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As I come to know these fine people, they share with me more of their personal and sensitive stories. Their collective story is what I am trying to share with you as my way of breaking the stereotypical beliefs that exist. "Blog names" have occasionally been given to me by the person whose story I am telling. Names are never their actual names and wherever I can do so, I might use the opposite pronoun (his/her, etc.) just to help increase their privacy.

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Tuesday, December 4, 2018

Dear Emergency Room and Urgent Care Staff,

Dear Emergency Room and Urgent Care Staff,

More than once, I have sat with a man or woman as they have been treated in your facility. On occasion, these good people have been admitted to your hospital for the primary cause of their visit.  Almost always, that cause has as its underlying issue, the addiction for which they suffer and the lifestyle that this addiction brings.  Pneumonia[1], acute diarrhea[2], bruises and breaks, slashes to the face, black eyes and torn ligaments from being hit by cars, motorcycles and abusive 'dates' are a few examples.   Pre-existing conditions made worse by life on the streets include diabetes[3], epilepsy[4], multiple sclerosis[5], arthritis[6] and more. 

For the many who come to you for service and don't need to be admitted for their presenting medical issues, far too often, I've seen you say "Have a good day."   Occasionally, and far less than most of the time, I've seen you hand them a sheet of paper with names and phone numbers "of places that might be able to help you (tomorrow or on Monday when they reopen) with your addiction."

As they leave patched up but still emotionally/spiritually bleeding to death from their addiction of which you were fully aware and did not apply your medical training, you are setting them up for additional crisis of which you may not be aware.

When you say "Have a good day." to that man you've treated, he leaves to continue his day, not feeling well from whatever brought him to you but on the mend thanks to whatever treatment you've provided.  He will go to his local street corner to 'fly a sign' that says "Hungry".  His increasingly emaciated appearance will actually help prove his case to folks who get stuck at his red light and are forced to consider this man for a minute.  Some may actually give him some change or random food item that they happen to have.  Others may yell or spit at him.  Some who know they won't get stuck at that light will throw things at him as they pass by.

When you say "Have a good day." to that woman you've treated, she leaves to continue her day, not feeling well from whatever brought her to you but on the mend thanks to whatever treatment you've provided. 

She will go to her local street corner to stand there well dressed seemingly waiting for a specific person to pick her up for a meeting when in fact she's standing there well dressed waiting for that random male to pick her up to use her for his own purposes.

Her increasingly emaciated appearance will actually hinder her ability to find a "safe date."  Through her own experiences and those of other ladies on the street, she will begin to realize that her natural physical beauty has faded to the point where "the only dates I can get are with guys who want to hurt ugly girls like me."

Some guy will stop to scan her and decide "She'll do."[7]  With fear, she gets into his broken down car or classy high end vehicle and they drive away. 

Half a day after being in your health care facility and four hours after hearing in a phone conversation the above bold red highlighted quote, the author thereof was assaulted by such a guy and would have been raped if she had not "kicked the shit out of him to get away from that car parked in a back alley many blocks away."  She continued:  "I walked those many blocks back to the bridge and he followed me in his car most of the way shouting horrible things at me the entire time."

Realizing that finding safe dates due to her declined physical beauty, women of the street may be tempted to turn to a pimp[8] who will arrange for dates to come to her.  Such is the case with one woman who has shared these thoughts with me.  Again, to drive home my point with you, this woman was in your health care facility not long before starting to consider this option.

Physicians and nurses of the E.R. and Urgent Care, each one of you have, upon your graduation pledged your career to some version of the Hippocratic Oath.  While your version may have been slightly different, the following is, I'm sure, a reasonable representation thereof.  I have made bold and red, the points therein that most apply to this open letter to you:

I swear to fulfill, to the best of my ability and judgment, this covenant:
I will respect the hard-won scientific gains of those physicians in whose steps I walk, and gladly share such knowledge as is mine with those who are to follow.
I will apply, for the benefit of the sick, all measures [that] are required, avoiding those twin traps of overtreatment and therapeutic nihilism.
I will remember that there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon's knife or the chemist's drug.
I will not be ashamed to say "I know not," nor will I fail to call in my colleagues when the skills of another are needed for a patient's recovery.
I will respect the privacy of my patients, for their problems are not disclosed to me that the world may know. Most especially must I tread with care in matters of life and death. If it is given me to save a life, all thanks. But it may also be within my power to take a life; this awesome responsibility must be faced with great humbleness and awareness of my own frailty. Above all, I must not play at God.
I will remember that I do not treat a fever chart, a cancerous growth, but a sick human being, whose illness may affect the person's family and economic stability. My responsibility includes these related problems if I am to care adequately for the sick.
I will prevent disease whenever I can, for prevention is preferable to cure.
I will remember that I remain a member of society, with special obligations to all my fellow human beings, those sound of mind and body as well as the infirm.
If I do not violate this oath, may I enjoy life and art, respected while I live and remembered with affection thereafter. May I always act so as to preserve the finest traditions of my calling and may I long experience the joy of healing those who seek my help.
—Written in 1964 by Louis Lasagna, Academic Dean of the School of Medicine at Tufts University, and used in many medical schools today.

Finally E.R. and Urgent Care Staff:  The next time any man or woman comes to your facility, please inquire into what your organization can do in the here and now for them to combat their addiction.


[1] an inflammation of one or both lungs, usually caused by infection from a bacterium or virus or, less commonly, by a chemical or physical irritant
[2] frequent and excessive discharging of the bowels producing thin watery feces, usually as a symptom of gastrointestinal upset or infection
[3] a disease in which the body’s ability to produce or respond to the hormone insulin is impaired, resulting in abnormal metabolism of carbohydrates and elevated levels of glucose in the blood and urine.
[4] a medical disorder involving episodes of irregular electrical discharge in the brain and characterized by the periodic sudden loss or impairment of consciousness, often accompanied by convulsions
[5] a serious progressive disease of the central nervous system, occurring mainly in young adults and thought to be caused by a malfunction of the immune system. It leads to the loss of myelin in the brain or spinal cord and causes muscle weakness, poor eyesight, slow speech, and some inability to move.
[6] a medical condition affecting a joint or joints, causing pain, swelling, and stiffness
[7] This is, of course, after multiple guys have stopped to scan her and then tell her to her face that she's far too ugly for "this line of service." 
[8] somebody, usually a man, who finds customers for a prostitute in return for a portion of the prostitute's earnings

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