How the ER touches the untouchables in society

I met a man recently who had wandered about life dragging the rotting corpse of his arm barely attached to the rest of his body for over a year. His limb carried such a pungent malodor he stopped eating months ago because the noxious stench of his own dripping pus made him perpetually nauseous. A former handyman, he had jimmied up a poor-man’s sling with a tattered Hanes undershirt. It too was crusted in a mix of sweat and pus, maggot eggs embedded in the curdled bodily fluid.

He was emaciated, his cheekbones protruding like wings from his otherwise gaunt face, a sickly yellow that glowed under the harsh fluorescent lights of the emergency room. He was also visibly ashamed of the repulsion he universally elicited.

When he walked into the emergency room with the festering arm hidden under a tattered blanket, the staff’s immediate response was, “what is that smell?!”, followed by the uncovering of his arm and the exclamation, “how long have you let this go?!”

His story started out simple. He’d been homeless for decades, although he did sometimes find odd jobs doing handyman work. While working on machinery, a beam had fallen and crushed his arm. He went to the emergency room where they told him his arm was broken, and he needed to get surgery. He signed out against medical advice because he wanted to continue his heroin habit, which was not tolerated within the walls of the hospital and certainly not pre-operatively.

He eloped and wandered the streets, and his arm grew more putrid and started its path towards gangrene. He bounced around emergency rooms, only to repeatedly sign out against medical advice to continue using heroin. His arm got worse — at one point it was the chew toy for a stray dog, which is how nearly three inches of bone had become exposed, dried, and outwardly decaying.

As would be suspected, the pain increased in his arm, so he did more heroin to temper it. He finally came to my ER hoping for the arm amputation he knew he would need. His hand by that time was barely attached, flopping around like a mottled, swollen, dead fish.

The inciting event that inspired him to come in after over a year? His drug dealers had refused to sell to him because the stink of rancid purulence dripping through his makeshift sling was not worth the money to them.

He was out of drugs, out of luck and finally seeking help.

Forsaken by even rogue street dealers, we were his last resort.

The beauty of the emergency room is that it truly sees people of all walks of life. It is the only institution in society that has its lights and doors open ‪24/7, 365 days a year and turns away no one. As such, it is also one of the only places where the absolutely most desolate receive voice.

This man is many things — impoverished, homeless, and underserved. Ultimately, however, each of those words in isolation, as a defining label for a class, is not sufficient to encompass his state.

He is not the single mother working three jobs that can’t afford ObamaCare — she gets a long-form feature in the New Yorker. He is not the prisoner on death row — he gets a Netflix documentary. He is not the unidentified homeless man on the street — he gets a viral photo in Humans of New York.

This man gets no one; he exists in a state of terminal depravity that has devolved into hopelessness. Ultimately, he stumbles into the emergency room and gets — depending on happenstance of the shift schedule — Me.

What am I to do? I can fix the medical, a metaphoric Band-Aid slapped on a literal amputation. What I do, however, will do nothing to address the complex web of political, social, economic and often psychological factors that landed this man in front of me in the first place.

Trying to explain the plight of this man will mostly garner just disbelief because of the discomfort it instills in us that our fellow man could exist in such condition. Worse, this man and others in similar states lack any advocates — few know they exist, and the rest don’t want to wrestle with the uncomfortable possibility that they do.

There exists a dark underpinning of society that evokes repulsion instead of empathy. As a society, we have long deemed this class unsavory to acknowledge and have been able to ignore it entirely, except for the occasional unidentified and unclaimed decomposing body found in an abandoned alleyway.

This class possesses no agency, no power, and no presence. They exist in a physical exile as well as a political one — roaming the streets under the cover of darkness and unmarked alleys, their voice and existence simply too far removed from the mainstream to ever hope to be heard.

Occasionally, as happened here, they do emerge into the light, to land squarely in my hospital bay. When that happens, we are forced to rectify the society we live in, the one where we preach about equality and minimizing the wealth gap, with the one we work in, the one where we are confronted with the deviants we’ve passively made castaways in our regular lives because we can’t cognitively assimilate them into our linear totem pole of socioeconomic class.

They are the untouchables, the deviants, the repulsive and the foul. They are those whose existence boggles our politely socialized minds. We can understand poor, desperate or mentally ill, at least enough to sympathize and attempt to mobilize around, but we can’t understand this underground class of societal lepers. So instead, we embrace ignorance as bliss – we espouse grandiose themes of egalitarianism for the classes we can label and identify, and leave those at the extreme fringe still completely unacknowledged.

But, for the bleeding hearts, these derelicts are still a part of our fellow mankind. And for the more pragmatic, they still do utilize our taxpayer-funded social safety nets. We may not see ourselves in them or them in us, but they are still one of us. We should not ignore them but acknowledge their plight and include it in the political discourse that shapes our social policies. The emergency room may be one of the only places where we come face to face with them — I have looked them dead in their gaunt eyes and I can say they are Man and they do still need our help.

Amy Ho is an emergency physician.  She can be reached at her self-titled site, Amy Faith Ho.

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