Notes from a naive, in-experienced, judgmental, rich doctor.

Thanks for the interesting comments about my last post.  I appreciate everyone’s input.  Granted, it’s a tough topic and worth lots of discussion.  We all have something to learn from one another.

For instance, from some comments I have learned that I am a self-centered, rich, naive, uninformed jerk who should simply stop demonizing and start loving.

Except that I’m not.  I have been practicing medicine, in an emergency department, for 15 years.  It’s hard to remain naive, sheltered or simple minded when you see everyone for everything.  I know drug addicts and alcoholics, abused women and children, confused immigrants who speak only Spanish and frightened exchange students.  I have shaken hands with more than my share of felons, and considered them pretty nice folks on the whole.  I try to see them all, to the extent that I am so far able, through the eyes of Christ.

I understand a great deal about the poor.  I am happy to see them.  I have written off their bills and seen them under EMTALA for free.  Our group seldom pursues collections on anyone.

But let me ask some questions. Those of you who think I’m demonizing the poor, those of you who think I need to shut up, sit down and do more, do you work in a setting like mine?  Some of you probably do, but many do not.  Have you struggled to find a disposition for a sick person, with no money, so that they can get the therapy, drug, equipment or surgery they need?  Did you do it at midnight or later, after your shift was over?

Have you pleaded with a drug addict or alcoholic to go into treatment?  Have you listened patiently to the rambling of a destitute schizophrenic, then struggled to find hospitalization for him or her?  Have you tried to explain to poor teenagers why it might be best not to have sex, so that they can avoid having a baby at 14?  Have you cared for the rape victim, the assault victim, the disabled, the violent or the demented, as their families held back tears?

Now, if you have, in some capacity, have you done it for no money?  Have you gone back over and over knowing it will be for no compensation?  Have you paid to do it, as we do when we pay malpractice and license fees?  Have you known, even as you donated your time in the third world, that any one of the persons you helped might just turn around and sue you for millions of dollars for an honest mistake?

Have you, in your care for the poor, ever been frustrated by those who simply refuse to stay in school, hold a job, stop using drugs or stop sleeping with everyone they meet, and thereby father (and mothering) children who aren’t the least bit interesting to them?  Have you watched those poor, who work as carpenters or mechanics, or who drink and fight all weekend, still manage to collect disability for nerves, back-pain or some other difficult to verify problem?  Have you gone in to see them and been cursed, or had them say ‘well, it’s about damn time!’

Have you, as you point your finger at me or any other Christian social conservative, ever really looked at what Jesus said?  Yes, he called us to care for the poor.  And he called us to seek the truth.  He called us to humble ourselves before God.  He called us to work with our talents.  He called us to sexual morality.  He called us to repentance.  He wasn’t just the guy who came and said, ‘be nice to the poor.’  He said ‘be holy.’  He said ‘follow me.’  He said ‘Go into all the world and make disciples of every people.’  He said he was coming back, and that when he does, he’s going to be very annoyed.  He said some people would be cast into the fiery pit.  He said ‘I am the way, the truth and the light.  No man comes to the Father except by me.’

I looked at the board last night at work; the light board that says what patients we have and where they are.  I saw their names all over that board and told a student who was shadowing me:  ‘See those names?  God loves every single one of them just the same as he loves me, or you.  And vice-versa.’  I believe that 100%  But I don’t believe that either poverty or riches excuse us from right behavior or effort.

A generation of young people )and many of their parents or grandparents) that come through our emergency departments have no sense of responsibility, no work ethic, no desire for advancement, no gratitude for what we give them and no respect for one another…they’re too busy partying and ‘hooking up.’

Jesus loves us all, but he calls us to the truth.  He calls us to hard truths at times.  And any Christian physician faces a duality.  We are called to love, but not coddle. We are called to accept but not enable.  We are called to tolerate, but not agree with all the beliefs, ethics or actions of our patients.

Fine.  Cell-phones are cheap.  Maybe I was dead wrong on that one.  Granted, there are desperate poor folks in America.  But I have a very hard time with many of those who, in the midst of their morbid obesity and lack of motivation, hide beneath the ‘nobility’ of poverty and use it as an excuse for others to engage in effort for them.

