I could hear the thud of its footsteps in my head and even feel the blast of warm breath but I did not know its power. I was in my office on a Friday afternoon when the phone rang. On the other side of the phone was a desperate social worker needing my help. She relayed a story that was all too familiar to me. The hospital was doing their routine Friday purge of patients especially for those who did not have insurance. Her client was about to be released even though he was in the last stages of AIDS and could not take care of himself. She wanted to know if we would take him in. At that time we did not have a clinic or medical staff available on the weekends to take care of someone with major presenting medical issues. If we took him in it would be the other residents who would have to take care of him. Residents usually did take care of each other but that was after a connection had been made by living together for a few weeks. They and I felt it was unfair for them to have to look after someone they did not know. They too were sick. Plus I was not sure how much assistance this particular man would need.
I declined and told her that the hospital should keep him for the weekend. I then could have some medical staff and residents at the ready to help him with his problems if he was well enough to do such things as to go to the bathroom and feed himself. A heavy sigh came over the phone. “The hospital will not keep him,” she said. I said of course they will if he is not well enough or has nowhere to go. She almost laughed at me on the other end, “The eight hundred pound gorilla does what it wants and if you get in its way it will crush you. And I am not going to be crushed.” I was nonplussed. It was Friday I had a date that night and now I could see I was going to be challenged to make it. I returned her laugh, “Well let me go to the hospital and see if I can avoid being crushed by the eight hundred gorilla.”
When I arrived at his room the nurses were glad to see me. They explained he refused to get out of bed and get ready to leave. I looked at his wasted body laying in the bed. ‘He does not look very healthy to me. Can he dress himself?’, I asked. He can but he will not. I nodded. “If you do not mind let me talk to him in private.” The nurses left us alone. He looked up at me from the bed and said, “If you help me get dressed I will go; they are not going to keep me,” he said with resignation in his voice. I said well let me get some basic information from you and then we will see what needs to be done.
As I interviewed him he winced whenever he moved. But to be honest he hardly moved. At the end of the interview I asked if I could help him sit up. He said yes. After I struggled to have him sit up on the side of the bed within ten seconds he had collapsed back in the bed. He was in no condition to be released. When the nurses came back they had looks of delightful anticipation which collapsed in almost horror when I told him I could not take him today but if they would hold him for the weekend I would gladly take him on Monday. I was hoping a weekend more in the hospital and he would be stronger but also Monday I would have all of our staff and we could between the six of us make it work. The nurse looked at me in disbelief and said, “You do not understand, the doctor has already signed his release.” I looked at her not amused, “But he is not capable of taking care of himself and he has nowhere to go.” That statement caused a stir I did not want or expect. They dashed out of the room in a panic. I was challenging the system. Now the law, ethics, and money stream were in my favor but not the bureaucracy.
So for the next two hours I merely sat and when asked said I could not take him. Nurses literally cried at my unreasonableness. They knew they could not take him to the curb and simply dump him now. They would have to have a solution I felt comfortable with. So they brought up physical therapists who literally picked up the poor man one on each side and showed me how he could “walk”. I sat down and said we did not have two people strong enough to help him walk. The physical therapist said they already signed paperwork that said he could be released. I said much to my later chagrin that he could not feed himself. They lifted the poor man up in the bed. One held him in place and one placed a cup in his hand and helped him direct it to his mouth. They looked at me as if to say see we told you he could feed himself. I sat down. Next they placed me on the phone with the attending doctor. Now as you may know doctors are the gods of the hospital (well maybe demigods, the board members are the real gods). The doctor asked me what the problem was? I explained why I could not take him. The doctor scoffed at me and said I signed him out believe me he can go. I incredulously asked, “Have you seen him?” It is here the doctor mad an error without thinking he told the truth, “No I have not. I have read his charts and he is able to be released.” You could tell after he said that he had not seen him he was through with me. “Look here.” he declared. “I have signed his release forms and I cannot take that back. He has to be released.” I said ‘why not’. He declared me unreasonable and hung up. I sat back down. Fifteen minutes later I found myself being directed to the office of the head of the hospital’s social work department and also the co-chair of the AIDS coalition.
When I knocked on her door she without looking up told me to sit down. Even though we knew each other she was very formal. ‘Look Michael you have everyone upset. You need to solve this problem.’ I told her I did not have the resources to solve the problem. But I was noticing I was tired of the pounding of the eight hundred pound gorilla and the breath was coming down strongly on my neck. “ You cannot simply say no. You have to offer a solution.’ I said the simplest was to let him stay and I will be here first thing Monday morning. She replied, “We cannot do that, we have already released him.” I sighed in frustration, ‘I have nothing I can offer today.’ She reminded me that my non-profit was dependent on the various organizations in town and I was not building good relationships with this attitude of mine. I sat.
After another fifteen minutes of cajoling me. She sighed in disgust, “I will tell you what I can do.” She presented this plan to me. He would be released but they would rent a hotel room for him, provide transportation to the hotel, for the next three days, and would have a nurse come by twice a day and would provide him with three meals a day. I looked at her bewildered; they would do all of that just so they could release him. Even though I felt a little dirty about the whole situation I agreed.
I called my boss who I had already alerted I thought I was about to cause a shit storm and let him know I had indeed caused a shit storm. I missed my date and because I had forgot in all the ordeal to call and warn her until later that night our non-existent relationship was over. I went by the hotel room every day to see him. He missed his ride to Phoenix Place, our group home for Persons Living With AIDS, to see me on Monday and showed up drunk on Tuesday.
Even though a review of the case with the senior staff found I had done the right thing, the ‘shit storm’ I had caused threatened a major breach with the hospital. We were in the formal stages of signing an agreement to open a clinic with several respite beds for the homeless and needed the hospital’s buy-in. So I had to make a formal apology or supposedly the whole deal would fall through. The clinic came into being.
A few weeks later I saw the original referring social worker and she with a smile on her face asked me, “How did the eight hundred pound gorilla work out for you?” I was sure she knew by now everything that had happened. I grimaced. That was the only comeback I had.