Qualitative Social Work

Copyright 2007 Sage Publications Los Angeles, London, New Delhi and Singapore, Vol. 6(4): 431446
www.sagepublications.com DOI:10.1177/1473325007083355

ARTICLE

A Day in the Life of a Hospital

Social Worker
Presenting Our Role Through the Personal
Narrative
Rita Wilder Craig
Humber River Regional Hospital, Canada

ABSTRACT

KEY WORDS:
narratives of
social work

Social workers have always used narratives in the service of

their clients. Many of us spend half our days listening to
stories and the other half repeating them in one form or
another, whether in assessments, in advocating for services
or for a more accurate understanding of a clients circumstances. While we excel at this kind of storytelling, we have
been held back from using the narrative genre in telling our
own story. That story is one that describes the intricacies and
variety of social work practice as well as the uniqueness that
distinguishes us from other helping professions. For hospital
social workers, who have experienced profound change in
recent years, it is especially important that we find innovative
and interesting ways to convey a richer and deeper understanding and appreciation of our role. The genre of personal
narrative allows us to do this in a voice suitable for the task.
When narratives are used in this way they can be seen as a
tool of advocacy for both ourselves and our clients
(Chambon, 2004).

personal
narratives
social work
writing

431

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432 Qualitative Social Work 6(4)

INTRODUCTION
Once upon a time everything was understood through stories.
Stories were called upon to make things understandable.
Parry and Doan (1994: 1)

My mother was a great storyteller. I suspect it was because of this that I became
a social worker. The stories my mother told me centered around two themes,
one was family, the other, coping with prejudice.
As the grandchild of Europeans of a religion and culture different from
the dominant group in England at the time, my mother anticipated the prejudice I would encounter. In what I see now as an effort to help me cope, she
invented a character known as The Bunny Rabbit with the Pink Tail. This
rabbit had many adventures that always had to do with the experience of being
an outsider. Through the rabbits many adventures in trying to be accepted as
one of the group despite the pink tail, I learned that the way to redeem oneself
from this status was to be kind, helpful and caring of others. Saving someone
from danger or likely death was also helpful. Although I was later to discover
that life is not so simple, being kind, helpful and caring always served me well
when I was able to live up to it.
Although I liked the rabbit stories, my favorite ones were about family.
The one I asked my mother to repeat many times concerned the birth of my
mother Sarah (known as Shirley because Sarah was too old fashioned), and
her twin brother, my Uncle Simon. They were born at home prematurely but
with a doctor in attendance. After their birth the doctor told my grandmother
that the babies looked weak and would likely not survive. Because of this he
suggested, She might as well not feed them. When he returned the next day
to find them looking better, he told her that Perhaps she should feed them
now. My mother would then say that of course my grandmother had fed them
as she wanted them to survive. When I was older I asked my mother why the
doctor would say such a terrible thing. She answered by telling me that people
were poor with many children and that the doctor had seen people unable to
cope with the children they had. As a child I loved this story. It had suspense
and drama with my grandmother placed in the role of hero. Later I was to
think of her action as a form of creative resistance against the power of a
doctors authority, which, even years later in England, was considerable. It was
through my mothers many stories that I got a sense of who I was and where
I came from. The grand narratives of English history (the Kings and Queens
of England) presented to me at school, certainly were not my history. My history
was to be found in the stories my mother told me.
When I write narratives of social work, these childhood stories often
reach the threshold of my consciousness and remind me of the importance of
having unique narratives that enable us to position ourselves both currently and
historically.
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Craig Day in the Life of a Hospital Social Worker 433

BACKGROUND
I write in order to explain things to myself.
(Mordecai Richler)

