This is my latest entry at my Huffington Post blog.  The ER is a kind of sanctuary.


People ran to the church for refuge in Medieval times. It was considered a place of safety, a sanctuary from civil punishment. In the church, one could claim a right to justice, food, water and shelter.  That role was recognized by church and government authorities alike; doubtless sometimes grudgingly as the wanted escaped harsh punishments.

These days, America’s emergency rooms have filled a similar role. I’m reminded of this because the holidays are here. For the next six weeks or so, my colleague around the country will be inundated by patients in their already packed emergency departments, whether local community hospitals or major teaching and trauma centers.

During the holidays, it’s easy for physicians and nurses to get frustrated by the tasks before us. This time of year, it’s even more evident than at others that many of our patients aren’t ‘classically’ sick. At least not in ways we thought we signed up to treat. What they are is sad, struggling and frightened. And what they seek is sanctuary; as surely as their ancestors, our ancestors, knocked on the door of churches in the night.

We can re-engineer our insurance systems and try to encourage people to go to clinics and family doctors. We can create government policies to reduce the use of ‘expensive care.’ (Emergency care is actually a small portion of the total healthcare budget.) It’s all a great idea! Emergency departments struggle to bear the brunt of our national medical inadequacies, whether lack of insurance, primary care or psychiatric care.

But I doubt that much will change. Because the emergency room is available 24/7/365. And for all too many people, young and old, it’s the only cathedral they’ve ever known; and the only place you can go when you’re drunk, bleeding, stoned, shot, stabbed, abused or assaulted.

If you want a glimpse into society and its varied ills, volunteer in your local emergency room. What you’ll see is a lot of humanity. Sure, there’s plenty of sickness. Diabetes and accidents, strokes and overdoses. Broken hips and broken backs. Uncontrolled diseases and newly diagnosed tumors. But if you look closely, you’ll see that much of what passes for emergencies is brokenness, and wounds of the heart and soul.

It’s the mother at her wit’s end because the feverish baby’s father left and won’t be back. It’s the grandmother raising four grandchildren because her daughter came to love methamphetamine more than motherhood. It’s one partner, abused by another. (Abuse isn’t limited to men or women, gay or straight.) It’s the undocumented alien who doesn’t know enough English to explain that she’s being trafficked and is desperate for rescue.

Human troubles also mean loneliness. Widows and widowers with no family nearby. The man whose dementia is just starting, and who wanders out in cold nights to find the cat that isn’t there, or face the intruder who never appears. Loneliness means young people, on their own, far from family if they have any at all. So much of their chest pain, their abdominal pain, their migraines or shortness of breath is just the fact that deep inside, deep in their broken hearts, they want to go home; even if they don’t have one.

We joke darkly, in emergency rooms, that our job is mainly about fluffing pillows and handing out warm blankets and turkey sandwiches. Yet, in contrast to the lives of many of our patients, those simple things we take for granted are like silver and gold, and probably are therapies as valuable to the wounded soul as antibiotics to the sick body.

If we step back and consider where we work for a second, we’ll see that the emergency departments of America stand in stark contrast to the lives of so many. Where our patients sometimes live in darkness, squalor, danger and hunger, whether run-down trailer, homeless tent or government project, the emergency departments are different. They are places of bright lights and warmth, safety and relief; where beds are clean and food is available. And if nothing else, places where there are people who are interested and polite. Doctors and nurses, secretaries and security guards, police officers and paramedics and others who won’t hit, won’t scream, won’t manipulate, won’t seduce.

The next few weeks will be busy times for my colleagues and for me. Holidays are always crazy in the ER. Clinics will be closed, out of town families will bring relatives to be ‘checked out.’ Family arguments and anger make hospitals into Level I Drama Centers. People will be depressed and suicidal even as others decide it’s a nice time to stop drinking and start rehab. We will still have manipulative drug abusers, violent offenders, patients who won’t follow our instructions and all the standard frustrations of life in medicine. All of us who work there will be grumpy and cynical before the New Year crashes upon us.

But if we pause and consider our mad-house emergency departments and trauma centers as places of holy sanctuary, especially this holiday (Holy Day) season, maybe we’ll be less bitter as we staff our brightly lit, warm and welcoming emergency departments; beacons in the dark night of all too many hurting souls.

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