Agraphia Medical Tragicomedy



"Hey, brotha. I need help. Look, I'm not gonna shit you, I'm an alcoholic. I'm homeless. I've got back pain. You can help me, you're a doctor. I need Ativan so I don't go into DT's and some Percocet for my pain.  Please, brotha,  I lay myself at your feet."

Before me lies an emaciated husk of a man, frost-bitten, his bleach-blonde hair pulled into dirty dreadlocks. The room reeks of alcohol, the tang of shitty beer lying uncomfortably in the air.  His bloodshot eyes track me as I walk over to examine him.

This was my first introduction to our resident frequent flier. He's famous; every ER doc in the city has treated him for everything from alcohol withdrawal to blood infections.  Among other things, he's an asshole, a florid alcoholic, and an abuser of the system (a news article estimated his ambulance rides, ER visits, and ICU stays costing the taxpayer more than $10 million).

Unsurprisingly, my exam is unremarkable. It's freezing out, and the ER is a refuge for a few hours from the biting cold and the unforgiving streets. I prepare myself for his discharge, and give him his papers.

"Your exam is normal today. I can't find a reason that your back hurts. I'm sending you home."

"Fuck you, man. I can already tell, I can't change your mind. I know your type. Yea, I'll fuckin' go. You know how cold it is outside? Yea, I'll fuckin' go. I'll go, you privileged sumbitch. You have no idea what it's like to be homeless."

He leaves without much fuss. A nurse claps me on the back for handling him well. She thinks my no-nonsense attitude approach will serve me well as an ER doc.  All the same, a small voice in the back of my head wonders if I should have been more compassionate.

The rest of the shift goes uneventfully, and as I drive home, I notice it's cold out, cold enough to freeze the windshield on my car. I run inside my heated house and crack a beer. Life is good.

"You have no idea..."

Out of guilt, I throw on a sweater and my overcoat, and shuffle outside. It is bitingly cold; I start shivering instantly. The stars are frigid, beautiful, and unforgiving, the moon austere behind a single veil of cloud. He was only wearing a sweater and some thin pants when I discharged him. He must be freezing right now. I last all of 5 minutes; my teeth chatter so hard I fear I'll break the enamel. I rush inside, the warmth enveloping me like an old friend.

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  1. Its not your fault, brother. Don’t let it get to you. Likely your city has a place to go, but they require that he stay sober so he picked drink and the street. The right choice is not always the one that will make you feel good; giving him pain pills would have been unhelpful medically and unethical. Give some money to a shelter in town and let it go.

  2. you could have called around for a local homeless shelter to see if they had any beds open and told him to go there instead of using the hospital resources because its expensive

  3. Not quite that easy, Justin. Most shelters close at night, fill up, or simply don’t have beds that day. We’re open 24/7 though, and they know full well that we are legally obligated to give them a medical screening examination.

  4. It’s never easy, but you made the right call.

    These people have a way of making YOU feel guilty for working hard and trying to make something of yourself. Even though they’re the one with the problem.

  5. I know this is old, regardless…..It least the guy was honest. He told you he was a homless drunk. That is more then you get out of half the white collar drug seekers. His back might have actually hurt. Maybe from shaking all night from the cold or DTs. If he were going threw withdrawl any pain would feel 100x worse then what is. Muscles tighten and contract. There wouldn’t be any great findings maybe a muscle spasm. If anything you could have it least tryed getting him into in patient detox or a pysch eval.He might have stayed to detox because he would have a place to stay VS the cold
    In turn he might have actually got clean. There is a lot of ifs or mights here. You’ll never know because you didnt give him options. To Doctor Grumpy “these people” fantastic wording.You dont no what “these people” been threw. You already make your mind up on what type of people your treating before they even speak.You took an oath to help people. If your burnt out maybe its time to call it quits.

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