Brown hair, slouching posture, camouflage pants and deep South Carolina inflection, the young man in the emergency room looked just like the average, rural, southern teen . His grandmother brought him to see me one night, concerned about a rash he had developed.  Using my most reassuring tone, I told her that he was fine, but that his parents should take him to his family doctor if he didn’t improve.  Grandma appeared uncomfortable. “Well, he lives part time with me and part time with his aunt.  His momma’s dead, and his daddy’s in prison.”  He looked impassive, unmoved by this information, having faced it for who knows how many of his young years.  He was as American as I, but he was an alien.

In our emergency department, we see many aliens.  Some are University students, who speak languages mysterious to me.  Others, workers in local industry, speak Spanish.  Like the textile worker one night whose arm was pulled off.  He screamed his pain in Spanish, and I understood so little.  He was in an alien country, and suddenly exiled into a land of trauma and disability.

But the majority of the aliens we see and treat are just like that young man with the rash.  They look and sound just like the rest of us.  They come to emergency rooms across America for thousands of reasons, from illness to injury.  But when they do, they enter a land that is different from the one where they dwell day and night.  Frequently, we don’t even know why they come.  Their complaints are vague, and their illnesses mysterious.  Competent doctors and nurses everywhere see them and scratch their heads, uncertain what to treat.  This is because their problems are a confusing mixture of the physical, mental, social and spiritual.  Mostly, I believe, they just want a little trip out of the wasteland they call home, into a place of safety, bright lights, warmth and cleanliness.  Like Toni, who has visited our emergency room over 800 times, because somehow, her life is a labyrinth of anxiety. The essence of the problem is that these patients are traveling out of their own bad dreams, for help and healing, and maybe just to explore the possibility of emigrating to another life where there is hope.

Most of us only read about the lives they lead.  Paramedics tell me stories of the homes they enter, pungent smelling, with trash thick on the floor where unbathed children or grandchildren play amid occasional chickens and dogs.  Some of these houses can only be entered with police escort, as weapons are brandished as if it were nothing.  Every night, as my clean, healthy children dream in safety, millions live in filth and fear.  They wander through a desert, really.  I have met these hollow eyed aliens over the years of my practice, and they are dusty and thirsty from travel.  They often come from their land of pain in search of shelter.  Some have lived their infant months, or adult decades, in a land where beatings are as regular as sunshine.  From birth they have smelled alcohol, heavy on the breath of the persons who should have been caring for them, but who swore and gambled and fought every weekend, or every night.  I remember Dale, a narcotic abuser whose alcohol level was four times legally intoxicated, but who said, “I gotta go doc!  I have to baby-sit my nephew!”

They have learned violence by receiving it: as children from parents, as young men struggling for manhood in bars, as young women whose husbands learned that women are for beating and sex, no more. And they have known too many friends and family killed or maimed at someone’s hand.  I remember the desperate question of  a young man who had been shot in the spine as he lay with another man’s girlfriend:  “Will I ever walk again?” Drunken drivers have driven them as many miles as bus drivers.  And disease, born of neglect, obesity, tobacco or alcohol has ravaged their lives.  Aliens in the land of health, and safety.

Love is a thing these lost souls have heard about.  But it has become hopelessly intertwined with lies and sex.  Girls and boys hear “I love you” from parents who hate one another to the point of hitting, and sooner or later the love they ache for is lavished by absent parents on a new spouse and new children.  As these sad ones grow a little older, they learn that love is assured only with the body, and children who should be playing games find themselves playing adult, stumbling through the motions and words of intimacy in a frantic search for the love they lost over years.  Aliens in search of the land of love.

But there are others.  The elderly who have lost all family, who lie lonely at home, or in nursing homes only marginally better than loneliness.  They are aliens in a world which youth rules with an iron hand. When we see them, often calling 911 just to be rescued from silence, they come to us looking for a country of small comforts to see them to their final days. And there are those who have spent lifetimes stumbling in a thorny wilderness of hallucinations, tortured memories, or crushing depression.  Aliens in the bright land of sanity.

Still more aliens wander our hospitals as staff, who have become victims themselves.  These men and women have seen too much pain, touched too many dying bodies, held too many hands of broken families.  In the process, sponge like, they have absorbed it all until it has blinded them, convincing them that their narrow view of the world is the only view, and that horror outweighs beauty.  They have exiled themselves from good things, seeking refuge in drugs, alcohol or sex, and have become the very persons they hoped to aid in their youthful enthusiasm.

Aliens are all around us, and nowhere are they more evident to me than in my workplace.  I am frustrated by them, because many refuse to try and escape.  Many have wandered in frightening lands by their own choice.  And in the process, some cause as much pain as they feel.  They fight and drink and hate and curse until no one can be near them.  But I’m learning.

And I learned a lot from reading the Old Testament.  The God of Israel, a people lost in the desert, had a special place in his heart for exiles, wanderers and aliens. “Do not mistreat an alien, or oppress him, for you were aliens in Egypt.”, says Exodus 22:21. “The Lord watches over the alien…”  from Psalm 146:9.  In the wisdom of these verses, and the reality of my profession, God showed me that aliens need not look different, except for the sadness in their eyes, and they need not speak another language, except so often the language of pain.  And those of us who live in the land of good things, in the land of health and safety can sometimes help if only by showing those persons a little of the hospitality of our high country, so that they might want to return.  And if we can help get them across the border to stay, we honor the King who graced us with the places of blessing where we live every day in peace.

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