She is 61, and she can’t help but smack her lips together repetitively. She has no teeth, and the curvature of her spine makes her a miniature version of what she once was. Her frizzy hair is a purple-gray tone, and there are dark particles of something in the knots alongside her left temple. Her clothes are too loose, and there are food stains on her shirt. The ambulance arrived at her home, and there were pills strewn all over her floor and scattered pill bottles. She tells me that it wasn’t her — that someone had been in her apartment. That they were putting different pills in those bottles that weren’t hers. The pills were showing up on her floor. She was being followed when she went places.

Her lips smacked harder as her anxiety mounted. She had to flush all the pills down the toilet because they weren’t her pills, and so she didn’t have her own to take. I ask if there is family I may call. She stares back at me with hollowed eyes and does not respond. She had just been released from the hospital a week ago for paranoid thoughts, but it is clear she will need to come back in.

He is 70, and his anxiety is like a storm cloud exploding in the room. He is overwhelmed because he cannot pay the bills and someone has stolen his identity. His furnace is broken, and he is afraid the pipes will explode. He is concerned there is a carbon monoxide leak in their home, and they are all being poisoned. At times, he cannot speak because he is so overcome with his panic. He stutters and spits and cannot get the words out. I hold his hand and rock it back and forth as if to relieve the tremors that riddle his body. I tell him it is okay over and over as I hold on; at times, he appears momentarily calmed and is again able to speak until the next wave of emotions takes prey over him. His family arrives, and there are tears of fear, pain, and love filling their eyes. None of this is real. No one has stolen his identity. There are no broken furnaces and no carbon monoxide leaks. He paces at home and cannot eat or sleep. They have even called the fire department to the house to prove to him that there is no carbon monoxide leak. But it has not helped. These delusions have become his reality.

He is 57 and drinks every day and lives on the streets. He comes in one to two times a week for pain. Sometimes, he says his pain is so bad he wants to shoot himself. He says he has guns at his son’s house. This time he said he fell and his hip hurts. I help him take his pants off, and he smells of urine and stool. Where can he go to take a shower? There are no bruises, scrapes, or cuts, but I X-ray his hip, and there are no fractures. He says he won’t actually shoot himself if he can have a sandwich and bus tokens to go. He asks for a sandwich and bus tokens with every visit. He says his pain is 10 out of 10 and immediately falls asleep. It is the warmest and quietest place he will sleep until he comes back next week.

He is 20, and he overdosed on heroin. He was not breathing when the ambulance arrived. They gave him medication and resuscitated him, and now his heart is racing. He looks bewildered as if he is on fire with anger. He says he knows it is dangerous. He has seen his friend dead in a car from a heroin overdose with the needle still in his arm. Maybe this is his rock bottom. I ask him if he is ready for me to help him get help, so he doesn’t die, too. He was close this time. He says he understands what I am saying and he appreciates it. He says he is ready to stop, but he just doesn’t need help today.

These were four people I met on my evening shift last night. There are endless more stories like theirs. I don’t know where they were before they got to here, but I know life has not handed them anything. Their days are constant, steep uphill climbs. It may be addiction. It may be mental illness. It may be violence. It may be homelessness. It clasps its grip on them and won’t let them go. Day to day, it swallows them and pulls them back down deep. There is little voice that advocates for and represents them. There is an endless judgment that looks down upon them.

Friends and family will ask me how my shift went. I often don’t know what to say. Sometimes I feel I can help and do great things. Sometimes it is a vat of endless, hopeless stories in a system with limited resources that continually seems to fail in one way or another. We will keep showing up and keep doing what we can, but it certainly is not enough.

Cindy Winebrenner is an emergency physician who blogs at Mom-Wife-Doctor Thoughts.

Image credit: Shutterstock.com