Sunday, 23 November 2014

Admitting Office (2014)

For Jimmie and Bertie

The young woman stepped into my office.  There was nothing particularly remarkable about her with the exception of her eyes, which expressed sadness and confusion, as if she didn’t quite understand, or want to acknowledge, where she was or why she was there.  I invited her to have a seat and waited for her to tell me who she was.    

It was the summer of 1983, and I was working the 3.30 to midnight shift in the admitting office of a Boston area hospital.  My job title was ‘admitting officer’, which sounds much more prestigious than it was.  

During my shift, most admissions came through the emergency room, and usually a family member would be sent to my office to complete the necessary paperwork.  If no family member was available, I would walk down the corridor to the ER to interview the patient and get a signature.  If the patient was unconscious, I would write patient unable to sign. Once, the nurse sent me into a room to get a signature, but the man on the table was dead.  (I’d never actually seen a dead person, but despite my lack of experience, I was pretty confident in my assessment of his condition).  ‘I think Mr. ______ is dead’, I confided solemnly to the nurses. They all went running, but as it turned out, they already knew that patient was dead; they'd given me the wrong room number.  

The young woman in my office looked like she might be about to cry.  I waited.  I was used to people crying in my office; I usually just made sympathetic faces and waited for them to collect themselves so that we could take care of the business at hand.  She was young; in fact, I estimated that she was probably about my age, which at the time was 23.  She reminded me of myself in other ways; the clothes she was wearing were clothes I might have chosen.  She was twisting her hair in the way I used to do when I was a teenager, and still did in moments of extreme stress.  While I waited, I ran through my mental map of available hospital beds, considering options. 

In addition to completing the admitting paperwork, my job entailed assigning patients a bed on the appropriate ward, depending on the diagnosis.  I quickly learned the acronyms that represented the various diagnoses patients were admitted with: MVA, CVA, chest pain rule out MI.  Some nights we had non-stop admissions.  (The nursing supervisor blamed those nights on the full moon.  I was skeptical, but ‘so was I before I worked here’ she said.  I decided to keep an open mind). If I sent too many admissions to any one ward, the nurses would call me, telling me to start assigning beds in M3, the ‘private room’ ward, using ‘code three.’ There were three admission codes for M3:  One, patient request; two, patient is a doctor or hospital employee (or immediate family member of a doctor or employee); and three, no other bed available.  The hospital could only bill the private rate for code one, and I soon learned that the use of code three was fraught with political implications because it was interpreted very differently by nurses and administrators.  Administrators were interested in the availability of the physical bed, whereas nurses were more concerned with the availability of nursing personnel to attend to the bed’s occupant.  As admitting officers, we were expected to follow the administration’s interpretation of code 3, but I never said no to the nurses.  I knew some of them well.  If they said they were overwhelmed, they were. 

We weren’t always busy.  Sometimes there were quiet nights; then, we would play Monopoly or Trivial Pursuit in the break room --  me, my co-worker Diane, and Roger the IT guy.  (We didn't call him the IT guy because in those days the IT department was called Data Processing).  Roger’s job was to run all the reports at midnight, so Diane and I had to be sure to input all the patient data by 11:59 p.m.  If a patient was admitted before midnight, but we didn't get the information into the computer in time, the name wouldn’t appear on that night’s census, the hospital couldn't bill for that day, and we would be sure to hear about it.  

My visitor had now collected herself enough to speak.  'It's my grandfather', she said, the desperation in her voice evident.  ‘I think he’s dying.’  Her lip started to tremble and her eyes filled with tears again.  I felt a familiar stab to my heart.  I tried not to think.  We travel in time and space every time we think, but we don’t always like where we end up.  Impossible to control, our thoughts break loose and take us where they will. Just like small children -- take your attention off them for a moment and they’ll be off somewhere getting in trouble.  And I knew exactly where mine were going. 

