This is my EM News column for May.  I hope you enjoy it!  I’ll put up a link to EM News as soon as it’s available.

Missionary to Emergistan

I know a fine, caring physician who has a heart for God and a heart for people. He often goes overseas to serve the poor and needy in the third world. I saw him in his lucrative practice, where he recently asked this question. ‘Ed, do you do any mission work?’ ‘No,’ I replied. ‘Well, maybe someday’ he said, and patted my shoulder in encouragement.

It bothered me. It seemed like a kind of pity. It bothered me because, like so many great moments, I hesitated. Later, I knew what I should have said: ‘Yes I do! Every day that I walk into that emergency department!’ But I didn’t say that. I smiled and went on my way.

I thought about it some more. Mission work, mission work, where do I go….and it hit me. Every day I travel to work in Emergistan.

Emergistan is less a place than a state of mind. It is a place that is so unlike the rest of the human experience, many individuals find it hard to believe the stories we bring back. ‘People actually suck on their fentanyl patches…and die?’ ‘Yes, yes they do.’ ‘People come to the ER in ambulances for…for colds?’ ‘Yes, yes they do.’ The customs are difficult to explain.

In Emergistan, there seems almost a different kind of language. Spend enough time there, as we do, and you understand some of it. You understand tingling and buzzing, squeezing and spinning, burning and vomicking, and any of a dozen words for genitalia or a hundred words for drugs…tabs, bars, ruffies, Special K, K-2, bath salt and all the rest. You know that two beers means two dozen, that disability doesn’t always mean disability.

But it isn’t just the words. It’s the content, the meaning that evades so many. Even after years we don’t fully understand leaving, with staples in one’s scalp, to go ‘finish the fight.’ We don’t understand a 15-year-old child whose parents are excited about her second pregnancy, or a 22-year-old man thrilled to be committed, once again, because it will help get his disability. We have difficulty with an old lady ignored in her home while sores develop on her back, or a new-born with a broken skull because its cry interrupted someone’s television show. We weep, out loud or silently, at the young father with a new brain mass.

Emergistan is not only a different mindset, it’s practically a different dimension. A place of bizarre time and space. In it, a woman can have an exam, CT scan, labs and pain medicine in a two hour period, even as her husband stamps the floor and curses because, ‘we been here two hours and ain’t nobody done nothing!’ Two hours is interpreted as four, four hours as eight. What most would call a one, or a five is always a ten on the pain scale. And a work excuse is a civil right in the endlessly shifting constitution of the land.

Perhaps it’s no surprise. While we travel there, and while we see many patients like ourselves who do not desire to be there and who are in great peril and great need, we do not grasp the mindset or philosophy of the native Emergistanis…those whose lives seem to revolve around the triage desk, the patient room, the CT scanner, the coveted prescription. They are unfortunate, in some ways, many having been neglected their entire lives. Never nurtured by parents, never loved by spouses, never taught to cope (as evidenced by their constant anxiety), never taught to learn or to strive. Only taught to need, to dramatize, to expect.

I know, our experience in Emergistan makes us cynical. But it may be because so much bad, so much manipulation, so much need, so much pain ends up there. We see it. We see the refugees from normality, the abused and wretched, all mixed in with the abusing and hateful, the dishonest, the reckless and addicted, the slothful and cruel mixed with the dying and broken. It’s hard not to mix them all up.

It’s also hard because we are expected to do it as if it were mission work. For some it is. For some, whose faith or philosophy call them to give altruistically, it is a genuine mission work. For others who do not hold that view, who are compelled by government to work in Emergistan for free, it is a place of bitterness and anger that grows (understandably) with every passing mandate, every new rule about our travels and travails there, imposed by those who have never, ever truly crossed the border with us, who only know that it saves money when we do so at our own expense and risk.

Emergistan gets inside you. Sometimes you love it. It can be a land of thrills and challenges, rescuing hapless Emergistanis from disease and accident, and sometimes from their own bad decisions. Sometimes you hate it because it is all consuming and overwhelming. Or because the tragedy, like a parasite, has found its way into your heart and mind and made you fearful of every cough, every fever, every car you pass on the highway, every person you pass on the street. Emergistan’s doctors bear emotional scars that may never heal in this life.

Here’s the thing. They can call me bitter or angry, burnt out or hateful. But I love Emergistan. It is a kind of home for me, where I spend days and nights, where I make my living, where I support my family. In some ways, I am a dual citizen. I understand the regular world, the world of normal rules and behaviors, of clean offices and polite conversation, where sobriety is expected and work rewarded. But I understand addicts and drunks, violent criminals and irritable, dying old men, fearful mothers with sick children and frustrated, beat-down physicians and nurses. I see so much. I have seen so much.

I can criticize and observe, I can lay out the truth as I see it because I have been there, I have served there. I am a veteran of the daily battles of my second home in Emergistan. I know the truth as no policy maker ever will. I am, and have always been, committed to that other country that daily seems to suck out my soul and daily calls me back again; that rejuventates me with every save, every successful intubation, every good diagnosis, every smile of gratitude from the sick or fearful.

I am a missionary, I suppose. And so are you. And we can hold our heads high, for we have worked in one of the hardest, darkest places in the world. The psychotic, overwhelming, frantic, tragic Republic of Emergistan.

May her streets be paved with oxycodone.

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