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Into the Void: The Tragedy of Lynne Spalding's Disappearance Is How Close at Hand She Was Lost 

Tuesday, Nov 4 2014
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At 9 p.m., a note of a disappeared patient was logged for the next security shift. Spalding had been transformed again: This time, she was described as Asian. (Spalding was, again, white.)

But that message never got through, either.

The hospital is no stranger to what are known as AWOL patients — Away Without Leave. From January to October 2013, 96 patients had gone missing. As for deaths and serious injuries resulting from these disappearances, no such cases had officially occurred there during the previous decade. (In 2012, there were 16 such cases statewide.)

San Francisco General Hospital is not unique in dealing with AWOLs. According to 2011 data from the state, 38,333 patients in California either left a hospital without informing the staff or signed a statement to leave despite medical advice to the contrary. Hospitals are not legally able to make patients stay in their care except in certain extreme cases, so when patients walk away, they can't be stopped. This bit of chaos is baked into a modern hospital's programming and nearly impossible to change. Spalding's disappearance was one more noise in a noisy system.

The stairwell Spalding walked into is a tall square tower attached to the outside of the hospital. Each floor's blue exit door opens onto an outdoor landing where another door leads down into the stairwell. At the bottom of the shaft, five stories below, an unlocked door opens onto the street.

From the fifth-floor landing, past the netting strung up to stop pigeons roosting, a courtyard can be seen. Red brick hospital buildings — older than the main facility — enclose two patches of grass and a couple of benches. Trees grow along the brick buildings' edges and cast their shade on bright flower beds below.

This is where Spalding found herself on the morning of Sept. 21. She may have been confused and delirious. That delirium — and the fact that the doors into the hospital on the floors below her were all locked — may have been what kept her from walking to the bottom of the stairwell. If she had, she'd have found her salvation: an unlocked exit door opening to the outside.

Delirium or no, Spalding was not the first person who failed to find that exit door.

A woman visiting her son in the hospital in June 2013 had inadvertently walked out of a similar emergency exit only to find the door locked behind her.

She banged on the door but no one came to help. She walked a flight down to the next floor, tried to open a locked door, and then did the same several stories below. Both doors were locked. She started to get frantic. Fifteen minutes passed before a nurse finally heard the banging and opened the door.

Unlike Spalding, this woman wasn't sick. She wasn't confused about where she was. Still, she'd been frightened about not being able to get out.

"No one heard me," she wrote in an email to the hospital after hearing about Spalding's case. "I was fearful of going through another door [at the bottom of the stairwell] in case it also locked behind me and I became trapped further."

The day of her disappearance, hospital security told Spalding's daughter she should call the police and report her mother as a missing person. She did.

Soon after the call, a sheriff's deputy told another security staffer that "the person was going to be discharged anyway and she decided to take off and then her daughter made a stink about it. That's all that was."

The first campus-wide search wasn't conducted until the afternoon of Sept. 30, nearly 10 days after she'd gone missing. But the Sheriff's Department's search did not include all stairwells. It missed the stairwell she was trapped in. A second search on Oct. 1, meant to fix the oversight, repeated the mistake.

In the meantime, Casey and Spalding's family organized their own search. "We put up fliers all over the city," he says.

Images of Spalding's face were stapled to neighborhood light poles and passed out to the hospital staff.

A Facebook page was started for her. In the About section it read, "My lovely friend Lynne Spalding has been missing for three days now, have you seen her?"

Everyone thought she had wandered off the hospital grounds.

The fliers and Facebook page sent them on wild goose chases, says Casey. They'd get calls about sightings in the Tenderloin or other areas and they'd rush to the neighborhood and find no one.

"If we had known she might still be in the hospital, we would never be out canvassing the whole city. We would be searching the hospital," a spokesman for her family later told the San Jose Mercury News.

Spalding was actually found twice.

The first time was on Oct. 4, when a UCSF researcher came upon her just after 7 a.m. She was lying on the concrete floor of the stairwell in her street clothes: a black-and-white jacket, black jeans, black boots.

A call was made to the hospital's security, notifying them that someone was lying in the stairwell on the third or fourth floor. "We'll take care of it," the caller was told by security.

No one came.

Spalding was discovered the second and final time by a maintenance man. He was doing a routine check of the emergency stairwell and found her at about 10 a.m. on Oct. 8.

This time around, she made it out of the hospital. Spalding left through the unlocked door at the bottom of the stairwell. She was carried out on a gurney, swaddled in white sheets. The IV insertion tubes from her treatment were still in her arms.

Seventeen days had passed since she'd gone missing.

The long ordeal had been fatal. Spalding's delirium was caused by clinical sepsis, a condition brought on by infection that can cause organ failure. But she died of an electrolyte imbalance complicated by alcoholism. It's hard to know exactly when she died and how lucid she was in her final days. Even the medical examiner's report has few details to fill in the blanks. It didn't even list a date of death. It only said she had been dead for "some" days before she was found.

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Jonah Owen Lamb

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