 Grandad has cancer, and he's dying read the short letter from my mother.  My mother never was one for trying to put a positive spin on things, not that there was much of a positive spin that could have been put on this particular thing.  I was 17, had left school, left home, and moved to Bournemouth, a popular seaside town on the south coast of England.  Having had some local success as a springboard and platform diver, with a respectable collection of silver cups and gold medals, my objective was to be hired as a show diver in the Bournemouth Aqua Circus.  I needed to perfect a couple of complicated dives before they would take me on, so I spent every day at the pool practicing.  I was there from opening to closing, supported in this endeavor by the benevolent British taxpayers via a program known as ‘the dole' (which has since been re-named the more politically correct 'job seeker's allowance.') The only condition for receiving my weekly stipend was that I present to the Job Center once a fortnight to ‘sign on’; i.e. sign a declaration that I was actively looking for a job. Despite dutifully ‘signing on’ as required, I was in fact not looking for a job at all.  I was in training for a job, which I thought was a fair substitute, but I suspected it would be wiser not to mention this to the nice lady at the Job Center, who always looked at me with such sympathetic eyes as I explained sadly that I had still not been successful in my quest for employment.

Bournemouth Aqua Circus, 1970s
 But as soon as I got my mother’s letter, all thoughts of the Aqua Circus disappeared, never to return.  I took the next train home.  I was in shock.  How could this be?  Grandad couldn't die!  Of course, on some level I’d always known that this would happen one day.  He had told me so himself on several occasions.  He didn’t make it sound too bad, though.  Unlike my mother, he liked to look on the bright side.  'A person isn’t really dead as long as someone who remembers them is still alive', he used to assure me, and I found this vaguely comforting without really understanding why.  He never minded talking about death, but then again, he’d had a lot of experience with it.  He’d been in the trenches in France in the First World War.  He had lost his whole family of origin -- both parents and a brother -- before the role of grandparent was bestowed on him by my arrival in the world.  But I had no experience of losing loved ones to death -- and didn't want to start.  Not now.  Not him.  

I went to my grandparents’ house as soon as I got home, having learned two things:  First, he had incurable stomach cancer, and second, he didn't know he was dying.  It had been decided not to tell him, which was something people did in those days when there was no hope, and I was expected to put on a happy face and encourage him to believe that he would soon be better.  I found him much the same as usual although his skin had taken on a slightly yellow color.  He was delighted to see me, asked how the diving was going, and whether he could make plans to come and see me the following summer in the Aqua Circus.  Knowing as I did that he was not expected to live until Christmas, I just stared at him.  What was I supposed to say to that?  I was going to be completely hopeless at keeping up this pretense.  I loved him so much, and he knew me so well.  He then brought up the topic of my 18th birthday, which was coming up in February. I couldn’t speak, but 'don’t worry, I'll be well by then' he reassured me.  ‘I’m not going to miss that.’  He sounded so sure.  I started to have hope.  Maybe there could be a miracle?  I visited him every day for the next few days, but then he became worse and was confined to bed. A home nurse was hired, my uncle arrived, and I was no longer allowed to see him.

Herbert Edward Walmisley, 1895-1977
My Grandad died a few days later, on Christmas Eve, and I never got to say goodbye. 

At 17, I was still young enough to believe that when something went wrong, it could be fixed.  But nobody was fixing this.  With typical teenage self-centeredness, I could neither imagine nor feel the despair or grief of my mother and grandmother.  Instead, it was ‘all about me’ and what I felt, which I assumed nobody else could understand.  I couldn’t understand it myself.  What did I feel? I felt the world changing around me.  I felt reality shift.  I had moved into a parallel universe, a world in which Grandad was gone, and where the very word gone, normally easy enough to understand, suddenly made no sense.  As if by some magician’s sleight of hand, everything else appeared exactly the same -- but I knew it wasn’t.  How could it be?  He was always there, always happy to see me; no, not just happy, overjoyed – he always made me feel that just by turning up, I had made his day.  So what was I supposed to do now?  How was I supposed to bear it?  My father did his best to comfort me, but there was nothing he could say, and he knew it.  I clung to Grandad’s belief that a person isn't really dead until the last person who knew them is dead. You are going to live for a long, long, time, I promised him.  

