IN POOR COMMUNITIES, stable access
to medicine is rare. Frequent moves
mean frequent changes in insurance,
Medicare eligibility and transportation
ability to a new doctor.
When the food runs out, when the
housing runs out, when the relation-
ships break, paramedics are people’s
last resource.
We have a regular patient in my city
named Leena*. Her temperament is that
of an underfed child. She flips a switch
in an instant between happy and angry,
laughing and crying, co-operative or
spitting at us. She calls us in the middleof the night because she ran out of
vodka or her bus driver looked at her
the wrong way. She likes to describe
her sexual escapades in uncomfort-
able detail and has thrown punches at
paramedics with little warning.
A strong series of laws prevents me
from “patient abandonment,” which is
what it’s legally called if I were to sit
down with her and say no—if I told
her, “Honey, you’ve called us nine
times in the last four days. You got
kicked out of the emergency room this
morning for spitting on a nurse. You
got kicked out of your last shelter forfighting a guard. You don’t even have
a medical complaint; you’re just tired.
I get it, the sun’s going down, and the
sidewalk is cracked, and the rats come
out soon, and that sucks. I hear you.
I wish there was something I could do.
But the ER is supposed to be for med-
ical emergencies, for people who are
dying. And there could be someone
like that trying to call us right now, but
we can’t help them because we’re here
with you. Again.”
I wish I could be the person who got
these patients into a long-term care
facility, who got them therapy, whosingle-handedly lifted them from the
darkness. But all I can do is put them
on the gurney and take them back to
the hospital.
I was trained in school to react in a
matter of seconds to life-or-death situ-
ations: open the airway, stop the bleed-
ing. Emergencies. But for someone like
Leena, being tired and alone is an
emergency. Her life has gotten so far
outside of her control that she can’t see
more than an hour from now. And in
the next hour, the sun’s going to set
and the night fog’s coming in. Instead
of leaving her on the street, I try to talkI WAS TRAINED TO REACT TO LIFE-OR-DEATH
SITUATIONS. BUT FOR SOME PATIENTS, BEING
TIRED AND ALONE IS AN EMERGENCY.reader’s digest
76 september 2019