Does it seem as if our culture turns to the institution of medicine for every issue imaginable?  Sometimes it feels that way to me.  The average emergency department is a virtual laboratory of case-studies documenting the very allegation I am making. I have seen countless patients who turn to the ER, with ever increasing dependency, to solve all of their problems.

In my practice I have cared for all of the standard emergencies.  But more and more, I am trying to help someone who is addicted or trying to understand a family who wants us to ‘do something about grandma.’  I’m explaining why ‘pregnancy test’ is not a particularly good reason to come to the ER unless bleeding or pain is involved.

I’m sorting through the various allegations of parents and teenagers to decide who is, and who isn’t crazy, dangerous, suicidal, at risk; who is or isn’t having sex.  I’m looking at the old, intoxicated alcoholic who says he has some vague pain, but who is already asking to leave even as he is angry that I haven’t helped him more; or at his family who doesn’t see why we can’t ‘just keep him and watch him a couple of days, then send him somewhere!’
Day after day I’m reassuring someone who, despite the world’s best health care, is still afraid; like the man with the recent angioplasty to whom I say ‘you’re fine, everything looks great!’
Law enforcement brings me patients who say they’re suicidal as soon as the handcuffs are placed, and who deny it as quickly as the charges are dropped by the on-call judge.  Adult protective services tells me I need to admit the homeless person, because ‘we don’t have any place for her.’

It seems as if every day, someone looks at me and says something like this:  ‘But what do you mean you don’t know?  I’m afraid!’  Or, ‘What do you mean nothing is wrong?  I waited four hours for you to tell me nothing is wrong?’  Or they say, more frankly, ‘I’m just so afraid all the time.  I feel like I’m going crazy.’

What are the common denominators?  Fear, anxiety, frustration, anger, loss, sloth, criminality, uncertainty, self-loathing, bitterness…the list goes on and on.  Brokenness, abuse, hatred…sin.
Like so many physicians, I vacillate between compassion and frustration; between love for, and frustration with, the endless legion of individuals who ask me to solve their life crises.  People who ask me to fix things that dwell far beyond the relative simplicity of strokes and heart attacks; situations that make poisonings and car crashes seem remarkably welcome.

I wonder, sometimes, what did humans do before the availability of 24 hour emergency departments?  Doubtless, lives were lost that could have been saved.  I’m glad we do what we do.  But I still have to wonder, in those days when family doctors had to be awakened at home, when trauma centers were unheard-of, when ambulances doubled as hearses (or the opposite), how many life crises were emergencies?  In the days when insurance didn’t exist as a widespread entity or entitlement; when no EMTALA-like mandate bludgeoned hospitals or doctors, when one hoped for professionalism and compassion, and one felt bound to show gratitude if not offer compensation, how were things?

I guess I’ll never know.  But the thing is, I’m not pining for the past; I’m wondering for the future.  Why is it that our emergency rooms and clinics are overwhelmed?  Why do trauma centers become the locus of so much psychic misery and social dysfunction?  Why is it so vast a need that the government feels compelled to step in and try to make access available to all for less?  Why is it so important?  Why is it a crisis?
Is it that we, as a society, are desperately concerned for our health?  I doubt it, really.  Smoking, alcohol, inactivity, obesity, drug use, risky sexual behavior by gay and straight alike, these all speak to a people concerned more with avoiding consequences than with ensuring health.

So why must we be there?  Why do the hospitals and clinics and emergency rooms and all the rest have to be available at all times for everyone and everything?

I believe we are now used as a replacement for faith; a substitute for religious belief and the love, hope, order, community, ethic and guidance it provides; or always provided.

A reader of my EMN column recently asked, ‘have we replaced religion?’  Perhaps we have.  The message of universities and cultural elites is loud and clear.  Religious faith is for the irrational, the un-evolved, the weak (that’s a line I heard at work).  It’s not for the strong, the modern man or woman, the clear-sighted, the free-thinker.  And so, the message trickles down as ideas often do, from the intellectual to the average citizen; from the university classroom to the television series.  And now, generations of our patients have grown up believing there is no meaning.

This, I think, is why they show disregard for their own health, even as they covet it.  The body, with no transcendent meaning, might as well be abused.  But even as they abuse their souls and feel sorrow and guilt, so they abuse their bodies but hope to pull them back from the brink of sickness and death.

It all manifests itself in fear, in terror, in drama, in the misery of personal hells and sicknesses real or imagined.  Our patients, in all of their post-modern, health-care accessible world are petrified of the sickness of their bodies (one tangible thing they believe in even as they disregard it), by the prospect of physical death, and by the brokenness of their hearts.

The hospital is the new cathedral; the nurses and doctors the priesthood of a faith with no ultimate hope except the hope to stave off the inevitable.

Have we replaced religion?  Not intentionally, but perhaps inadvertently.  We have tried to care for people in a kind of fossilized Christian ethic; fossilized because it uses scientific, tangible mechanisms to care for the body, neglecting all the while the flat-line of the soul beneath the gasping body, desperate for breath, also known as spirit.

Have we replaced religion? Perhaps.  But every shift in every ER is a bracing reminder that we’ve done it poorly if at all.  I pray we aren’t held accountable for our failure.


0 0 votes
Article Rating