I realized, not long ago, that the modern hospital emergency department is much more than meets the eye.
Sure, it’s the place where the severely ill and injured receive modern, timely care by well-trained professionals. Obviously, it’s the place where many Americans receive their primary care, due to their inability to pay, or their lack of insurance (voluntary or involuntary).
And yes, it’s the place where physicians and nurses wrestle the drunks, the drug abusers, the overdoses, the arrested felons with ‘seizures,’ and manage many of society’s other problems when no one else wants to deal with them. This includes looking after the homeless when shelters aren’t available (or willing to take them), caring for the schizophrenic and suicidal when all the psych beds are full and they have no insurance (most of them, incidentally), helping with nursing-home placement for frustrated family members of demented elderly men and women; and on and on, ad infinitum.
And of course, let’s not forget that the emergency department is the source of a huge amount of the illegal prescription drugs that circulate in America, thanks to modern medicine’s acceptance of the already-tired dogma that we should always treat everyone’s pain, and never doubt their story. In a sense, the emergency department is the source of an enormous underground economy!
But more than all of these things, the modern emergency department is a kind of social sciences laboratory. In fact, about 30 years into the existence of the specialty of emergency medicine, I feel comfortable saying that we have shown.with remarkable precision that the more radical social revolutions of the 20th century were shameful, stunning failures. And the reason I can say it is not based on carefully designed studies, or because I’ve observed it from the comfort of the ivory tower of academia, but because I, and many others like me, treat the casualties of those social revolutions day, after day, after day. Some examples, you ask?
‘Drug use is normal, good, relaxing and enlightening. Only Puritans and other fundamentalists have any problems with drugs.’
I see the scars on patients from years of injecting heroin and methamphetamine. I see the lifeless, pointless existence of heavy marijuana users, who have almost no inertia to achieve. I see the agitated misery, heart attacks and strokes of cocaine users. I see the endless somnolence of narcotic abusers who are ‘hurting so bad,’ even as they fall asleep begging for another prescription for Oxycontin, Percocet, Vicodin, Methadone, Morphine or whatever their narcotic of choice may be. I see the shattered parents, the displaced children, the wounded spouses, the frustrated police officers. I see the way they drain society of patience and money; and the horrible way their lives were ruined, when they could have been happy and productive. Drugs are liberating? I don’t think so.
‘Sex is natural and anyone who tries to limit sex is an old-fashioned prude; probably a Puritan or fundamentalist…see above re: drugs.’
Well, there’s nothing more exciting and liberating than a fresh, painful case of herpes in a teen-age girl. I just saw one. She was in pain, and she was crying; not the brightest bulb, bless her, even she knew that it would never be cured. ‘Well, sure, but if she had used a condom…’ If she had used a condom, she’d still be faced with the reality that condoms are only 50% effective at preventing STD transmission. She was 17 and had already given birth to one child. Sex certainly liberated her. See, in the emergency department we see the painful pelvic infections women endure, that can result in infertility, tubal pregnancy and chronic pain. We see the mistrust between partners when one has an STD and another does not. ‘Excuse me, I have what? I’m going to kill him…’ We see embarrassed young men with burning, draining infections. We see the depressed and anxious who are suffering from the betrayal of infidelity. We see the unplanned, undesired pregnancies and the children left behind by a relaxed, ‘free’ sexual lifestyle. We see those teenage girls with the exploding rates of STD’s. (Half of all African-American teen girls have a sexually transmitted infection.)
The mantra of ‘free love’ that began in the 60’s wasn’t about liberation; it was about enslavement to the desires of those who started it and who wanted no restraint on their behavior. The echoes of that movement still sound today in the weeping of patients with non-lethal infections and the grief of those with HIV. Nice work guys! We’re finally free from sexual restraint. And more miserable than ever. Not to mention the marriages broken by infidelity and pornography. The ‘liberated’ women all but enslaved in the pornography industry, or trapped in lives of prostitution where they develop diseases, or are victims of violence, and eventually end up in the emergency room themselves, liberated from health and self-respect.
‘The way to fix poverty is to give services, food and money to them, so that they will feel compelled to improve themselves.’