Tell me more, though, about alcohol and tobacco, the absence of motivation, the absence of fathers, teen-pregnancy, sexually transmitted diseases and serial sex partners, disdain of faith and morality and the disdain of learning.  Tell me how cheap those are.  Tell me how everyone has a right to those things.  If you contemplate them, and roll around in them the way we do, you’ll get a slight idea of what we face, day and night, in the emergency departments of this country.

And until you have, indeed, considered all sides of the debate; until you have, actually, struggled with all your effort to help the poor in person, and done it for no pay; until you have held the hand of the HIV patient and tried to comfort the poor, abused child, then don’t judge me as naive, or stupid, or inexperienced.

Frankly, it’s a little insulting.  My career has made me one of the least naive people on earth.

And until you read and accept all that Jesus said, don’t just snip out the convenient bits about the poor.

Edwin

10 thoughts on “Notes from a naive, in-experienced, judgmental, rich doctor.

  1. I was just catching up on your last two post and their comments. I also lived in a third world country (Cambodia) for two years. Also I’m an ER nurse for the past three years. Jesus did sit with the sinners and commune with the poor, but He also said to the adulterous woman to “go thy way, and sin no more.” Lydia, indeed Jesus didn’t criticize people for things they’ve done, but he didn’t pretend they were OK just because of their background. In Cambodia I saw the poorest of the poor, who despite their poverty, still chose to be productive and Christ-like. So when I see the “poor” around me as I work in the ER I see zero reasons they can’t be rich too. Rich or poor doesn’t have anything to do with possessions, but has everything to do with perceptions. I was watching the news the other day when a “poor” person affected by today’s financial crisis complained that they couldn’t afford cold cereal and milk any more. So what? Buy eggs and oatmeal instead, beans can be your main protein source (that’s what my family has to do to make ends meet). People are loosing their houses; to build his house my grandpa bought used army footlockers at auction to use as sheetrock to hold in his newspaper insulation, and his mortgage didn’t foreclose because he bought too much house. A Vietnamese family I knew living in Cambodia didn’t complain when they ran out of rice for the day, they collected garbage to recycle for eating money. Imagine that, working for your needs. I also heard on the news about a Hispanic couple who raised three kids and paid for their college by dumpster diving for can to recycle, that was in California.

    Lydia, America’s problem is more and more of us expect something for nothing. There is a big difference between selfish and holding others responsible for their actions. America’s problem is instead of asking what we can do for our country we’re asking our country to do everything for us. What would Jesus do? I can’t say for sure but He wouldn’t encourage people to sit and wait for handouts.

    Now, before you accuse me of being cold hearted I give about 12% of my income to church and charity. I volunteer with various service organizations. I believe if we did away with mandatory charity (i.e. medicaid/medicare/social security) I’d have that much more to contribute. You want a real example of why private charity is better than government supported charity, read “Three cups of Tea” about a man who builds primary schools in Pakistan for $12,000 when governments build the same for $75,000. There are no dentists who take Medicaid in my town because they all got tired of government oversight (you have to pull one tooth per visit, instead of more economic and comfortable multiple extractions).

    I’m not tired of working with, or for people with less money than me. I’m tired of those who demand I serve them when they have no intension of reimbursing me, regardless of how much money they have. When we enable government to take care of us, all we do is enable those who refuse to care for themselves. There’s no doubt things are bad, and are probably going to get worse. So we should probably help people be lazier by supplying them with everything they need regardless of their contribution. That will fix things.

  2. Thank you Dr. Leap for so eloquently verbalizing my thoughts and opinions. We need more of this honesty. Just because we as doctors tell our patients that smoking is bad for their health does not mean we “demonize” smokers. Or when we tell patients they should take their blood pressure medications even when they can’t “feel” their hypertension we aren’t judging them but providing good medical care. So what I ask, what is wrong with asking these same individuals to take Personal Responsibility for their lives and their healthcare. Spend less on wants and more on needs.