I wrote my first social work narrative after a particularly gruelling day. I had
seen patients who were dying, families with elderly relatives needing placement,
one man needing cardiac rehabilitation, and finally I facilitated a meeting in the
Intensive Care Unit (ICU). This last case of the day was particularly difficult
as I had never met the patient and knew little about the case, which belonged
to a colleague who at the last minute was unable to attend.
When I eventually located the patient who had been moved unexpectedly to the ICU from a regular floor, I introduced myself and found a
chair for his wife. The rest of us, the team from a local chronic care hospital
and myself, stood around the bed. The visiting team was there to decide if they
would accept Mr Gee and his wife Mary for training on how to use the complicated equipment needed to keep him alive if she took him home.
The care they described was overwhelming. I could not believe this was
even being contemplated. The team noted their concern over reduced (government provided) Home Care and the patients inadequate private insurance.
They wondered also about the emotional and physical burdens for Mary and
suggested they might be too great for her. When they asked her what she
thought, she looked close to tears as she mumbled that she was, Not so young
anymore. The social worker from the visiting team gently suggested that Mr
and Mrs Gee consider a permanent placement at the teams facility. That decision
however would entail a wait of many months due to lack of beds.
A nurse had told me that Mr Gee had the ability to communicate even
though he had a permanent tracheotomy, and he could certainly hear everything. However, despite my attempts to engage him in the process a number of
times, he remained silent. Eventually, the social worker announced that the team
would make its final decision later and would let us know. They suggested that
in the meantime Mrs Gee watch the nurses and imagine herself doing most of
that work. Mrs Gee did not respond. Later I asked the social worker who would
be able to take on such a task. Only those with twice the insurance Mrs Gee
has and an extensive support system she responded.
The absurdity of this whole encounter struck me as I walked back to
my office. I wondered if the option of taking Mr Gee home was presented as
a possibility because of the long wait time for a hospital placement. I also thought
about how Mrs Gee might feel if, as seemed likely, the application was ultimately rejected. Would she believe it was because of some personal failing on
her part rather than an inadequate system of caring for people in her husbands
situation? There was nothing I could do apart from leave my colleague a message
asking her to talk to Mrs Gee about what happened in the meeting and also
to see Mr Gee.
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434 Qualitative Social Work 6(4)

I returned to my office exhausted sat staring at my computer and

thought about doing notes and entering my statistics. But instead of writing
notes I started writing about my day. The pace of work allowed no time for
emotional processing and this together with the intense nature of the work
often left me feeling disconnected, afloat in a sea of the days distress. The
writing acted as an antidote to this. I also recalled Alan Irvings (1999: 46) observation that the humanities can inform us as nothing else can of the absurdities
encountered in everyday social work practice.
When I read the completed narrative I no longer wondered if the stress
I felt was because I was not efficient enough or in need of time management
help comments that have been used by management to silence requests for
paid overtime or additional social work coverage. My narrative not only highlighted the difficult work we were doing and the unique skills it entailed, it also
brought into sharp focus the effects of restructuring, downsizing and emphasis
on decreased length of stay that had been going on in hospitals since the 1990s
(Globerman, 1999; Globerman et al., 1996, 2002). I would have felt better if
research presented recently by the Ontario Association of Social Work had been
available to me then. These disturbing findings indicated that of those social
workers responding, 71.6 percent were working between 1 and 6 hours of unpaid
overtime each week for an estimated average donation to their organizations of
$5,824 each year, totaling an estimated $6.5m last year (Antle et al., 2006).

PRESENTING AND PUBLISHING NARRATIVES

Life needs more exposing. If anyone has a chance to contribute to the expos,
I say, take it.
(Weingarten, 1997: xii)

When I read my original narrative to a few colleagues in preparation for the

Social Work Week event where I was to make my first presentation, I was told
that no one would believe this happened in one day and I had better change
it. Before the presentation, I shortened the piece to make it appear credible.
Feedback after my first presentation was positive. While non social
workers commented on the complexity and variety of our work, my social
work colleagues said that the narratives captured the nature of the work we do
and especially the frenetic pace, epitomized by the rush from one patient to
another. I was also told that the stories were both validating and entertaining.
It was after my colleagues comments that I came to appreciate the collective
nature of the narratives that they were both personal and collective all at
once (Chambon, 2004: 2). It was with this understanding that I presented them
from that time. It was also after this first presentation that I came to see the
possibility of using the narratives as a means of advocacy for the role of social
work in hospitals.