Well, sure. Plenty of families need help. I love helping them. I don’t care a bit when I don’t get paid by a family in need. But plenty of families are lazy; and have been lazy for generations, thanks to the welfare state. We see them come to the ER en masse, an entire family with cold symptoms or insect bites, all checking in because ‘we might as well, since we’re here.’ They call ambulances for prescription refills but never do the things that might help them, like giving up cigarettes. They over-eat, over-drink and under-move, all the while collecting welfare to support their obesity. They collect disability for ‘nerves’ or ‘anxiety’ or some unverifiable pain, all the while working on cars, partying, hunting and having the physical capacity to make multiple children, all supported by the state, all supported by the tax dollars of the gainfully employed. Their children? Rarely are they ever taught that there is value to education, value to knowledge for knowledge sake. Seldom are they aware that a home can be a place of hope and encouragement, progress and comfort. Home, to many of the children seen in the emergency department, is the place where adults have rotating sexual partners, use drugs, get drunk and scream profanity at their children. Great idea; give people just enough to keep them from starving, but don’t expect enough from them to let them lift themselves up from their low estate. And heaven forbid we should use any discernment and try to teach them right from wrong! Another idea down the gutter; another group of children and adults down the drain. I’m not judging. I see them, I touch them, I hear their stories, I close their wounds and write their prescriptions. AndI feel sorrow in my heart for the way their lives are being wasted.
‘Families can be defined in any way, family integrity is over-rated and men are entirely unnecessary for a proper home!’
Do you know why I see children who are anxious and afraid? Do you know why children seek each other out for sex, and have children of their own at such young ages? Because they are terrified. Why is that? They lack the peace of safe and stable families. They lack the boundaries and discipline, born of love, that proper families give. They want the protection, wisdom, affection of a man and woman, together for the long haul. Without those things, we see what we do in the ER; teen mothers, teen fathers, irresponsible parents shifting sexual alliances from week to week, month to month, moving in with lovers and moving away from them. The children are circling in a whirlpool of pending disaster, and they know it. They are depressed, fearful and lonely. They are verbally, physically and sexually abused. They have sex too young; they use alcohol and drugs; they mark their bodies with tattoos and piercings, seeking to make themselves interesting, or beautiful, or acceptable to someone, since they don’t have that acceptance at home, where the definition of family changes from week to week, fad to fad. The ER is full of young people, and adults, who are so devastated by the lack of family that they can barely function. Those young men and women need, whenever possible, both a mother and a father. And that father is necessary for more than sperm donation. His job is to protect the mother and the children. His job is to build his sons up, and make them into safe, responsible older men. His name is to be terrifying to the men who want to date his daughter, and to show her how valuable she is to him; how worthy of good treatment. Is family necessary? Absolutely. Are we just as well off without it? Not a chance. The misery of broken families is testament to the failure of that ridiculous theory.
‘Religion is an impedance to modern thought, and we need to be liberated from it by the clear, crystal light of pure science.’
Great! Now, when someone’s child is crushed in a car wreck, when someone’s spouse is murdered, when cancer is discovered on a routine exam, when death comes suddenly and unexpectedly, you scientific folks go and comfort them with the knowledge that their loved ones will merely fertilize the earth for future generations. What? Too busy to hang out comforting the sick and dying? Right, I understand.
Well, how about the people who were from those broken homes, who were and are addicted, who lived as hookers, killers and thieves, or even the ones whose families were intact but cruel and distant. What about all of those who hear the voices that say, ‘you’re no good, you’re worthless!’ What say you to them? ‘Well, if you try hard enough, you may be worthwhile and do something useful. Here are some financial handouts to help you along. Take these pills and see a psychiatrist if you can afford one.’ How about this, for all those broken hearts I see day in and day out? ‘The God of the universe says you’re his beloved, and wants you to know that your sins are forgiven if only you’ll accept the gift! Your past will be wiped away, and you will be new. It won’t be easy, but the church will do its best to love you, and you can know in your heart that your heavenly Father adores you.’ That’s better. At least it offers hope without any request of performance, and without the fickle approval of other broken, deceptive, human beings. We need to accept each other; but we also need to know that a higher power considers us infinitely worthwhile.
See, the ER is the laboratory where we have seen the truth. And the truth is, America, indeed the modern world, has lost its way. Read research from sociologists if you want. Study academic journals over a pricey Latte. Wax poetic about the masses and their struggles, about the judgmental ‘religionists.’ Seek higher taxes as if money were the balm for all suffering. Tell jokes about drugs and sex; watch some porn, take your daily antidepressant. Relax over a glass of wine and plan ways to make America even more free, more fair, more progressive. But take it from a guy down in the mud, it’s a hurting world; and hurt all the more by social revolutions that led, ultimately, to immeasurable individual disasters; see nowhere more clearly than in the emergency department of your local hospital.
