No Emergency Contact

No Emergency Contact

Mary Zheng | Nonfiction

I am a social worker in an emergency department. My job is easy. After people are admitted, I gather their story, and then I ask them questions to verify their address, phone number, preferred pharmacy, and other slivers of innocuous information. They are simple questions, basic and painless.

My job is hard. On perhaps the worst day of someone’s life, I rip open the curtains to their room and wrestle them from what little comfort they’ve gleaned in the sterile setting. I pester them with unexpectedly intimate questions, each one a loaded pistol. It helps me plan for a safe discharge; it helps me know how to help.

Do you have a walker, or a cane, or anything like that? Because most people brought in by ambulance don’t have time to grab walkers, canes, or anything like that before the EMTs scoop them onto the stretcher. I have to ask. If the answer is yes: a reminder of how brittle their bodies have become. If the answer is no: an insinuation that they are too weak, that they are bounding toward a silver sickle that glimmers in dying light.

Do you live with anyone? If the answer is yes: why would they not? Why would I assume they don’t have any family or friends or lovers? If the answer is no: a reminder that they will return to an empty house where loneliness will cradle them to sleep.

​And my favorite: Do you have any emergency contacts? If the answer is yes: name, relationship, and number, please and thank you. But if the answer is no: an irrevocable admission that there is not one soul they can count on on this planet of 7.8 billion people. Nobody cares that they’re here, that this is perhaps the worst day of their life.

It’s possible a patient’s emergency contact needs to be updated. When the patient is suffering from addiction, that possibility is as high as they are. This is part of the contract, a tacit condition agreed upon when they dance their first dance with heroin.

The chart for 23-year-old Matilda says what she already divulged to the doctor: she began running away from her parents when she was seventeen, running and running until one day they stopped chasing. She has a five year old who stays with her mother. She has a boyfriend who gives her drugs. She also has a social media page where she crowdfunds her daily habit of fourteen bags of heroin—most people do three or four per day—along with three to six green bars (“Those are Xanax,” she explains) laced with fentanyl (“I love that shit,” she proclaims, as if she is talking about Caramel Macchiatos or when the metro doors open right where you are waiting).

With only a few shifts under my belt, I am too new on the job to go in alone, so I follow my supervisor. We draw back the tan, checkered curtains and see a young girl with blue, blue eyes that do not rise to meet ours. Matilda stares vacantly into the bleach-soaked air. She has one glitzy stud in her nose and one piercing under her bottom lip—crooked, more to the left than the right. She is bird-like with spindly bones, pummeled effete by addiction. She’s so skeletal, the blood pressure cuff winds around her arm four times. She is fragile, bone white, her tie-dyed leggings hanging loose like sagging skin under a grandmother’s chin.

We ask more than just perfunctory questions to patients with substance use disorder, so my supervisor asks Matilda about her drug usage. Does she want help? Has she ever had sober time?

“I’ve gone to rehab a few times but never stayed,” Matilda answers.

“What keeps you from staying?” my supervisor asks.

“Boys,” she admits, whispering the word soft and flat.

After we leave Matilda’s room, my supervisor and I will look at each other with swollen hearts. We will wordlessly lament about how she is at that age when she chases both boys and drugs.

For now, my supervisor reads from a sheet of paper splattered with information culled from prior hospital visits.

“And is this your address?”

“Pft, not for years. I stay with a friend now.” Matilda brags with metallic brashness. “That old place? That was when I was still a kid—I’m not a kid anymore.”

Noted. The address on file is crossed out and replaced with nothing, because she can’t recall her friend’s address.

“How about an emergency contact? We have on file that it’s your mom. Is that right?”

Matilda’s swagger curdles and clumps into fetid shame. She shakes her little head, no. Her silence is drenched in dread. Her blue, blue eyes stare into the corner and are draped in a heavy cloak of regret. She recognizes that right now, she has nobody.

After my supervisor and I finish with Matilda, I sit behind my laptop and swivel in my chair. Something about Matilda gnaws like a dog. She is so young, her eyes so hollow. I ask my supervisor if I can go back. Just to talk to her, to see if I can learn anything else that might help with her recovery since she started to dissociate earlier.

I peel back the curtains. “Hey, Matilda… you probably feel like shit right now.”

Silence, as if she hasn't heard me. She focuses on the air, perhaps on something ahead of her, but certainly not right now.

I think about Freud and PTSD and everything I’ve read about how people dissociate when they are faced with something they don’t want to face. But they come alive when the topic changes. I change the topic.

“Want some water?”

“Oh, I would love some.” She exhales in relief, her gaze pulling to mine like a magnet. She has come alive.

I grab her two cups of water. She guzzles them down and speaks about life on the streets. She may not want to talk about how awful drugs make her feel, but she sure is willing to share how great they are.

She needs about four Xanax bars laced with fentanyl per day to keep withdrawal at bay, she says, but some days she’ll just take three to avoid “going to work.” Those three words launch out of her mouth and slice through the air, piercing me. I know what kind of work she means. It is the kind most women on the street engage in, and it is not the kind most do willingly.

Four or five times in her life, Matilda has taken twelve bars all at once.

“I don’t swallow my pills,” she stresses. Instead, she chews. “It hits you harder that way.” ​

Once, after she stuffed all twelve bars in her mouth and was chewing with the hunger of somebody starved, a man said something to her, or gave her something— she doesn’t remember—so she opened her mouth to say, “Thank you,” but all that came out was a puff of green. It engulfed the man’s face. He almost beat her after that.

It’s been months since Matilda. I see patients by myself now. I’ve learned to ask questions that will draw out their lives.

Some people are like Matilda, with dozens of bridges to rebuild but zero begun. Their untouched hammers and nails glitter under the sun; they dare not look down at the charred planks strewn in the gorge of their addiction.

There are also those who have put their materials to use. They have laid out planks for their base, or they have securely bolted the beams down. Their bridge is taking shape. Or perhaps all that’s left is the handrail, so people who have fallen off before can now safely walk across.

Holding close to my vision of what a patient’s bridge might look like, I am sometimes able to answer questions about their lives without asking. When the image is clear enough, I do just that.

​I don’t want things to hit you any harder.

Names have been changed.

art credit: "between two worlds" (2019) by Federica Colletti, Mikeshake Magazine