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Craig Day in the Life of a Hospital Social Worker 435

Later narratives did not depict a real day as that first one did. Instead
they were compiled to show what I felt was a typical day. One group of stories
was included to show how referrals requesting instrumental tasks such as
completing rehabilitation, palliative care or nursing home placement applications, tasks that some have suggested are the bread and butter of hospital
social work, although seemingly straightforward, often end up being very far
from that. This important work is now been done in many hospitals by discharge
care coordinators who have replaced social workers.
I also tailored the presentations to the audience. For non social workers,
especially administration, I kept reflections to a minimum. Here the purpose
was to advocate for our profession, with examples chosen to promote a more
accurate understanding of our role and hopefully demonstrate the added value
(Nelson, 2004) that social workers bring to hospital work. For social workers,
I included additional reflections, as the purpose here was more one of validation. As Ann Weick has commented, social workers often have difficulty
believing what they do is important, even though in their hearts they know
differently (Weick, 2000: 396). I have discussed her work and especially this
comment with many social work colleagues. These conversations almost always
generate a story about an encounter that the social worker initially decided was
not that important, but seen in light of Weicks comments, they reflected that
the encounter actually had a profound impact on the client.
After presenting in my own hospital I decided to send in abstracts to
social work conferences and somewhat to my surprise, they were accepted. I
gradually began to think about the possibility of publishing and partly in preparation for this took an autobiographical writing course. I also read them to my
twenty-something son Matt. He remains my main means of gauging whether
a piece is even remotely interesting. Because most of the narratives were written
to be read aloud, I realized that I would have to be careful when submitting
pieces for publication as the intonation, inflection, timbre and pace of delivery
that I used to illustrate emotion, meaning and especially humor, would be absent
in print.
I was fortunate to have had the first two articles I submitted for publication accepted one by the Journal of Palliative Care (Wilder Craig, 2004) and
the other by the journal Reflections Narratives of Professional Helping (Wilder
Craig, 2005). I had been told that journals welcome articles by front-line
workers, although not surprisingly, given the amount of work involved in even
a short article, few submit them. Although I was pleased to see my work in
these journals, I very much wanted to have an article accepted by a mainstream
social work journal. In this however, I was not successful. My submission to a
Canadian journal was returned with not even a comment and I was left to guess
at the reason for the rejection. Eventually I decided it was most likely because
my article was written in a form that was not scientific, i.e. it was not the

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436 Qualitative Social Work 6(4)

proper way to write about the weighty subjects we address (Witkin, 2000: 390).
Both Witkin and Hartman have discussed, in editorials in Social Work, how
journals with their APA style requirements act as gatekeepers (Witkin, 2000:
390) for those interested in different forms of writing, in effect subjugating
this other form of knowledge to the margins (Hartman, 1992: 483).

FINDING OUR VOICE IN DIFFICULT TIMES

The problem of describing what social workers do continues to plague us.
(Ann Weick, 2000: 396)

Ann Weick (2000) has written from a particular framework about social works
alliance with the scientific enterprise and the difficulties we encounter when
we try to use a scientific voice to describe what we do. Weick calls this social
works second voice and notes that it speaks from a place where emotions are
replaced with studied disinterest and complexity is resolved by narrowing the
point of study (Weick, 2000: 398). It is also a voice framed by logic, rationality and rules, where right and might are more important than care and comfort
and where winning eclipses warmth and worry (Weick, 2000: 398). Our reliance
on this voice, she suggests, has resulted in a chasm of silence that has acted to
mute the professions collective wisdom and power (Weick, 2000: 396).
Most of us have become experts in using this voice as it is the voice of
the larger corporate culture that is so much part of our world. However, it is
a voice that is not up to the task of either describing adequately what we do
or of differentiating social work from the work of other helping professions.
Weick suggests that the voice that is capable of doing this is what she calls our
first voice the voice of storytelling. This voice is seen as the essential voice
of social work and one that is found most fully in what we have come to call
practice wisdom (Weick, 2000: 400). Although Weick acknowledges that it will
be difficult, she asks that we clear our throats and speak in this voice of caring
if we wish to describe adequately the rich practice heritage that makes social
work distinctively itself (Weick, 2000: 398).
In the USA, the National Association of Social Workers recently took
action in this regard with the launch of a nationwide image campaign. They
see this as vitally important as they note that social work is one of the most
misunderstood professions (Clark and Oliver, 2006). In their print ads they use
short vignettes to tell a story, with photographs of real social workers and real
clients.
Regardless of the voice used to describe our role, social workers in
hospitals have experienced an additional profound loss of voice. As a consequence of restructuring, many hospitals changed to a program management
structure, which included the disbanding of social work departments as well

