My column in April’s Emergency Medicine News

incapable...but naturally

incapable...but naturally

The Scourge of Incapacity

Those of us who work in emergency care are often deemed insensitive by others. When we rant about the situations we see, sensitive people genuinely believe that we’re cold, uncaring or burnt-out. I have been accused of: ultra-conservatism, right-wing lunacy, being judgmental (the worst insult a post-modern can muster, by the way) and of being a ‘greedy, Mercedes-driving doctor.’ (In point of fact, I now drive a Toyota Tundra pickup.) Someone even said my newspaper readers should ignore my opinion about medical finances because I was just ‘po-mouthing.’ This is a Southern-ism that implies I was making my situation sound dismal when I was actually quite well off.

While I’m sure that a few physicians are, in fact, cold and uncaring, most of the docs I meet are anything but. What they are, however, is possessed of the remarkable clarity about humans that can only come from working with actual people rather than theories or ideologies. It’s a kind of insight that cannot be achieved in the purely academic world, nor is it attainable in Internet chat rooms. However, it may be of interest to realize that, as I long suspected, it isn’t just doctors who deal with reality.

I often speak about our struggles with a dear friend and fellow church-deacon who is a manager in a local grocery store. My friend is as kind a man as you’ll ever meet in your life. Devoted to family, to friends and to God, he volunteers at a local elementary school, spending time with at-risk children. He comes to church early to pray for the many needs that burden his heart. He would literally give you the shirt off of his back. And he’s fed up with the abuse he sees in his grocery store.

He told me, ‘Ed, I see people using food stamps to buy food I could never afford. And I have a good job!’ He recently held-forth about a woman using her WIC (Women, Infants and Children) card to buy six gallons of milk at once. When he half-jokingly asked what she did with all of the milk, she pointed to a toddler and said, ‘she drinks all of it.’ Later, leaving the store, the ‘customer’ was heard to say, ‘What does he care? He ain’t payin’ for it!’ Except, of course, that he is.

My friends who are deputies and highway patrolmen feel the same; as do many of my friends whose work as attorneys puts them in contact with the welfare and social services systems. They are often frustrated by the abuses they see, by the parade of bad decisions, and by a beauracracy that almost seems to encourage and reward the abuse of benefits and services, while rarely elevating anyone.

One of my own favorite gremlins is disability. So many of my patients seem to see disability as a career goal. A friend of mine is a school counselor. When she recently asked a young high school student what his post-graduation plans were, he never missed a beat. ‘Guess I’ll get disability for my nerves, like the rest of my family.’ Aim high.

The thing about those of us in emergency medicine, the thing that makes those outside our circle think we’re bitter, is that stories like the ones above just drive us crazy. In the same way as patients coming to the ER for routine pregnancy tests, asking for prescriptions for Tylenol and seeking FMLA forms for ankle sprains. In the same way as the diabetic who refuses to get the $4.00 prescription at Wal-Mart, but regularly goes to MacDonald’s before coming to the E.D.

There are, doubtless, well-meaning persons who will read this and still marvel at our insensitivity. So I was doing a little reflection on what it is about these situations that so frustrates us. Is it, after all, about the money? Are we just mad because we aren’t being paid? Well, that can’t be it. My disabled patients, my Medicaid patients, they all have insurance. I’m paid for seeing them! Maybe not a full market value, but something is better than nothing.

Is it elitism? Do I consider myself better than these folks, who are often poor and uneducated? Probably not. My faith teaches me that, in terms of our absolute worth, we’re all the same in the eyes of God. And my own grandparents were laborers and small business-owners, as well as subsistence farmers. I have no animosity towards those who struggle.

And it hit me. Those who struggle! I like it when people struggle; not in the sense of hopelessness or crushing misery. By struggle I mean those who try; who set goals and go through life trying to be better, happier, more successful, more resourceful; more independent. I’m happy to help those who try, and happy to help those who are actually in need! I’ll gladly give care to the truly sick. I’ll stay late, bend-over backwards, beg, borrow and plead to do whatever it takes to help them. And for those who try? Anything. If they’re trying to do what’s right, trying to get healthy, to rise out of generational poverty, trying to recover from an accident or mistake, a prison-sentence or a true disabling injury, well I’m honored to be there for them.

What bothers me, what bothers us as a collective, is not that people need us. It’s not even that people need us for free. It’s that they have begun to worship at the altar of incapacity and what the wise men of old called sloth. We are an over-medicated, under-educated nation bent on proving that we cannot, rather than showing that we can. Having inverted the ethics of our forefathers, our goal is no longer autonomy, but dependence.

We have abandoned the sense of guilt that, in the past, made our citizens try to achieve on their own to avoid being burdens. We have, in fact, abandoned the entire idea of guilt in exchange for a kind of social love-fest, where anything goes as long as we want it.

And nowhere do we see the results of this experiment more clearly, more painfully, than in the emergency department. Young and old alike swamp our departments, convinced that someone owes them money and compassion for their own dysfunctional life-choices and beloved incapacity.

It isn’t that we’re burnt-out. It isn’t that we’re cold. It’s just that we understand better than most what it means to try. No one told us that ‘not-trying’ was an option. And we’re just weary of being responsible for an endless parade of patients who believe we owe them something; and who consistently refuse to do anything for themselves.

So don’t let anyone call you bitter, shallow, greedy or anything else. Gather your friends, businessmen, police officers, social workers; collect their stories and pass them on. Explain that you aren’t the only person frustrated with our deteriorating social situation.

And be proud that, in a world of epidemic and voluntary incapacity, you remain capable, and proud of it.

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