Injuries of the working class or “if you get hurt, do it at work.”

This is the fourth in a series of workplace analysis pieces. The third is here

I work near an inpatient facility where they house folks who can’t take care of themselves. Mostly the people with severe cognitive disabilities. It bills itself as “a residential community with therapeutic and medical support services.” The employees there get wrecked.

I think about 10% of our patients work at the facility and the injuries are pretty staggering. Falls form loading docks resulting in a combination of wrist, shoulder and hip injuries while understaffed, combined shoulder and neck injuries from restraining residents while understaffed, slipping on ice while delivering food to the houses on a tight schedule while understaffed. You get the picture.

The second guy injured his shoulder while restraining a patient, tore his labrum, and wasn’t place on modified duty. During our evaluation, I told him he had a roughly 50-50% shot of doing well with conservative management versus needing surgery. He then went back to work, hurt himself again while restraining a patient, setting himself a month back. Was placed on modified duty finally, but got talked into one-on-one ing a resident who was supposed to be a two-on-one for supervision and got hurt again.

We’re getting back to better finally, but he asked to get back to normal duty soon. I asked him why not stay on modified duty. He responded that him not being able to restrain patients meant that more patients would actually get the two-on-one coverage they needed, and would force the supervisors to do something more than sitting in their offices, but he felt strange not working. I convinced him of the advantage of staying on modified duty.

My slipped-on-ice gal is maybe my favorite patient of all time. Definitely undiagnosed ADHD, in her 60’s. Maybe the best grandmother alive. Grew up running wild in the Dragoon mountains in Arizona and says she knows where an old conquistador grave is. Funny as hell, hates cops. Anyways she fell on ice and landed on her hip while running back and forth from a slowly moving truck, dropping trays of food off at client houses. She then kept working on it and developed chronic pain in her gluteal muscles, put on a bunch of weight, and is struggling to get back to her prior level of activity. Her boss says that anyone cleared at all by the doctor is “100%” and won’t modify duty for her.

She wants to get back to work because she has pride in it. She’s good at making sure the diets are nutritious and meet resident’s dietary restrictions. She’s efficient in the kitchen and makes good food. Plus, she’s competitive with her coworkers in a friendly way. Her son desperately wants her not to go back. Covid’s running rampant around here, and she almost died of a respiratory infection a few years ago. I tried to convince her to retire early, but the best she’ll do for herself is work a year more until she gets a full ten at the facility, hoping for better retirement.

The people have a lot of pride in their work based on the camraderie with their workmates, and being excellent at their job.They’re also a little resigned. I’m not sure they see a path to meaningful change in the conditions of their labor, and I can’t say I can either. There’s a feeling of inevitability to it all, since everyone there gets hurt. They’re proud of their injuries, having come and gone from the clinic 3-4 times over the past 10 years ifI had to guess.

The ones who get through my door on work comp get taken care of well, actually. It’s rare I don’t see them getting adequate healthcare (if not excessive, there’s a lot of wasted care/overutilization when the payer is willing to shell out big bucks), and they get paid.

As a patient of mine who got thrown 100’ feet from a semi once told me “if you get hurt, do it at work.”