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Craig Day in the Life of a Hospital Social Worker 437

as the termination of Director of Social Work positions. Social workers neither

reported any longer to people in their own discipline, nor were they supervised, appraised, hired or fired by them (Globerman and Bogo, 2002). At the
end of the day we found ourselves separated from our leaders and with a
diminished or absent collective voice.

FINDING OUR VOICE THROUGH THE PERSONAL NARRATIVE

What is the importance of storytelling, of narrative? Simply put, it is all. Narrative confers meaning to a life in the same way that it conveys meaning to an
otherwise confusing jumble of facts and figures.
(Elizabeth Nestor, 2006: 295)

The personal narrative is seen to have both historical origins and modern significance. This form of writing began around 3000 BCE with the Egyptians who
left first person accounts of their lives in tombs. More recently it is seen as part
of an innovative postmodern trend that seeks alternatives to the grand narratives of history (the official dominant view from the top), preferring to look at
the lives of ordinary people that would otherwise remain untold (Rainer, 1997).
While historically this genre is not alien to social work literature (Goldstein,
1993), it remains the kind of writing that is not generally done by us (Swenson,
2004) and not often seen in mainstream social work journals. Riessman and
Quinney (2005: 397), in their review of various types of (published) narrative
research, note that first person autobiographical accounts typically appear in
highly-specialized journals such as Reflections and Reflective Practice where this
kind of experimental writing is encouraged.
The current vogue for personal narratives can be seen by looking at the
works of authors such as Irvin Yalom and Oliver Sacks who have received
critical acclaim when writing in this genre. While one should probably not give
up ones day job, literary prizes can be won by less well known front-line practitioners. In 2006, the Canadian writer and ER physician Vincent Lam (2006)
won the Giller Prize, a prestigious Canadian literary award for his book of
clinical tales. Although mainstream social work journals have yet to embrace
this genre, some American psychiatric journals have done so. The journal of
the American Psychiatric Association, Psychiatric Services is particularly interesting. It publishes regular columns written by patients or family members about
encounters with the mental health system, often not complimentary.
In 1998, an article appeared in this journal written, remarkably, by a
student of social work at Smith College. She wrote in the form of an open
letter to utilization workers. After discussing her own encounters with the
mental health system, she proceeded in a manner typical of social workers
writing in this genre, by noting implications for present users of the system,

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438 Qualitative Social Work 6(4)

pointing out the risk and inadequacy of trying to measure mental illness and
mood disorders in corporate managed care terms. She concluded that she may
not have recovered if the current fixation on utilization (i.e. shortened length
of stay) was in practice at the time (Pemberton, 1998).
Two other examples of how this third eye of social work plays out in
personal narrative can be seen in the works of Anthony Maluccio (2003) and
Carol Swenson (2004). Maluccio (2003: 16), in writing about the loss of his
Italian language after immigrating to America notes: I realized I had to write
this article in which I first present some of my recollections and then consider
their potential significance for social work practice. Swenson (2004: 458),
writing about her mother-in-laws descent into Alzheimers disease, notes: At
some point it occurred to me that this account, through its detail and its narrative qualities, could potentially inform social workers in ways that more
traditional professional writing cannot.
Goldstein (1993) remarks that the authors of such writings speak from
experience with their authority earned from having been there. He suggests
that in ordinary conversation having been there is enough to allow us to tell our
stories and have them heard with a measure of trust and confidence. Goldstein
(1993: 441) also suggests that this genre of writing can serve as an adjunct or
alternative to the conventional scholarly works found in professional social work
journals and notes that because social works primary interest is the person in a
situation, our understanding would be furthered by a body of literature that in
language and style more closely resembled the nuances of the human situation.
The following is one in a series of Days in the Life. This type of narrative is particularly useful for hospital social workers as it allows us to showcase
what is felt to be a hallmark of our work the ability and the opportunity to
make a difference in a brief encounter (Gregorian, 2005: 6). It also provides an
opportunity to use humor, which contributes to the non-threatening nature of
the presentations, a feature that various colleagues (at conferences) remarked
was particularly important when presenting to administration.
Although the topic of social work does not normally inspire laughter
(Mik-Meyer, 2007: 10), I would like to reapply to social work in general Witkins
(1999: 101) comment about the journal he edited at the time, that social work
should not be a laugh-free zone. Max Siporin (1984: 464) has also suggested
that if social work humor were more widely known it would help improve our
public image and enhance the communitys understanding of, and support for,
our work.
I wrote the following piece, intended to be read aloud, after I moved
from the service where I wrote my first narrative to a slightly less hectic position.
I always begin with an introduction that varies according to the audience, and
try to limit the reading of the narrative to about 15 minutes.

