Naked and Homeless

The police came at about 5 AM to the ER with a strange request. They needed a patient gown. They wondered if we might have an extra one. We gave them two. One for the front and one for the back.

We were highly motivated to assist the policemen. Not just because we liked the officers on duty, nor because they had come to assist us in the ER a few times in the past (using tasers, bean bag shotguns, and various other toys) when we had violent patients. No, in this case we were motivated because the gowns were needed for a patient who had recently escaped the ER by breaking down a door and running out into the streets. Not only that, she had run out into 48 degree temperatures, quite cold for our part of Florida, and although she was gowned appropriately at the time she left, we were concerned for her safety and well being.

The patient was apprehended not long after her escape by the police, who found her jogging naked down the street. This was both a relief, and a cause for concern (or amusement) depending on the mood and personality of the health care worker receiving the news. The naked part was not that surprising, since the patient had initially arrived dressed in her usual “business attire” with both nipples exposed to anyone willing to look. Such a presentation is not all that uncommon among street prostitutes, or those involved in our thriving local drug trade.

After the patient was covered front and back with the hospital gowns, she was placed back in the police car to be taken to jail (for assaulting a health care worker prior to her “escape”). This outcome was of course applauded by the ER staff, but then the conversation inevitably turned to our many local ER patrons who are “frequent fliers”. So often they come with dishonesty or “lack of candor” about their illnesses. Sometimes they present lying about their substance abuse, and no explanation for why they have $3,000 cash stuffed in their underwear. Nearly always they vastly underestimate their alcohol consumption. They place an enormous burden on ER staff across the country.

We have liberals, conservatives, and apolitical types in the ER. And we all pretty much agree that there is no conceivable government program or hospital solution that will end substance abuse, alcoholism, or prostitution. Nothing will stop patients from lying to police or health care workers, or abandoning their families, or choosing drugs over their jobs. Human nature being what it is, some persons will always choose to be lazy, or idle or dishonest. Some will be thieves or prostitutes (or worse yet, politicians).

These conversations inevitably lead to one of two conclusions. Some want to give up, saying you can’t fix human nature. Some insist there has to be an answer, people are valuable. I agree… with both camps.

Although it may be true that we cannot “fix” human nature, there are two areas of action where we can make a dent in these horrendous destroyers of humanity.

The first is the purview of pastors, the second is the province of politicians.

If we can intervene early and often in the lives of children and adolescents to provide worth, structure, a loving family, a caring adult, a hope for the future… research has shown that the odds of a child living a productive and happy life are vastly higher when they grow up in a supportive and caring environment. I am all for this, and I encourage all efforts, faith based and otherwise, to enhance the value and ostensible worth of all lives. This can admittedly be quite complex, because the very same behaviors we are seeing in the ER (homelessness, mental illness, alcoholism, substance abuse, prostitution) also inflict serious, sometimes lifelong emotional damage on any children in proximity to these behaviors. And the same adults we are “rescuing” daily or weekly from their indulgences are sometimes inflicting serious emotional damage on their own children and families.

But what of those already afflicted in the current pandemic of alcoholism, homelessness, alcoholism, and crime? Is there hope to end this suffering? Have we finally passed enough legislation to end these blights on humanity? (Resoundingly NO.) Or are the very government programs designed to alleviate suffering, sometimes making the problems worse? (Sometimes, unfortunately, YES.)

And this is where we enter the province of politicians. You may sense that I do not always hold politicians in high esteem. It is true. But politicians have a place, and I do not wish to demean the office to the point where no decent, honorable or honest person would run for office. For if and when we reach that point (and I fear we are ever so close) our nation is doomed.

Nevertheless, what can we do about our naked, substance abusing, homeless, aggressive prostitute? After all, we provided her, and hundreds of other alcoholics and substance abusers, a place to sleep, food to eat, and a bus pass as they were leaving. We worked them up in their stupor with lab work and CT scans that often cost thousands or tens of thousands of dollars… the costs of which are shifted to more upstanding citizens with insurance. We speak to them with respect and offer psychiatrists for those who are severely depressed, homicidal, or suicidal. We “believe them” and take it seriously when they say they are suicidal, even though every fiber of our experience and professional training tell us they are lying, and all they really want is “3 hots and a cot”. What more can we do?

Are we helping these patients at all? We probable prevent some withdrawal seizures. Perhaps we are occasionally able to prevent a suicide or homicide. I am certainly happy at these benefits of our ministrations. But more often, are we not merely helping them be better, more successful drug addicts? Are we not just removing the natural consequences of substance abuse and alcoholism, taking away the very discomforts and inconveniences which might drive a man or woman to sobriety?

Tens of thousands of times every day across this country this process repeats itself. A patient spends their last dime on drugs or alcohol, then runs to a local ER for treatment of their DT’s, or their falls, or their confusion, or for free food. Sometimes it is just for a warm bed because all their rent money went to cocaine. And we provide.

And the next day or the next week the cycle repeats, and they come in again with an alcohol level 5 or 6 times the legal limit. Or maybe comatose this time from opiate OD, or agitated, hallucinating, and aggressive on cocaine. And we do it all again… and again… and again.

I cannot tell you the cost to society that this represents. In some ways I do not even care. My question is simply this. Are we harming our patient? With all our coddling and warm fuzzies, are we actually making lives, families and society WORSE rather than making them better?

I believe many times we are.

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Emergency Room Physician. Student of science and student of scripture. Defending truth in a post-truth society. I believe that Truth exists, and I believe it is our duty and privilege to seek it out, amidst ignorance, frivolity, and misconceptions.

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