Every morning that Yvonne Rosebraugh backs out of her La Mesa garage and goes to work, there's a chance she'll end her day in tears. Yet she loves her job. Those are two wide-apart emotions we have to square.
Yvonne, 52, is a social worker whose job is to safeguard the interests of home-bound and hospitalized patients who have serious medical problems. It's a "trigger-warning" that this is not a story about Pollyanna. It's about life, and Pollyanna is fiction.
It's the job Yvonne trained for, but that doesn't always make it fun. Sometimes really sick or hurt people die. And when it's a child, well, she has two children of her own. However, part of the job description is to lash down the heart strings in an emotional storm.
"It was a child under age 3 who had been in a fatal accident. It was my first death, and I thought to myself - I've trained for this. I know what to expect. I'm either going to make it or I'm not going to be able to do this at all, period. This is going to be my first case or my last case.
"I walked into the room where this child was, and I'll never forget those expressionless eyes fixed on the ceiling in a lifeless body, and I was OK. I had to do my job. I had to go get the family.
"It was the longest walk of my life. As soon as we walked into the room, the mother collapsed. I held her as she fell to the floor. That is absolutely the worst thing that anybody could ever go through, the death of their child. Nothing in this world can compare to that, nothing, and you never, ever want to experience that.
"It was tough, but I handled it."
What did that teach you about you?
"That I am resilient, that I can be there to support a grieving family in crisis and not fall apart myself."
Yvonne's position is to look after the interests of chronically ill patients or those so banged up by accidents that they require long-term care. She is the go-between connecting them and health-care providers who could lose track of them in the shuffle, and insurance companies to whom they might just be a policy number.
She is paid by those providers to be an occasional pain in the budget by telling them what they're doing wrong or not doing. Sort of the old comedy-routine slap in the face followed by, "Thanks, I needed that."
Contrary to the image-cum-myth about social workers, Yvonne is a cheerful, blunt-spoken woman. That's probably a combination of nature and on-the-job nurture. She says people are entitled to understandable truth, and that's what she tries to give them.
Though patients get their truth straight, if it's not accepted, she won't engage in unwinnable arguments, adding that the most predictable disputes are with alcoholics.
Yvonne says, "I have talked to alcoholics about their addiction sickness, and they just tell me something like, ‘I just have a sensitive liver.' Their denial in many ways is so deep, they justify even cirrhosis. They refuse to take responsibility. They can't. They're incapable of it."
Have you had any who said, "I'm an alcoholic and it's killing me, but I can't stop"?
"Well, if I have, it's only been a handful."
Do you confront them with it, like, "This is going to kill you"?
"Absolutely. They often glare at me and ask me to leave. People don't like it when you hold the mirror up to their face: ‘Look. This is who you are.' They don't like that."
Any difference between men and women alcoholics?
You must have observed some success stories with alcoholics.
"Absolutely. When they reach rock bottom and know it, and are honest about their illness, they've got a chance. I've seen them make it. I wouldn't say a lot, but I've seen it.
"My favorite uncle died of cirrhosis of the liver. I've worked with young people in their 20s who drink a liter of vodka a day. It's just a horrible, horrible disease, and it's just so sad, and it makes me feel very helpless."
You've probably watched a lot of patients find God or lose God or call on God.
"Certainly. For people earnest in their faith, it's a great coping mechanism. People survive crises easier if they have faith. If they don't, they have a harder time."
Do you encounter people who believe they're being healed by faith?
Let me guess: You say, "That's wonderful."
Sometimes, even Yvonne's good stories are sad.
She tells of a patient, 25 years old, who will graduate this semester from UC San Diego and then go on to law school. He has one problem that doesn't seem insurmountable to him: He's paralyzed from the neck down.
"He can't even move to mouth his words, but his main nurse who's known him for five years can read his lips. To others, it doesn't mean anything, but she knows what he's saying, and he's very well-spoken."
Yvonne says in amazement, "He can only move his thumb, and he writes 10-page college papers."
She says the man won a David vs. Goliath battle with Medi-Cal over allocation of nursing hours, a victory she says was uphill, very steeply. By prevailing in his appeal, he will continue to receive 24-hour nursing care, meaning he can continue his education.
Yvonne says he's got a tough, lawyer-like attitude toward his disease and is determined to make his life successful.
By using his thumb?
"Yeah. Not even his fingers."