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Craig Day in the Life of a Hospital Social Worker 439

A DAY IN THE LIFE OF A HOSPITAL SOCIAL WORKER

All sorrows can be borne if you put them into a story or tell a story about them.
(Isak Dinesen cited in Arendt, 1958: 117)

At 9:00 am I enter the Church Street site of this three-site hospital. I walk past
the Second Cup and take the elevator to my office on the 2nd floor. This
floor is the home of Outpatient Oncology, Outpatient Geriatrics and a small
Inpatient Medical/Surgical unit. I turn on my computer and check my voice
mail. The first message is from the ER social worker rasping into the phone
that he is sick today and could I cover for him. I inwardly groan. This is not a
good day for him to be away as I have two outpatient clinics as well as my usual
inpatient unit and I know that the ER staff have little understanding of what
it means to cover while doing another job.
I look at my internal email and see that its time for another lottery to
decide who will park on site and who will be in the Prayer Palace, a nearby
religious establishment where the hospital rents parking for staff. For a while
we had a shuttle bus with Prayer Palace written prominently on its side. This
prompted more than one patient to comment on the surprising religiosity of
the staff.
I also see that a lecture is being given at noon. I close my email and go
to the nursing station to collect my referrals. The first one is for a Frank Brown
from the chemo clinic. I have never met Frank before and the reason for
referral has been left blank. This is such a common occurrence I barely notice
it. Although at times it can cause awkward moments and be difficult in terms
of prioritizing cases, I often prefer it as it allows the client to tell his or her
own story rather than the one the doctor prescribes.
Outpatient Oncology often looks like a war zone and today is no exception. The population expanded when the hospital merged from three separate
hospitals into one, but the clinic remained the same. The decor is dreary and
there are often not enough chairs for the patients and family members who
come with them. Some are standing. This is difficult as a lot of waiting goes
on in this clinic. It is often an all-day affair. They even serve lunch here, although
most people dont feel much like eating.
I see that the nurse has found Frank. I introduce myself and take him to
my office. My office at least is pleasant, with many plants and a large window
(albeit overlooking a roof ). I feel better taking patients away from the dreariness of the clinic for my own sake as well as theirs. Frank is 58 years old and
suffering from lung cancer. He pulls along a portable oxygen tank. He looks
tired and emaciated. A baseball cap covers his hairless head. When I ask how I
can help him, Frank says he has no idea. I ask if he has any financial problems,
the most common reason for official referrals from the clinic. No, he says. We

