I often joke that I’m not only an emergency medicine specialist; I’m an’alcoholologist.’ It took quite a while for me to develop that expertise. See, I grew up in a home where no one used alcohol and none of our friends used alcohol. Consequently, other than some college and medical school exposure to the stuff, I was pretty naÃ¯ve about alcohol.
Now, 15 years into my practice, 18 years after medical school, I can safely say I’m well-versed in the management of intoxicated people. I can calm them, negotiate with them, speak their language (“˜just two beers doc!’), manage their injuries and keep them safe without much difficulty.
It’s a useful skill, since emergency departments see lots of people who are intoxicated. In fact, American hospitals spend vast amounts of money caring for alcohol-related accidents and illnesses.
The scenario goes like this: EMS picks up an unconscious person. He smells of alcohol, but no one knows exactly what happened. He was on the ground, so he may have fallen and sustained an injury. The paramedics put him on a backboard and in a neck collar in case his neck or back are broken. He arrives at the hospital. He might end up on the ventilator because he isn’t breathing effectively. He may become combative, requiring nurses, physicians, paramedics, security and police-officers to try to contain his behavior. We take x-rays of his neck or back, or of any injured body part. If he’s very confused or stays unconscious, he’ll get a CT scan of the brain to rule out brain injury or stroke. Labs are drawn.
As he gradually awakens, he grows belligerent. He’s angry at the staff, at his friends, at his life. If he isn’t admitted, if he doesn’t have an obvious medical problem, we discharge him; though it may require valiant efforts to get him a ride home. We may have to call a taxi (which the hospital often pays for). On the way out, we may try to guide him toward some kind of rehab. At the end of the encounter, everyone is tired and frustrated. More often than not, the patient will never pay for the care he received. Far too often, he’ll do it all again. If friends or family take him home, they shake their heads in sadness.
That said, I admit that we sometimes fail. People slip through the cracks.
Intoxicated persons can be treated badly, neglected, ignored. Medicine is imperfect, its practitioners flawed.
Still, why do we do it? Why do hospitals and physicians, nurses and paramedics, even hospital administrators, keep pressing on and caring for society’s alcohol abusers? Why do we use staff and resources to do tests that we all suspect will show nothing, just to rule out the possibility of a problem in someone who constantly abuses the good will (and finances) of society? Why do we plead with them to be still, or cajole and bribe them to stay safe in our emergency rooms, rather than just letting them get up and leave?
We might argue that if not for medical malpractice, we’d say’there’s the door!’ Without the risk of lawsuit, we might allow paramedics to leave them where they’re found. Without plaintiff’s attorneys, we wouldn’t order those tests. And that might be part of it.
Perhaps we do it because we know that alcoholism is a disease; a terrible, destructive disease, and so we feel duty-bound to treat its victims however difficult or expensive it may be.
Maybe we do it from a collective evolutionary instinct. If we treat the sickest, the herd will be better and safer. That might be true.
But I submit that the reasons we try to do right are deep and wonderful. In medicine, we care for the drunks because we recognize the worth of even the most difficult and broken person. We jump through hoops and try our best, we give our time and our skills, we accept that we’ll never see a dime, because at its foundation, medicine and our culture rest on the assertion that each individual has intrinsic worth in God’s eyes, and so must have worth in our own.
That’s the reason we wade through blood, vomit and stool. That’s the reason we face the risk of flying fists. That’s the reason we come back and do the same things, to the same people month after month, year after year.
“˜For God so loved the world,’ the scripture says. And the world includes the drunk as well as the sober.
Edwin Leap is an emergency physician who blogs at edwinleap.com.