When a patient who is hopelessly paralyzed claims he or she will walk again, how do you react?
"Usually you say nothing because there's nothing to say. You change the subject.
"You try to redirect the conversation. You say, ‘We don't know about the future. Let's talk about the things that you can do today.'"
What if they ask you, "Do you think I'll walk again?" What do you say?
Even though you know it's not going to happen?
"Miracles do happen, but I'm not surprised when they don't. I refuse to give false hope."
She says the Latino culture sometimes feeds on unrealistic hope. She is well familiar with it, having been born a Lopez.
She says it sometimes goes like this: "God is going to restore my loved one. He's going to make her come back. She's going to be the same person."
She says many Latinos have a greater reluctance to "pull the plug" than people from other cultures.
"Because they feel like they're killing that person. It's very religious-based. ‘Thou shalt not kill.' It's not up to them to kill. Only God gets to take life.
"You can't say anything. You just don't say anything. You just can't. They may be holding on to an unreasonable belief, but they're entitled to it."
You're saying that's cultural?
"I know it is."
You're going to get PC heat for saying that, you know.
"I can't help that."
In dealing with catastrophic trauma, many ordinary families "completely fall apart. Completely," Yvonne says, adding that there are many ways to fall apart. She's seen most of them - divorce, mental illness and especially denial.
"They can't see the reality that's lying in the bed in front of them. They want to believe what they tell themselves. These are well-grounded individuals, well-educated, but they don't listen. You tell them what's happening with their loved one, and they can't see it."
Do some patients feel guilty for what their disablement has caused their family?
"Absolutely. They feel useless. One man who comes to mind was going into hospice. He welcomed it because he felt his life had no meaning. His health was getting worse as his family struggled more. That was the reality. When it was time to go into hospice, he saw it as a release.
"He obviously said to himself, ‘Now, my family will be at peace, and I won't be a burden.' His family, though, was very loving and cared about him very much."
Didn't having a loving family make a difference?
"No. In his depression, that made him feel even more guilty.
"I try to call them on it. I say, ‘You're not listening to what your family is telling you. They love you, you mean a great deal to them. They look forward to seeing you in the morning, and having a conversation with you, and hearing what you're thinking or what you're reading, and to tell you how you enrich their lives.'"
Do you sometimes think you don't do a bit of good?
"A lot. There was another patient I had with muscular dystrophy. I hate that disease, for God's sake. He was in his early 20s. His mom was really frustrated with him because she wanted him to go to college. He was kind of moping along, always making excuses for why he wasn't going to college.
"We would try to support the mom and try to encourage him. However, he decided one day that he was going to check out, and he did. It was during the night. His mom woke up to find him dead. He had cut off the air to his breathing machine.
"He had no history of depression. He just wanted to die. Sometimes, it just happens."
Yvonne says she sometimes runs into a wall of resistance from those she tries to help as soon as she walks in the door. She often traces the cause to negative experiences the patients have had with public social workers.
"I have to stop and say, ‘I sense you're really unhappy with my being here. Do you want me to come back? Do we need to talk about this?' That's very hard for me to say, because people are supposed to be grateful that a social worker is there to help them."
I'm surprised they're not.
"Sometimes they couldn't care less.
"In-Home Supportive Services is a county program. Some - not all - of the social workers there are horrible. They show no compassion. I hate to align myself with them just because we're all social workers. I have to use what people skills I have just to bring the patient around."
We sometimes read stories of people rising above horrible circumstances and achieving great things. However, "sometimes" means infrequent. Yvonne and health-care professionals like her deal with the frequent, the everyday stuff that's not inspiring. We can't appreciate the weight of their burden unless we realize what they cope with and the awful challenges of those they serve. We owe it to them to be educated, to listen to their stories.
Yvonne drives the point home. "Some of my cases are really gut-wrenching, and I carry them away with me. However, I have to take care of myself and protect my husband and my kids, and not let that trauma touch their lives.
"It does affect you. I mean, there's secondary trauma which health-care workers experience a lot. You just have to be careful and remember that what you do is a good thing."
Yvonne ends with a slow head shake and a smile: "I love what I do. I do love what I do, but it's hard. It's really hard."
She'll get up tomorrow morning and do it all over again.
Fred Dickey's home page is freddickey.net. He believes every life is an adventure and welcomes ideas at firstname.lastname@example.org.