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440 Qualitative Social Work 6(4)

look at each other for a moment. Well, perhaps you can tell me whats been
happening in your life recently, I suggest.
Frank begins to tell me the story of his illness. He lived near an old Air
Force base and is convinced that his illness was caused by the remaining
chemicals left in the ground, even after they spent millions trying to clean it
up. Other members of Franks family are also ill with cancer, including two
siblings. A brother died only a month earlier. When I ask Frank how he has
been coping with all of this, he responds that he has been doing well, except
for the dreams. Frank is awakened at night by horrendous images of creatures
in black hooded robes coming to his bed, entering his body and trying to drag
him off. Frank has told no one except his wife about these dreams. He thinks
the dreams are about his death. Frank is often afraid to go back to sleep, fearing
the dreams will return. When I ask if there are times that the dreams are better
or worse, Frank tells me they always come when he is in pain. He is reluctant
to take additional pain medication, fearing that the more medication, the closer
to death he becomes. Before Frank leaves, I ask if I can discuss what he has
told me with his doctor. He agrees and we make another appointment.
I take a brief break, make some tea and think about Frank. I wonder if
the oncologist will see him as a man in a fight against the dying of the light.
Even if he does he will no doubt urge him to take more pain medication. I
return to my other referrals and see that a rehabilitation application is needed
for a Tom Lawson. I briefly review the notes and see that Tom is a 63-yearold man with a history of diabetes. He has just had a below-knee amputation.
I collect my rehab forms and enter the room.
Tom is tearful when he tells me what happened to him. I came to the
ER when a staple got stuck my foot he says. But it got worse and turned to
gangrene. Tom tells me that they first removed some toes and then part of his
leg. By now he is sobbing. Sometimes I think Im not going to make it, he
says. I ask Tom about his support system. He tells me his family of origin is in
another province and besides this he had a terrible childhood and does not wish
to contact his parents. He is separated from his wife but has a son that he is
close to.
Tom begins to talk about his marriage and why it ended. He has a violent
temper. Although he has never hit anyone, he describes his anger as being so
bad it causes him to smash things. Tom and his wife are still friends though,
and in fact she comes to visit Tom in the middle of our interview. She tells me
that Tom is a wonderful person apart from the smashing. I find Toms story
hard to believe, as he seems to be such a mild-mannered man. I ask him if he
was ever able to control his anger by doing something else. No he replies.
Never? I ask. Well, only once. I threw a wet cloth over my face and went out
for a walk. I look down at my notes and see that he worked for the same
company for 16 years. I ask him how he managed to hold this job. Did he never

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Craig Day in the Life of a Hospital Social Worker 441

get angry at work? Oh yes, but that was easy he said. I would go for a walk
and smoke a cigarette for a few minutes. Did that work? I ask. Oh yes, very
well he replies.
I look down at my watch and see that I have been here nearly an hour
and we have not yet discussed his rehab application. I am torn between wanting
to give him more time and the pressure to move on to the client I know will
soon be waiting outside my office. I am part way through the application when
Tom tells me that he has been feeling so depressed since his surgery that he has
been having suicidal thoughts several times a day. I put down the forms. When
Tom thinks about suicide he imagines placing scissors on his chest that he then
hammers in with his fist. We talk about this and I assess the risk of him doing
this bizarre act as low. However, he says he has other thoughts: that the diabetes
will get him and that he will have more of his leg cut off . When I ask Tom
what kind of thoughts he has when he is able to think in a more hopeful way
of the future, he says that he tells himself to be more positive, face life and
go on living and, most importantly, that he has to be strong for his son. We
discuss ways Tom has been strong in the past. His wife joins in. We eventually
complete the rehab forms and I tell him that I am going to make a referral for
the psychiatrist to speak to him. He says this is OK.
I run back to my office to see my next client, a man from the chemo
clinic that I had made an appointment with a week earlier. Mr Grey and his
wife are sitting in the small waiting room in front of my office. The referral
was for an application to a palliative care unit. A thin, elderly, distinguishedlooking man enters my office followed by his wife, a large woman who looks
25 years younger. I ask Mr Grey what his doctor has told him about his condition
and what his understanding is of this application. I am always careful to ask this
question as when I first came to the clinic I found out to my own, as well as
the clients distress, that sometimes doctors were not quite straightforward with
what palliative care actually means. On this occasion though, Mr Grey seems
to have a good understanding. He begins to tell me about his disease and how
it has affected his life. In the middle of this, his wife interrupts and tells me that
she is also not well. She explains at length about her back problem. As she talks,
she opens her handbag and takes out a large tensor bandage that she places on
my coffee table. She tells me she uses this to support her back and usually puts
it on before she leaves the house. She then proceeds to remove her sweater.
Initially I try to convince myself this is not happening, but eventually I have
to face the fact that Mrs Grey is sitting in my office in a blue satin bra around
which she winds the bandage in a criss-cross manner. Mr Grey completely
ignores this and continues with his story. Eventually both the bandaging and
the application are complete and they prepare to leave my office.
I think about this incident and about other people who have taken their
clothing off in my office. The others though, were cancer patients who insisted