Well said, Sir Edwin.
Never forget, however, that these are the very people Christ spent his time with. He did not approve of their behavior, but he loved them.
I don’t doubt you do, but it is easy to fall into cynicism.
Keep up the good work.
Ed nurse of 38 years
This is absolutely the very best narrative about the downward spiral of all things American. Give it to me, I deserve it, I am an American. Get a job, why? Stop having kids, why? It is the American way, our government will dig us out of whatever mire we have made.
Interesting thoughts, but you don’t seem to realize the major selection bias we have in the Emergency Department.
That’s a wonderful depiction of the society of today. Not only America… the whole world. The Lord spent his time with them and was sad because they were like sheeps without shepherd.
I really like your blog. Thank you.
God Bless you, Sir. You have given voice to my thoughts. The extreme amount of pathology we encounter in the ER is painful to watch. There is a deep sadness that comes from seeing hurting, broken people; it’s actually one of the things that keeps me coming back to work. These people NEED us… sometimes we’re all they’ve got. People are different, with different gifts and abilities… we physicians possess intellect, drive, calm… and hopefully a servant’s heart; a heart of compassion. To use those gifts in the service of your fellow man can be a painful, sacrificial enterprise… but… Read more »
I agree with 99% of what you say. I would add several points. One is that racism may not be as overt as it once was, but is still present and its effects will be around for more generations. Also, the lack of concern or care of the haves, the NIMBY syndrome, or the out of sight out of mind syndrome is a factor. In addition, this country’s middle class has been losing ground for some time as those at the top grow richer. But yes, we are floundering and it does affect us all.
I was once told by a priest that technology was the downfall of civilization. It ripped families apart, provided a venue for paedophiles, distracted teenagers and was a major source of evil. I argued with him for hours that it also brought knowledge sharing, shined the light on ethnic cleansing in Kosovo (it was 1998) and brought enlightenment to millions. I had the same thought while reading your post. To blame the counter-culture movement for the marginalized people of today is a leap (if you’ll excuse the pun). Yes, the emergency sees the worst that society has to offer. But… Read more »
I guess you’re right. My former husband and I plaaned a pregnancy when I was 15 because I knew my mother would kick me out of the house for fear of embarassment. Happened to! My only sibbling, my sister, she eloped at 15 too.
I guess she made out ok. Myself, I walked out of the frying pan right into the fire. Been a punching bag most of my life.
My name here, Surgeon in My Dreams, is just what it says. That was my dream through childhood, to be a surgeon. Blew that one away.
Excellent and insightful piece. I work in a small ER as a tech and while being in suburbia tends to insulate us from some of the extreme excesses of reality, we still see a lot of what you mention. It’s heartbreaking. And I’m not one of these people who idealizes the past and believes it was all perfect back then. But I know in my heart that some of the values and practices we had in the past encouraged stronger families who were less dependent on government and, more importantly, less likely to live on the edge of the abyss.… Read more »
Sorry but why ignore the tons of evidence that condom use and talking to teenagers (and younger kids) about sex helps prevent STDs and unwanted pregnancies. Sorry but in the ´western world´ (with the exception of the US) you´d be kindly laughed at or maybe referred for some desperately needed continuing medical education.
While Graham is correct that there IS a huge selection bias, I got to see a lot of this over the last two years while watching my parents go in and out of the ERs and to the nurising home, until they passed on. I gave a lot of credit to the ER staff, from the MDs all the way to the Social Workers (met some great ones, and some not so great), to the guy who cleans the floors. A LOT of the “reforms” and “social experiments” work fine, if you have that “solid middle class” family to back… Read more »
Great post. Thanks.
Yes, there is this layer of our population that floats in and out of social service and medical offices, soaking up entitlement until they collect their free burial. Like the guy who needed emergency financial assistance because he had just bought a cell phone which left him with no money. He objected strenuously when I told him that emergency assistance wasn’t intended to solve the problem he had just created. Naturally I was criticized by my supervisor.
OK, I can agree that Drugs, Annonymous Sex, and STDs are Bad ummm kay, but don’t be dissin my Porn, I dont care how smart you are. Whats next, Rock n’ Roll?