    To Lydia, I don’t demonize the poor and I’m sorry if you mistook my previous comment as such. As Edwin has mentioned I too am part of the “social conservative” crowd and you know what – I pray for my patients. I love my patients. I believe my work is my ministry. I have traveled to numerous third world countries on my own dime – money I earned through honest work – and performed medical mission work or built houses or fed the hungry. I have even founded a charity to continue this work and organized it such that it is not “handouts” but rather empowers the individuals we help to help themselves. They provide the knowledge and skills and we find the capital. They often invest their own money as well. They organize the supplies and build the water well and we help pay for it and then they maintain it to provide an example. I have no problem with charity but I spend my charity on these types of projects and if the government would spend less time worrying about “spreading the wealth” and spend more time reorganizing and supervising the currently abused programs I might have more money to continue this work. If you feel guilty for earning money and must give it to someone else to spend for it to be “noble” then send Edwin a message and he can give you my e-mail address and I’ll give away your money. Every cent – 100% goes to the project. I doubt that’s what you want. You would rather choose how to spend your hard earned dollars and help people as you see fit. You want to make sure your charitable contributions aren’t squandered. I may disagree with your comment but I bet you are a very loving and charitable person as I think you will find many of us “social conservatives” are as well! There is value in work and we should do more to encourage work but those kinds of programs and rhetoric don’t get people elected. So label me rich, I am -now- when compared to the vast majority of the world but that does not make me evil and I will not apologize for what I earn through work. Label me social conservative – I am. But don’t label me a racist or elitist, and please don’t dare accuse me of demonizing the poor or not loving them because I want them to be successful and have a job and a family and create loving homes for their children. I care and I bet you do too!

  3. I am sorry that you took my comment as an attack on you personally. I am not judging you, nor do I think you are naive, nor do I think you are not sincere in your caring for every kind of people or as a Christian loving them, nor do I think you are demonizing the poor. My response is written for whoever reads it – not just you.

    I am a nurse in an ER in downtown Detroit. I also volunteer time in a clinic for the uninsured. I am finishing my studies to be a nurse practitioner and all my rotations have been in hard core poverty situations. So far I am protected from law suits, I get paid a salary for my care of patients in the ER and I haven’t yet had to be solely responsible to find care for a patient. That day will be coming all to soon. But, in my 18 years as a nurse, I have held the hands of patients with HIV. I have counselled teenagers about pregnancy and STD’s. I have treated people who are lazy and expect the health care system to give them everything for no cost. I have wept with the abused and the assaulted. I have questioned the homeless who come to the ER with complaints just to get a sandwich. I have tried to find homeless shelters and free care for the poor when they are discharged from the hospital. I have refused to write work notes for the patient who missed work the day before showing up in the ED hungover. I struggle with the futility of trying to get an 8th grader whose only goal in life is to be old enough to go the bar and can’t spell a sentence correctly to want to go to college and make a life for himself.Just last night I was working with a gay EMT in triage and was asked by a gay patient if I was part of their community as if it was a totally normal thing. Sometimes I think nurses have to spend more time getting involved in the patient’s problems.

    I have worked closely with a large number of doctors – we have laughed over the psych people, we have bemoaned the abuse of the ER, we have struggled with the gunshot victim, we have sighed over the woman wanting an STD check in the ER at 2 am, we have cried for those we want to treat with more and are unable to, we have berated the drug seeker. I understand what you are facing.

    Yes I get frustrated with those who abuse the system, the chronic patients who don’t follow their plan of care and don’t realize they are going to become very expensive patients when the consequences of their non-compliance kicks in. Yes I get frustrated with the evidence of sin in this world – violence, drugs, alcohol,abortion, teenage pregnancies, broken families etc.

    I have not just taken snippets from the Scripture about the poor. Yes, God loves the sinner but He does not accept sinful behavior nor does He expect Christians to. I struggle to love people the way Jesus would love them. My selfishness gets in the way of a lot things.

    I have lived and worked in a third world country. I have seen America through someone else’s eyes. I have seen what America has that other countries do not have. Some of my best friends have a whole lot less than I do. I have walked with them in their need. And I know it was only because of God’s divine plan that I live in America and not over there. Yet I struggle with why I should be so privileged.

    I stand by the fact that a lot of the problems of the health system is simply a product of what America has made it to be. The way people are today is a result of sin in this world. This is not going to go away. In fact, as the Bible says, things are going to get worse. I constantly need to look at myself and find a way to deal with all the wrongs that is constructive and honoring to God. I seek to make a difference,if only for a second, in whoever comes my way – no matter what is going on in that person’s life. I have a long way to go to make that a reality but I know that God is faithful to make up for my weaknesses. I refuse to allow the frustrations of sin in the world bog me down when it so easily can. I take comfort in the fact that when my life is over, I will be in a place where all the questions, the frustrations and sin will not matter anymore. And until then I do the best I can to bring heaven to this earth. This is the choice I have made.