Those sad events replayed in my mind as I looked at the young woman who was now watching me, expectantly.  I didn’t know what to say.  What could I tell her?  That five years from now you’ll still feel the pain of missing him?  That sometimes you’ll dream about him, that he’s there, in your life, just like he always was.  You’ll be so happy to see him, and you’ll tell him ‘I can’t believe it’s you, I thought you were dead!’ and he’ll say ‘no, no, remember what I told you, I’m not really dead as long as anyone who remembers me is still alive.’ You’ll start to suspect you are dreaming and fight against waking, trying to prolong the time together, but eventually you’ll wake up and feel your heart break all over again.  No, I didn’t want to say any of that.  I couldn’t do anything or say anything to make it better for her.  I felt that asking for her grandfather's insurance information would be cold-hearted, but after all that's why she had come to my office.  But she wasn’t talking, and I decided it wasn’t my place to talk.  It was my place to respect the silence.

But the silence was short lived.  Suddenly, there was a quick knock, the door opened, and my husband’s head, with his black and white Jack Daniels baseball cap on it, popped into my office.  'Where's the car?' he asked, beaming at my visitor with his characteristically cheerful grin.  Pulled back to reality, from remembering the dead to considering the practical concerns of the living, I wondered what on earth he was doing there. Why couldn’t he find the car?  Then I remembered.  It had been a busy evening at work, and I’d forgotten to call him with the message that I'd parked in a different lot. 

My husband worked just down the street from the hospital.  He worked the day shift, and I worked evenings. We had two babies and one car, so we’d devised an ingenious system to share work, childcare, and the car. At 6 a.m., we’d bundle the babies into the car, and I’d drive him to work, then come home again.  At 3 p.m. the babysitter (an upstairs neighbor) came down, and I'd drive to work for my shift.  At 5 p.m. he'd walk to the hospital, pick up the car, drive home, and send the babysitter home.  At midnight he’d then load the babies back into the car and come pick me up.  Life sometimes felt very difficult, especially getting the babies in and out of the car at midnight and 6 a.m., especially when there were blizzards, which there often were, but they didn’t seem to mind.  In fact they soon learned to sleep blissfully through the routine of zipping snowsuits over pajamas and the buckling/unbuckling of car seats.

Boston, 1983, Sarah, Art, Michael and Christine
On that particular day, the parking lot I usually used was closed because the lines were being repainted, so I had parked on the other side of the hospital.  When he hadn’t found the car in its usual place, he had come looking for me.  'Oh, sorry', I said, quickly remembering.  ‘It's in the Ibsen parking lot.'  I felt embarrassed that my personal life had invaded my work environment, especially at such a delicate moment. 

But after my husband’s head popped out again, my visitor seemed to relax a little.  She handed me her grandfather’s documents, and even managed a half-smile.  Perhaps she’d decided that a person who couldn’t remember where she’d parked the car, and who had a husband with a Jack Daniels baseball cap and a big smile, was human after all.  I suddenly realized two things:  First, I didn't have to choose between being businesslike and sympathetic; I could be both.  Second, I couldn’t always help the people who came to my office; some problems have no solution, at least not in this world. Sometimes all you can do is empathize and connect with someone.   Clearly this was one of those times. 

