I am currently placed for my second year internship at a hospital in the East Bronx, with my specific focus, the surgical units. I work with a close-knit group of surgical social workers. The cases I take vary, depending on which surgical service has heavier caseloads. I have had the privilege of working with a variety of units
(general, vascular, burn, orthopaedics, surgical intensive care, trauma) and through this, have seen a wide range of cases, met a diverse set of individuals.
This specific job of hospital social workers requires us to complete psychosocial assessments with patients. Our role is to gather their information, provide social-emotional support, to assist patients in answering questions they might have or referring them to someone who can best help with their inquiry. We provide outside referrals for post-discharge services, vouch for their rights in interdisciplinary meetings, and work with families. As is with most social work, there is never a dull moment.
Anyways, recently I was to complete a psychosocial assessment on a specific patient whose story had me amazed. This gentleman was a classic case of being at the wrong place at the wrong time. His chart read “GSW Head”: a gunshot wound to his head. This man was outside for a smoke, and next he was on the floor after being shot.
In our interdisciplinary rounds with doctors, we receive updates on the status of the patients. I had to do a double take when I learnt that this individual was essentially receiving surgery to clean his head wound, have some brief physical and occupational therapy, and could be heading home shortly.
WAIT WHAT? He was shot in the head just days ago, and can probably go home within the week? I’ve had patients who have had longer hospital stays for minor surgeries, but he was going to be discharged so soon after this!? I was giddy as though I was going to meet someone famous, truly excited to meet this man who had just escaped death.
Before I entered this man’s room, I prepared myself for what I might expect from him, as I do prior to meeting any of my patients. I prepared myself to be faced with possible resistance, as the assessment includes personal questions that patients sometimes find intrusive. Also, I was aware he may also be angry and frustrated with this injury, possibly with something he felt was lacking in his care. I imagined myself in his situation and would surely be experiencing some sort of existential crisis. Perhaps this experience brought this patient a greater belief in a higher power? Possibly he would want to see outside therapy, or a member of the hospital clergy; all of which I kept in mind.
But what I was mostly prepared for acute stress reactions. This man was out smoking a cigarette and GOT SHOT IN THE HEAD, I could not imagine not having paranoia or fears that came from such a trauma.
I was ready to do my best to help him process his feelings about this event (of course, only if he was). And I prepared myself to provide empathetic support however I could.
I entered his hospital room and greeted him, adding, “so I heard what happened to you, wow! How are you feeling today?” He responded with a small laugh, as though to say oh, well you know, things happen…
So I sat beside this patient, and began my introduction. “Hi, my name is Michelle Holzapfel, I’m a social work intern, and my role is to offer emotional support and to answer any questions you might have—“
“Actually, yes. I would like some help,” He eagerly interrupted me.
All right, Michelle. Let’s do this.
And so he continued; “I’ve actually been having a lot of issues with my wife for the past two months… and I don’t know what I can do anymore.”
And just as I was about to offer the referrals and supports I had lined up in my head prior to meeting this gentleman, I stopped myself. Because wait what? I almost wanted to question the patient. I wanted to ask him “but seriously, you were just shot in the head, how is this something you’re thinking about?”.
Side note: I did not. This may have been my priority but it wasn’t his right now.
Instead, I spoke with this patient as he described the pain that he was truly feeling; that of his relationship. The possible acute stress, or miraculously still being alive was seemingly insignificant, inconsequential to this patient in comparison to this important issue on his mind.
Of course, this is not to say that this gentleman won’t take the outpatient mental health referral I provided him and use it at a later time to discuss this trauma. Perhaps he was still experiencing the shock that some do after a traumatic event, and it would reappear at another time. All that mattered was that at the moment I met with this patient, my idea of what he needed at that specific time was not in fact true. I broke the golden rule; I made an assumption about a client. I was so certain that the focus of someone who had “GSW Head” on his chart would essentially want to talk about it, but I was wrong.
And who knows, someday he might be in couples counselling and be ready to talk about a GSW to his Head.