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patients’ personal lives that captured my interest on a daily basis.
And it was these same stories that unsettled me deeply as I spent
more and more time in the “drunk tank” in the back of the ED.
Intoxication. Hearing voices. Intoxicated. Found wandering. ETOH.
Hallucinations. Heroin OD. Took “a bunch of pills.” SI. Intoxication.
“No place to go.” SI. Too drunk for jail. OD. “Hearing voices.” Heroin.
ETOH. SI. Heroin OD. Found down. ETOH. SI. Intoxicated. OD.
ETOH. “Doesn’t want to live.” ETOH.
The very existence of a place like an emergency department with
doors that are never closed, fully staffed with doctors, nurses, and
social workers, is an unbelievable blessing for society in more ways
that I can even count. It has essentially become the solution to every
problem having to do with medical emergencies in everyday life,
and it is often taken for granted in a world where everything from
hamburgers and TV shows to appendectomies and cardiac catheterizations is expected to be drive-through and on-demand. Emergency
departments are the safety net of and for our health care system, but
should they also be the safety net for social responsibility?
No generalization can encapsulate the range of circumstances
surrounding each individual’s odyssey toward becoming a “regular”
in the ED, and surely there would be great variation in the degree of
sympathy with which those men and women would be viewed by
many, in accord with the degree to which personal choice, rather
than situational misfortune or socioeconomic disadvantage, played
a role in forming his or her current self. Nevertheless, the plight of
these individuals - these patients - refuses to leave my mind.
It is clear that many of these individuals either should be or already
are patients of psychiatry, and it is only natural that some of them
may occasionally slip through the cracks of the system and land in
the ED, as is the case for patients in all other areas of medicine. But
to label and group all of these men and women into that category
and dismiss their collective affliction by writing it off as “just the
way it is” would be a disservice to all of humanity. Additionally, it
should not be the responsibility of inner-city emergency departments
around the country to shoulder the burden of taking care of all of
these individuals. The patience and compassion that I witnessed in
so many physicians and nurses, not to mention the oft-overlooked
and under-appreciated techs, in their dealings with these men and
women was encouraging, if not inspiring.
These patients taught me that they are not the products of a defective health care system, but of a defective society. They taught
me that it is not health care workers who need to do more for them,
but their communities that do. They taught me that they did not
slip through the cracks, but were born in the abyss.
They taught me that we, as fellow human beings, are not doing
enough.
Note: Stephen Love is a second year medical student at the University
of Louisville with an interest in psychiatry.
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