I worked two nights this week.  It was the middle of the week, Wednesday and Thursday.  It was April.  And it was insane.  Standard stuff, suicidal thoughts, alcohol binges, violent outbursts, dog-bites, etc.  I thought, for a while, that it was Memorial Day, and I was just out of touch with the calender.

I was very tired and slept poorly before working both nights.  For all that I felt miserable, and got by on my prayers, my wife’s prayers, God’s grace, tortilla chips and sweet-tea, I strangely enjoyed my shifts.

I have to admit that I still find night-shift patients fascinating.  So often they’re part of a subculture that simply comes out after dark.

You know the old saying ‘there’s nothing there in the dark that wasn’t there in the day?’   That’s a lie.  I know a little about animals and humans and there are plenty of things out at night that weren’t there in the daylight.  Sure, they exist in the day, but daytime is when they rest in dark dens in preparation for the nights predations.

Granted, there are some very ill, and very badly injured, people who use emergency rooms at night.  But there are some to whom the ER is just another place to go, another box to check off on the ‘to do list.’

In envision the cheese-dip and white-powder covered Day-Timer lying around a cluttered apartment, with unopened mail and opened beer cans.  ‘April 22, 2008:  My list:  Buy cocaine, drink case of beer, hit neighbor with tire-tool, key car in parking lot, hit on neighbor’s teenage daughter, hurt back in Wal-Mart, get arrested yelling at manager, fake seizure, insist on being taken to ER instead of jail, climb off of backboard, urinate in corner, ask for coffee and ice chips, hit on nurse, call doctor ‘SOB,’ spend two hours calling for ride home, stumble out the door in the dawn’s light like an unhappy vampire.  Go home to sleep after breakfast of potato-chips and Mountain Dew, sleep, repeat.’

For some of our female patients the schedule book has the words ‘Redneck Woman’ in feminine pink on the cover, but list goes as follows: ‘Go to Taco Bell for late dinner.  Go to ER and complain of vague pelvic pain for Lortab, pass out after argument on cell-phone with boyfriend, call boyfriend to come to ER while crying with either pain or emotional distress, have boyfriend yell at ER doctor for not giving pain medicine fast enough, call nurse suggestive and angry names, threaten to call administration, call angry parents to come yell at doctor, get obligatory pregnancy test, ask for crackers and soda because ‘my sugar gets low.’  Stumble home in the morning after meeting cool guy in waiting room with back pain and Lortab prescription.  Get phone number.  Leave with work excuse in hand, watch movies all day, sleep briefly, repeat.’

I’m not being cruel, I’m telling it like it so often is.  Ask the people who staff America’s EMS systems and emergency departments.   But the truth is, I like these folks. They’re bold, they’re unashamed, they know what they want and they go for it!  Like the overdose with slurred speech who looked at me and said ‘cannn I havvvv sommthinnng for pppain, my tooootttth is kkkkillinggg meee.’

Hands on hips I said, ‘You’re joking, right?’ ‘Well,’ she recovered, ‘maybe after all of this is over?’

These patients give us our best stories, they keep us constantly entertained, and truth is, they are in deep need.  They need normality, they need healing for the brokenness of generations of dysfunctional families.  They need pride and sobriety and goals.  They need to decide to raise their sons and daughters well, without night-time wanderings and family-court drama.  I consider many of them my favorite patients.  I know them, medical history, allergies, surgeries, medications, genealogy and all.  I don’t always want to see them coming through the door, but I like them all the same.

As I thought about the crazy morass of night in the ER, I realized that many of my Christian physician friends feel inadequate because they aren’t in distant mission fields, or because they don’t work in environments that are uplifting.  It occurs to me that the emergency department at night is a place of so much need that Jesus probably wants me there.  If he were walking among us in the flesh, he’d hang out there too, along with every other locale of pain and misery in the world.  Since he dwells in those of us who call ourselves his disciples, he must want me and other believing doctors to go to places like our emergency department, a certified place of enormous need.

He said, ‘it isn’t the well who need a physician, but the sick.’  That being the case, the sick rise up in the night and come to the ER.  They drink and fight and get arrested and call me names.  And I don’t always have to like them, and I sure don’t have to enable them, but one thing I’m duty-bound to do is to try to treat them with love and respect, for the sake of the Physician I hope to emulate.  God help me, they drive me crazy.  But Jesus knew they would.

I like to think that he laughs along with me.  I like to think he’d roll his eyes too, when they do all of the silly things they do.  But where I can place stitches and take x-rays, intubate and transfer, lecture and observe, he can heal.

As I go from madness to madness, I hope that my anger and frustration doesn’t drive Jesus away.  I hope that when I walk into the room and out of it, he lingers and works some hope, some miracle I can’t.  I believe he does; despite my humanity and incapacity as a healer.  I don’t have much time to talk to them. I’m not sure I could explain to them that all their sins can be forgiven, all their past healed, all their futures transformed.  But even if I can’t, he can whisper it to them, head injuries and all.  And if I’m a little kind, if I joke a bit, if I smile at the sad-eyed children, I may plant a seed of hope in the lives of people who have known so little of it.

But if that’s how it is Lord, if that’s how it’s going to be, go ahead and get ready to forgive me for my snippy remarks and cynical outlook.  I’ll try harder.  And how about making me a little more rested before I take care of all your assorted fruit-loops, OK?

I know he understands what I mean.


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