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Frogman and the Stoic Exchange


Frogman and the Stoic Exchange:


It’s Tuesday evening in early January. I am sitting - in a quaint coffee/wine restaurant on the Upper Eastside of Manhattan. I have just completed my annual medical examination at Mt. Sinai Medical Center. This is my second time here. I am enrolled in a 30-year follow-up study for World Trade Center (WTC) First Responders from 9/11. I hate this procedure, i.e., the anxiety, the dread, the poking, the prodding. Months before you actually arrive, you begin to receive text messages, emails and mail-delivered information to remind you of the pending appointment, as well as what particular information you should bring with you.

When you arrive at Mt. Sinai, you check-in with Security at the front desk (very friendly and welcoming). You are then instructed to take the elevators to the third floor. Upon leaving the elevator - you turn left and walk down the hall. There you are met with staff sitting behind a Reception/Nursing Desk (friendly and accommodating). It is here - you sign-in for your examination, first electronically and then with a healthy amount of paperwork. Today, as I was completing the documentation, I was approached by a woman in a lab coat - and with more paper documents in her hand. She asked me if I would be willing to participate in a: ‘Research Study on Hepatitis C’. For me, she said the magic words - ‘Research Study’. I am a big believer in the value of Clinical Research. I said, ‘Yes, for sure.’ I read the disclaimer - and signed the document.

At this point, a Nurse announced my name. As she noticed - I was still working through the paperwork - she told me to ‘take my time’ - and when I was finished to let her know. I completed the paperwork and joined her at the front desk. She guided me into her office - and we sat down for the beginning of the review. As standard procedure, she reviewed my personal and family health history. She was engaging and we had a very nice, friendly and professional exchange. She outlined for me what the procedure would be today and what follow-up services were available - including Social Work services.

I was then escorted into an examining room and was met by a Nurse/Technician. This woman was personable, animated and had a great laugh. She administered the ‘Breathing Test” and then guided me into a ‘Lab Room’ to draw blood samples. It was here I witnessed evidence of the camaraderie and friendly exchange amongst staff. When this procedure was completed - she walked me back to the examining room and told me the Doctor would be arriving soon. However, prior to her leaving the room - there was a knock-on the door and in walks the first Nurse that I met. With her were two Doctors from the Preventative Care Division. They explained the various services available to individuals enrolled in this program. They were nice, informative and provided really good and solid recommendations.

As my evaluation was moving forward - the Nurses and Doctors left the room. Now I was asked to wait for the Medical Internist. As I was waiting, the nurse/technician came back to see how I was doing. Five minutes later, the Internist arrived. She was professional, engaging and interested in reviewing my health profile. She provided good recommendations and did a thorough examination. As she finished, she indicated she thought I was done - and then she realized I had one more stop on the way out: Social Work. So, again I was off to the waiting area.

As you can read, my experience was very positive throughout this event. The Staff were very friendly, engaging, supportive and responsive. I then met a representative of the Social Work Department. She called out my name, introduced herself and asked me to follow her. We walked down the hall and entered her office. I sat down and as she was gathering forms for the interview - I asked her: “ So, where did you go to School?” I thought this was a reasonable question - as I am a Professor of Psychology and my own graduate training is in Social Work. (In addition, throughout my whole professional life I have had an interest in the academic path that colleagues and students have traveled.)

Without skipping a beat, she responded: “I’m not sure what your question has to do with this discussion? In fact, asking me a question about me - will take away time allotted for my discussion about you”. As she was delivering this edict - my thought to myself was: “WHAT? YOU HAVE GOT TO BE KIDDING ME?” Here I was sitting as a volunteer in a medical study program (a program that I never wanted to belong to – a club where the initiation was being present as a First Responder at 9/11). And, if there were ever a place - where one would have expected a presence of compassion, empathy and care - it would have been in the Social Work component of that program - but far from it. Here, I was just delivered a sentence from a practitioner that could be carved out of a scene from a psychoanalytic therapy session in 1920 - where the posture of the therapist is disconnected and protected from exchanging in interpersonal dialogue with the patient. But the problem is - this setting is not about psychoanalytic therapy - but rather one would think - a solution-focused based casework intervention would be more effective.

As she was talking, I was also struck by a memory. The last time I came for this evaluation - I had the same outcome. Everyone (staff, nurses, doctors, support staff) was personable, friendly and professional. And when it came to the Social Work Division - there wasn’t a feel that the interaction was lead by the ‘heart’.

Look, I get it. It is not an easy position to be in. I am sure a daily exposure in a setting like this can wear you down professionally - or maybe it’s a ‘disconnect’ between the ‘paradigm of professional training’ and ‘the reality of the setting’. I get it. But then I ask - “how is it that everybody else in the setting is engaging and supportive - and then when you are directed to the division where you would expect to be flooded with compassion and empathy - it’s absent”. Remember, for many of us - hopping through this evaluation - we already feel like ‘frogs being poked’. For many of us, we have spent years trying to forget the images and scenes we encountered on that fateful day of 9/11 - and a stoic exchange doesn’t help one feel very comfortable. This is not a criticism of the Social Work Practitioner – far from it, but rather a suggestion to review the connection between a ‘practice setting’ and the ‘theoretical paradigm’ presently driving and influencing the delivery of care. Undeniably, the presence of Social Work is so important, in fact, vital. The overarching question is: “What part of Social Work?” Maybe it is time to stop and take a look at the pertinent role that Social Work has in a program like this – and if the present theoretical framework ‘anchoring’ the program is the ‘best fit’. Remember, the individuals that are now part of the ‘First-Responder cohort’ are 15 years older than when we first presented. In addition, across time, not only have we aged - but also our needs have shifted - this in light of the fact that new medical concerns are now being identified - concerning the impact generated from initial exposure to the calamity. The world has changed since 9/11 and so have the concerns of the First Responders. What a wonderful opportunity this could be to learn from a ‘teachable moment’. An opportunity where one would hope - opens a dialogue between the care providers and care receivers.

Yes, as the exchange continued - she did provide me with the necessary paperwork to access a service. However, that does not offset the initial exchange - or does it?

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L.T. Force, Ph.D., LCSW-R

January 09, 2018


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