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442 Qualitative Social Work 6(4)

on showing me their battle scars. Although I try to stop people doing this, I
was never very successful if the person was determined. Arthur Frank (1995)
might call these people wounded storytellers and see the wounds as giving them
narrative power. I would like to believe this. Sometimes I suspect that some feel
they have to prove their worthiness when asking for help. It is this that makes
me uncomfortable. I look at my watch and see that its noon. Just as I am about
to leave for lunch the chemo clinic calls, asking me to see a woman who is
distressed over lack of funds and needs to see me right away. At times like this
I recall a colleague telling me that she would often respond to what she felt
were non-urgent right away calls by noting that social work is not a drive
through. I hesitate but for once stand my ground and arrange for her to come
to my office at 1:00 pm.
I go to the auditorium for the noon lecture and sit with my social work
colleagues. The lecture is on tuberculosis. I hear that one third of the world is
infected. Later, I wonder if I heard this correctly. A pharmaceutical company is
sponsoring the lunch. We sit eating chicken and salad while the doctor talks
about drug resistant strains of TB. Did we know that the bacteria stay in the
air for several hours? In the middle of the lecture a code blue is called. The
lecture stops and for a brief moment we are conscious of a life held in the
balance that in some inexplicable way we are all connected to. Its on my
colleagues floor. Do you know who that is? I ask. Could be anyone, she
replies. Vicki works on telemetry, where all the patients are on heart monitors.
The lecture ends and we leave the auditorium trying not to think about the
air we are breathing.
When I return to my office I find a middle-aged woman sitting in the
waiting room. She clutches a breast prosthesis. I want you to sell this for me,
she states. Dr Wood says you can do this. I have no money and must sell it. I
ask her to come into my office and to elaborate on the problem. Apparently
she and her son had bought a prosthesis each and she only needs one. She tells
me that it cannot be returned. I consider asking her how such a thing might
happen, but remember I have only a short time before the other clinic begins.
I tell her in as polite a way as I can that I cant engage in financial transactions
with patients. She doesnt seem to hear this and I eventually say that I hardly
ever see patients who ask me to obtain such an item for them. She sighs. I ask
about her home and financial situation. She lives with her son but has only a
widows pension from her late husband. She has never worked in Canada and
is not of pensionable age. Eventually she prepares to leave my office. I urge her
to take the breast with her, but she insists that its too heavy to carry. I place
it on my shelf and she leaves.
I look in the waiting room and in the geriatricians office. I see neither
the geriatrician nor the first patient a reprieve. I begin typing notes from my
morning appointments into the computerized chart. I see that I have written

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Craig Day in the Life of a Hospital Social Worker 443