  4. I did not use “demonize the poor” in my response. Someone else coined these words. There is no way that I feel anyone is doing this. And I am sorry if anyone interpreted my response this way.

  5. To Lydia,

    Sorry I combined my response above to previous responses, (this blog entry and previous entry), and have inadvertently made it appear that the “demonize the poor” response was yours. I apologize for that and from reading your statements it is obvious that you are not of this belief and in fact quite the opposite.

    Suffice it to say that I agree with what the good Dr. Leap has written. Thanks for all that you do in service to others and good luck in your endeavors. Ok, back to working now and I’ll leave the writing to Leap who does a much better job!

  6. Lydia,

    Please don’t think I was especially replying to you. I was really just trying to establish my credibility, and it would seem the credibility of all of us ‘in the trenches,’ to speak about this issue. There are folks who might right my blog and think, from their theoretical ideological position, that I’m cruel and don’t know what I’m speaking about. I wanted to make the point that I do know. Clearly, so do you.

    We’re on the same page. And it is a constant battle. The dynamic tension between loving our patients and wanting to strangle them; between wanting to give and give and give, yet knowing that the giving isn’t always the answer.

    I’m with you. I can’t wait for heaven…well, the kids are small, so I can wait a bit. But there will be no more struggle, poverty, misery, sorrow or sighing. And what at wonderful image as He ‘wipes away every tear from our eyes.’

    Till then, we have to struggle with reality. And the answers, as we say down here, ‘ain’t that easy.’

    Thank you for your gracious description of your life, work, faith and compassion.

    I wonder to what extent the answer to the problems of health-care in general is a good old-fashioned revival in the house of medicine, and a general ‘baptism’ of all our efforts. If doctors, nurses, administrators and all the rest really believed their work transcendent, and called by God, it might be easier to get people to engage in charity!

    God go with you,

    Edwin

  7. Edwin,

    I see my words stung a bit. That was not my intent.

    I was raised Catholic, and attended 12 years of catholic schools. While your faith differs slightly from that in which I was raised, it’s not too different. Some say Christ loves us all. I don’t disagree with that assertion. But one of the core values I learned from my religion was this: pity.

    Not pity in the sense that I may look down on the poor. Not pity in the sense that I think they are lesser than I. Not pity in the sense that they are helpless and require my aid. Pity in the sense that I feel their suffering, and I forgive their flaws, and I grieve for their sins, even if they do not.

    It’s easy to hate the people we take care of (and my practice is not much different from yours; make no mistake, I have walked in your shoes). It’s easy to feel contempt or anger at their self destructive behavior, be it promiscuity, addiction, or improvident financial choices. These people are poor in part by accident of birth, and in part through their own choices.

    Pity them.

    And forgive them.

    And please note that I did not call you a name. In part I may be reacting to what some more, er, conservative, ER bloggers have said. Some of them turn my stomach with their open and unadulterated scorn for the poor. I don’t read their blogs any more. To the degree that I may have conflated your stance with theirs, I apologize. And if you read my blog you know that I too get frustrated with the people we serve. But you tread close to the line when you characterize the “smirking” teen. Why does she “smirk”? Because she takes pride or pleasure in her pregnancy? What’s the proper reaction? Shame and despair? Would you rather she aborted the child? Should she bring the child into the world with her heart full of resentment and anger? You and I agree that fifteen year old girls should not be mothers, and I fear for the children so born. But what’s the remedy, once she’s impregnated? I don’t have one. I take a deep breath, provide the service, and vote for a government which will provide comprehensive sex education, not the intellectually-satisfying but practically-unhelpful abstinence-only programs. To prevent the next girl from suffering the same fate.

    We see things differently. But I do not think our values differ too much, not where it counts.

    SF

  8. I was in no way trying to negate your insights or your frustrations at the abuses you see. You have very valid points and I admire your compassion for those you serve. But being among the working poor, it is at times embarrasing that people perceive what we find as necessities as a way to condemn us. While cell phones can certainly be cheaper than home phones, there is a proper time, place and way to use them. While someone is seeking your advice, they should not be using their cell phone. Poverty does not excuse bad manners. Poverty also should not negate good scense, but addiction often does and it occurs as often in the rich as the poor.

  9. I hope not though. I’ve found out that single mother welfare is not really worth it. Let us use students loans for an example. I really need students loans and you also have single mother loans.

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