So I took a chance.  I said, ‘I know exactly how you feel.’  Now, there are not many times in life you can say those words and really mean them, and have them be completely true, but this was one of those times.  And she knew it.  The connection was made. ‘Why don't we walk back down to the ER?’ I suggested.  ‘That way you can be with him and I can get the information I need there. There’s no reason you have to stay here.’   If her grandfather was really going to die, I wanted her to have the chance to say goodbye.  She was pleased at this suggestion and we walked in silent camaraderie down the hall to the ER, where I briefly met her parents, expressed my sympathies, and collected the necessary information.  Then I went back to my office, completed the admission process, the night went on with more patients and more admissions, and I didn’t think about the family again.

A few weeks later, I decided I wanted to sign up for classes at North Shore Community College.  As much as I loved my job in the admitting office, it was on the low end of the hospital pay scale.  I knew that to move into a better paying job at the hospital, or anywhere else, I would need a college degree.  People I knew were taking classes at the community college, and the hospital had a tuition reimbursement program, so I went over there one morning to register.  But there were multiple difficulties.  No, I couldn't produce a high school diploma because I hadn't gone to high school in the US.  Instead, I had 'O' levels from England, but the people in the college Admissions department had never heard of ‘O’ levels (I wasn’t convinced they had heard of England, either) and said I might have to take something called a 'GED.'  I was getting nowhere fast; it was all looking quite hopeless.  It would take me weeks to get my ‘O’ level certificates from England, and classes were starting in a few days.   The suggestion was made that I might like to wait for the next semester, but I'm not the kind of person who likes to wait, once I've made up my mind to do something.  So I dug my heels in and pushed a little, but 'I'm sorry, I can't help you'  announced the clerk firmly, looking past me to the next person in line.  Just then, a middle-aged woman walked out of a back office and stopped when she saw me. ‘Oh,’ she said, with a friendly smile, ‘it’s you!’ I had no idea who she was, but she clearly recognized me.  I smiled back and waited for her to explain.  'You work at the hospital, don't you?'  I nodded.  ‘You were so helpful to us when my father died' she said, her voice faltering just a little as she remembered that day.  ‘My daughter went to your office and you walked back with her to the ER, do you remember?'  I did. ‘We were so grateful to you,’ she went on.  ‘You were so kind.’  Kind, I considered.  People don’t usually say that about me.  People used to say that about Grandad, that he was kind.  And he was.  He was always kind.  He was the very embodiment of kindness, in fact.  I had never known anyone kinder.  Am I really kind too? I wondered. 

‘What are you doing here?' she asked.  'Registering for classes?'  Well, I'm trying, I said, and explained the difficulties.  It turned out she was the manager of the college admissions department and she took me into her office and sorted out my registration in less than two minutes.  She said, ‘get your 'O' level certificates to me when you can, but in the meantime I'll put in a system over-ride so that you can start next week.’  

After everything was arranged, I walked outside and headed to my car.  I was ecstatic!  Finally, at 23 years old, I was on my way to a college degree!  It was a beautiful September day, the heat of the summer had given way to a cooling breeze, and there were large red/orange leaves fluttering gently to the ground.  The parking lot looked just as it had when I arrived, but I knew that everything was different.  Reality had shifted, and in this new version of reality, all the opportunities in the world were suddenly within reach.  I realized that I was no longer walking; I was skipping! Who cares if anyone’s watching, I thought, and started turning, dancing, jumping, pretending to ice skate, spinning, the leaves crunching deliciously underfoot.   

Humming a happy tune, I found the car, opened the door, and got in.  I looked over at the man in the passenger seat, a contented smile on his kind, familiar face. Not really dead, but still with me, just as he had always promised.   


Click here for a poem by Brian Patten, ‘So Many Different Lengths of Time,’ which so beautifully expresses what my grandfather believed, and which comforts me now, many years later, as I mourn the recent loss of my beloved father.  I hold onto the belief that ‘a man lives for as long as we carry him inside us …  as long as we ourselves live, holding memories in common, a man lives.'  I wait patiently for the day that ‘he will not have ceased, but will have ceased to be separated by death.’   

Funeral flowers for James Tomlinson, 1926-2014, from his garden


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