
A couple of hours later, I heard heated voices coming from the area where her gurney was parked. I looked up and saw a young man in conversation with her. I assumed, correctly, that he was her son. Before I could get over to talk with them, I overheard some of their loud conversation including sentences like, “Get me the fuck out of here!” and “Just shut up!”
I wish there were some way for me to paint an adequate picture of the interpersonal pathology displayed between these two people. She showed clear signs of having a personality disorder. Everything was about her. All she could do was be indignant and nasty because she didn’t have everything exactly how she wanted it. She even lit up another cigarette and sat puffing away while her son berated her for behaving worse than his three-year-old.
I tried to intervene but soon realized I was not going to have any positive impact on the way they were dealing with each other. All I could do was give them their options: leave or wait quietly until social services could see her in the morning.
She demanded he take her to the hotel. He insisted she try to get some help. In the end, he took her away, cursing and complaining. I hate to think of how things went when they got back to the motel.
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