Day in and day out, night after night, those who practice emergency medicine struggle with the side-effects of society’s malfunctions.  We are on the receiving end of every over-dose, psychiatric crisis, shooting, stabbing, domestic violence incident and pre-incarceration physical.  We have absolutely no power to stem the tide of patients, sent by any and every outside physician, 911 call, worried family member, drunk buddy, nursing home administrator or social worker.  In essence, the dysfunction of society rests solidly on our emergency departments and trauma centers, where everyone else has elected to send problems so that they can feel vindicated, and make it home at 5 PM.

So as I sit here writing in Chick-fila, about to head off to another shift in our busy little emergency department, I am contemplating first causes. What is that makes our society so messed up?  How have we in emergency medicine become so…necessary?  And why is it so difficult to be needed?  Everyone thinks they need an i-Pad.  But the folks at Apple probably aren’t approaching their work-day with any anxiety or trepidation, unless they learned that the cafe is out of espresso.  But on our way to the shop, we know that we will face some struggles; because we are needed.

A century ago, despite a smaller population, were there millions of Americans wandering aimlessly about, holding to an indefinable, unspoken hope for something like an emergency room, which didn’t yet exist?  Maybe.  And certainly there were unnecessary deaths and suffering from a lack of basic medical care.  And yet, I wonder what the difference was.

Maybe I’m a dreamer, or an idealist, but I have to think that some of the general ability to function without trauma centers and emergency departments was the presence and primacy of the intact, engaged, respected family.  Ask yourself, the next time you work, how many of the crises you see would have been averted or solved entirely by a proper family.

It doesn’t take a fundamentalist to observe.  As physicians, it’s our job to observe, gather data, postulate, act and report.  And what I observe is people who are lonely and drifting, with no decent father or mother figures in their lives.  I observe teenage boys and girls wandering the night alone, on what should be school nights, with no adult even remotely concerned with either their whereabouts or their associations.

I observe young children bearing young children, all but alone except for their equally dysfunctional single-parent girlfriends, or their latest boyfriend (who will gladly impregnate them and walk away as well).  Do they come in for anxiety?  For depression and suicide?  Do they cut?  Do they have inexplicable symptoms, because their young minds can’t put words to the premature devastation of their lives?  Small wonder.

As I observe, I see women abandoned in painful divorce, who clutch their chests in fear and sorrow (as much as for angina) as they wonder who will now be their partner in life’s changes.  I see men drinking and drugging and fighting themselves into the grave because their fathers felt them unworthy of any attention; and because they recall with heavy guilt the way they did the same to their own children.  Who are invariably our patients as well.

Emergency departments are the overnight traveler’s inn’s for the drug addicted who were never told ‘no,’ for the alcoholics who were abused by alcoholics, for the schizophrenics whose family turned them out when it became hard, for the young women juggling motherhood and career with all but worthless husbands, who (if I may defend them at all), never saw manhood or fatherhood modeled in their own sad lives.

It’s brokenness all around, my friends.  And the crack in those lives began in a home that was less than a home.  The crack grew as each child grew, and found themselves abandoned, undefended from evil, uneducated in right or wrong.  They were never  therecipients of words of love, but often the recipients of abuse and molestation, cruel words and cruelest of all, complete disregard.  The youner ones were victims of a culture that said to their parents:  ‘Kids don’t need or want adults, so give them freedom and television and computers, and don’t judge them, because all kids have sex and use drugs and drink.  They’ll grow out of it.’  What utter lies! They grow out of it and grow into disease, depression, suicide attempts, disability, chronic pain, ciriminality and most pertinent to us, the constant need for an emergency room to solve what was never prevented.  Or maybe, an emergency room to serve as a kind of clean, polite, concerned family for those who never had one.

The data is compelling. Intact families are protective.  They reduce drug use, crime, ignorance, promiscuity and violence.  They increase success rates and education and worth in their children.  So many of our therapies and medicines and agencies would be moot if families were functional, if parents loved their childen more than themselves; and if children weren’t taught that MTV has more insight than their mothers and fathers.

I love my childen and I love my wife.  I believe in the absolute necessity of family.  And because I was raised in a loving family and try to protect my own, I feel passionately that a stunning amount of the drama, and even the real disease that we see, would blow away like dust in the wind.  If only everyone had a proper family of their own.

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