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Life in Emergistan

Life in Emergistan

No Matter What, EDs Care for Everyone

Leap, Edwin MD

doi: 10.1097/01.EEM.0000695588.55397.fe
    front line

    I have always loved history, but a lifetime in medicine makes me consider it in more personal ways. When I drive through the Appalachians and see a chimney standing alone by a creek, I wonder how long ago the house fell in or burned, who the last person was to call that place home, if he is still alive, and if there is anyone who knows that his great-grandparents raised a family there by the creek.

    I think the same about medicine. I contemplate on lonely mountain roads what happened 70 or 80 years ago when a person was injured, whether in a car, by a horse, or under a falling log. Where was he taken? Down the mountain to a basic hospital? To the house of a doctor? Did he have a chance? Was he remembered if he succumbed to injuries far from home?

    For all the ways that we're imperfect, the modern world of medicine is breathtaking in scope and compassion. Yes, it's expensive, and sometimes we do the wrong things. But on the balance, whatever happens to a person short of death (at least in the United States), he won't be taken to someone's house or left to suffer, and he won't be buried alone in the woods. Odds are he'll end up in some large or small emergency department staffed by our excellent colleagues.

    No matter where he is, who he is, how dirty he is, how difficult he is, someone will put him in a room and talk with him. Thanks to compassionate professionalism (and federal law), that care will not be predicated on money or insurance.

    However he smells, his clothes will be taken off, and however bloody his wounds, they will be cleaned, closed, and dressed. If he is wildly schizophrenic or his brain is basted in methamphetamine or alcohol, someone will try to calm him, temporarily restrain him for safety, and medicate him.

    However depressed or suicidal he is, however many times it has been said before, someone will try to see just how much of a danger he is and decide (yet again, with a bit of cynicism and weariness) if he needs to be committed to a facility. The staff may just decide to keep him in the ED for another day, another assessment, and a few more sandwiches. Sometimes just because he is homeless and has no options.

    Hope for All

    If that patient is in handcuffs, if he has been arrested for what seems like a terrible crime, he will still have his illness and injury evaluated. Whether it's the pre-incarceration physical due to chest pain, pepper spray in the eyes, or a gunshot wound to the chest, he will be treated appropriately. The same is true for the officer, stabbed, shot, or beaten, who comes to the hospital in the midst of chaos and danger. Every effort will be made to return him to the family he loves.

    However our colleagues feel about the T-shirt or tattoo on a patient, however vile the words he utters may be, the physicians, nurses, medics, clerks, and others who populate our world will do the right thing. They are remarkably adept at seeing the person behind the symbology, whatever viewpoint it represents, right or left, red or blue, up or down or sideways.

    There were doubtless times in history when a physician would simply look at that difficult, dirty, angry, confused, insulting patient and have him dragged to the curb, cursing and threatening, even if he was bleeding, crying, hurting, or dying. Civilizations in the past seldom had anything like the safety net of our hospitals and our professionals. The weak, poor, and dying simply lied down, looked up at a fading sky, whispered to their deities, closed their tear-filled eyes, ceased their wheezing, gasping breaths, and bled out in the dirt. Then they were dragged away unceremoniously.

    That is no longer the way, of course, not since we embraced an idea, a belief that has guided us with increasing clarity for millennia—the fundamental, intrinsic worth of the people who come to us and of every human being. Do we always do this perfectly? Hardly. But as I have worked around the country and watched as men and women working in emergency departments have lavished their time and energy on everyone, have exposed themselves to assault and infection, have worn themselves down for years, given themselves to every kind of person who came through the door, I have come to stand in awe.

    The men and women of emergency departments are often as broken and difficult as the most broken and difficult patients. But through it all, no matter what, they put all of that aside and care for the sick, the wounded, the psychotic, the addicted, the violent, and the dying.

    This is an expensive ethos in monetary terms, but it is priceless in terms of the humanity it conveys to society's bottom rungs, and it elevates and gives hope to us all.

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    Dr. Leappractices emergency medicine in rural South Carolina, is a member of the board of directors for the South Carolina College of Emergency Physicians and an op-ed columnist for the Greenville News. He is also the author of four books, Life in Emergistan, available, and Working Knights, Cats Don't Hike, and The Practice Test, all available, and of a blog, Follow him on Twitter@edwinleap, and read his past columns at

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