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Lady Liberty Emergency

Walker, Graham MD

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doi: 10.1097/01.EEM.0000516450.22370.52
    homeless, poor
    homeless, poor:
    homeless, poor

    “The New Colossus”

    Not like the brazen giant of Greek fame,

    With conquering limbs astride from land to land;

    Here at our sea-washed, sunset gates shall stand

    A mighty woman with a torch, whose flame

    Is the imprisoned lightning, and her name

    Mother of Exiles. From her beacon-hand

    Glows world-wide welcome; her mild eyes command

    The air-bridged harbor that twin cities frame.

    Keep, ancient lands, your storied pomp!” cries she

    With silent lips. “Give me your tired, your poor,

    Your huddled masses yearning to breathe free,

    The wretched refuse of your teeming shore.

    Send these, the homeless, tempest-tost to me,

    I lift my lamp beside the golden door!

    Most of you probably know this sonnet. It's engraved on the base of the Statue of Liberty, and was written by Emma Lazarus to raise money for the pedestal upon which Lady Liberty stands. (The next time you're in New York, it's worth the trip out to see her. It's hard to believe the statue was forged in the 1870s and designed using only pen and paper.)

    I was thinking about the “huddled masses” part of the poem in relation to the patients we see in the emergency department. We too take in the tired, the poor, and those yearning to breathe as well as the homeless and the wretched refuse. We don't usually care too much for storied pomp; we in the ED just want to take care of people who need it and move on.

    Emergency physicians also see a number of people who are often hidden from society. Medicine in general cares for people who are unwell and perhaps homebound, but we emergency providers end up seeing the patients who won't even see their own doctors. Whether it's from depression, substance use, neurosis, dementia, cost, or pure stubbornness and pride, many of our bread-and-butter ED patients are hidden from the rest of society — and even from the rest of medicine.

    Where in your normal, non-ED life would you end up bumping into some of our patients? I know in my routines, I probably never would — and never have. These are people who don't get out of the house. They don't go to the grocery store or the post office. Some are shut-ins of their own choice, while others are trapped by their own bodies and illnesses. They are our neighbors, and we don't even know them.

    It's a shame that it's so easy for most people never to interact with someone who is in a whole different sphere from where they are (and this has only worsened in our own social media echo chambers and bubbles). Would your spouse, your child, or your sibling ever find themselves interacting with someone who is chronically ill? Demented? Homeless? Dying? Or just elderly? If I weren't an emergency physician, I doubt I would either.

    We hide the infirm in our society, the same way we hide and deny death, and the hiding itself is very apparent. It shows in how fewer and fewer people have reasonable expectations about life and death and about injury and healing. If you don't know anyone who has died or anyone with chronic illness, it's hard to understand living and dying as well as health and illness. I see this in how people drop off their loved ones and leave them for us to manage. Or in how we make safe little communities and only interact with people from our own social class. Or in how we put the elderly in nursing homes instead of caring for them as our family. Even our own blood relatives are cared for by strangers.

    Every so often, someone will have befriended an elderly neighbor and bring him to the ED for his COPD exacerbations or his dementia and confusion. I'm always so happy to see people like this still exist in the world because it seems that our communities don't have nearly enough support for the isolated and the ill.

    If it takes a village to raise a child, it takes one to care for our ill as well. The more people get to know these “huddled masses,” the better our whole society will be. If they care for each other and see the ups and downs of people dealing with true medical illness, then maybe they'll start understanding what living and dying actually mean.

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