a few times full note to follow later. I tell myself not to write this again unless
I can be sure I will actually be able to do it.
Eventually both the geriatrician and the first patient arrive. I usually see
the family while Dr Z sees the patient. Mrs Watts is here with her middle-aged
son James. She has advanced Alzheimers disease and for the past few months
James has been sleeping in the kitchen with his mother in the living room. He
is afraid she might fall down the stairs when she wanders from her bedroom at
night. James yearns for his life back but is consumed with guilt about abandoning his mother. Dr Z and I wonder if when a bed is offered at a nursing home,
he will be able to accept it.
Just as the next family arrives I am paged to the ER. Dr Z says she can
manage and I leave her with Gina and her mother. Ginas mother has lost the
ability to recognize her face in the mirror and often tells Gina to get that woman
who has stolen her clothes. In the ER I am asked to see Rose, a
69-year-old woman, brought in by ambulance, who was swearing at the nurses.
This time the reason for referral was noted. Rose was an EU (emotionally
upset). The chart revealed that Rose was also a cancer patient with a metastatic
disease. She had received surgery and chemotherapy at the hospital some time
ago. She also had a colostomy that she apparently refused to care for herself.
I find Rose lying on a stretcher in a private room, complaining loudly
and swearing at the nurse.Get me out of here she demands. I introduce myself
and ask what brought her to the hospital. I have cancer, isnt that all you need
to know? she yells, after which she promptly curses God. Further conversation
reveals that God is a prominent entity in Roses life. He is, at the same time,
someone in whom she does not believe, yet who is clearly to blame for all her
suffering. After more cursing, she asks me pointedly if she is going to die.
Never an easy question, however one chooses to respond. I carefully ask Rose
what her doctors have told her. She swears some more and then says that she
surely is going to die because cancer kills you know. I am silent for a moment
and Rose looks at me. Can you get me a cocktail? she asks. I smile and tell
her I dont think this is allowed. Rose begins to tell me about growing up in
California and how she had her first cocktail there. She later married
and moved to Toronto with her Canadian husband. Her brother remains in
California. I speak with the nurse to see what is going to happen to Rose. She
is being admitted for medical reasons. I tell her this and this time she doesnt
object. She asks me to call her husband and her brother. I tell her Ill do this
and will seek her out tomorrow on the inpatient floor. We say goodbye and I
return to the clinic, relieved that I was able to connect with her in this brief
encounter.
The next patient is already in the office with Dr Z so I take the opportunity to input some assessments. After a while I go down to the Second Cup,
buy two expensive cups of coffee and return to the clinic where Dr Z and I

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444 Qualitative Social Work 6(4)

discuss todays patients. We wonder what it must be like to look in the mirror
and not recognize yourself.
Its 5:15 when I return to my own office. I think about entering my
statistics, an official accounting of my time. I am already a couple of days
behind but I feel too tired to do this. I page my friend, a social work colleague
to see if she would like a ride to the subway. I meet her in the lobby and we
both drive home.

CONCLUSION
Social work practice is often referred to as both an art and a science. But regardless of where science fits into the scheme of the profession, art is what we do,
what we use interpretively, imaginatively and creatively . . .
(Howard Goldstein, 1992: 51)

While both scientific and artistic methods provide us with different ways of
knowing (Hartman, 1990), narrative methods allow a window into the lived
experience that other research does not (Swenson, 2004: 451).
The personal narrative in particular, offers an innovative and memorable
way for individual social workers to present a more accurate understanding of
their role in various settings. It also enables us to reclaim a language of care that
Weick suggests, social work has let slip through its fingers (Weick, 2000: 400).
Finding new ways to present our role seems especially important now,
not only for those of us in hospitals whose positions are being threatened
(Nelson, 2004), but for social workers in the general community who are
engaging in image campaigns in order to bring forward a more realistic view
of their work ( Jackson, 2004). Used in this way, the genre of personal narrative can also be seen as a tool of advocacy for both our clients and ourselves
(Chambon, 2004).
Acknowledgements

The anonymous reviewers for their helpful suggestions; Barry Craig; Matthew Craig and
my colleagues; Christina Black, MSW, RSW at Baycrest Hospital, and Susan Cooperstock, MSW, RSW at Humber River Regional Hospital, with whom I had many conversations about the issues discussed in this article.
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Rita Wilder Craig is a social worker in inpatient mental health at an acute

care community hospital in Metropolitan Toronto. She received her social work
education at both York University and the University of Toronto. She is a
member of the Ontario College of Social Workers and Social Service Workers,
the Ontario Association of Social Workers and the Canadian Society of Counsellors and Therapists. She has published narratives of social work in the Journal
of Palliative Care and Reflections: Narratives of Professional Helping and a narrative
poem (in press) in the journal Canadian Woman Studies. She has presented narratives in many different places including national and international conferences,
at hospital Grand Rounds and to students of social work. Address: Rita Wilder
Craig MSW, RSW, Humber River Regional Hospital, 2175 Keele Street,
Toronto, ON, Canada. [email: rcraig@hrrh.on.ca]

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