There is a list of names in every Emergency Department that is well known to each individual that works and fuels that ER. And I’m telling you, it is never a good thing when you are the patient with the name that we immediately recognize upon popping up in our waiting room. For the most part, it indicates that you are chronically sick and chronically in need of emergency healthcare. This runs the gamut of chronic illness. You may have a weak heart that frequently gets overloaded and you end up short of breath with fluid filling your lungs. This may mean you have failing kidneys that cause your electrolytes to go dangerously high as they cannot be filtered through your kidneys. This may mean you are an alcoholic with poorly managed diabetes coming in with abnormally high blood sugars. This may mean that you have mental illness that causes unmanageable panic attacks or leaves you feeling unsafe and suicidal. This may mean that you have chronic pain and frequent exacerbations of uncontrolled pain. This may mean you are addicted to narcotics and doctor shop for refills on pain prescriptions. This may mean you look for providers that will give you IV medications to give you the high that some pain medications can provide. Whatever the reason, a familiar name in the Emergency Department is never a good thing.
On this particular day, I stepped into the chaos of an already bustling Emergency Department. My colleagues mid-hustle, moving swiftly and deftly about the chaos of a busy day. And there, waiting to be seen was a name I was all too familiar with. She is a mother, a wife, a member of our community, a person who struggles with mental illness and self-harm. Triggered by events that send her stress into an insurmountable wall. I don’t pretend for one second to know what she lives through on a daily basis. I don’t pretend to understand these uncontrollable urges. I don’t pretend to understand what it must feel like to come to the same emergency department, see the same healthcare providers, anticipating how they may react, judge, or act. I don’t pretend to comprehend how difficult, how humiliating, or how much courage that must take. What I know is that she comes into our emergency department on a regular basis with undeniable self-inflicted wounds that take a prolonged period to repair.
There was a time when I called for social services every time she came in. She always gently declined their services. Even when they came to talk to her anyway, she dodged and ducked out of their way. She will assert how she has a therapist appointment right around the corner. That her therapist knows she is here. That she is working through some very hard things. I’ve called her therapist on occasions and she has corroborated what she has told me. It is a difficult case, her therapist tells me. During one instance, she was admitted to the hospital for a more intensive mental health evaluation and management. It turned out, this only snowballed her mental illness and made her spiral deeper down a dark hole.
I’ve seen her enough to know she means it when she says she is not suicidal. She often greets me cheerfully. Talks about the weather, about her day and her week and her kids, as if she wasn’t there for self-inflicted injuries, but just for a regular slip and fall. In the same conversation, she gives instruction and suggestions on how she would like her repairs done. I slow my breathing and try to wrap my head around how I should act. This is not normal and I cannot help her normalize this behavior. On the other hand, she is a mother, a wife, a member of a community that is deserving of basic human courtesies and respect. She is a human being that is struggling. Struggling so hard to just live a daily life accepting all the triggers and finding a way to assimilate them in a healthy fashion.
If I am being one hundred percent honest, it can be hard for us with patients we see frequently to not see them through a lens of judgment. The patient with a weak heart that is on a low salt diet that eats ham and gravy over the holidays with his family. The patient with failing kidneys that routinely misses one or two rounds of dialysis and is in need of immediate intervention to ensure his heart doesn’t go into a lethal rhythm. The alcoholic patient that has uncontrolled high sugars and will continue to drink when he is discharged from the hospital. The young patient with debilitating anxiety convinced he is having a heart attack that comes in monthly to have it checked and is in need of persistent reassurance. The patient with chronic pain that comes in with abdominal pain regularly and requests large doses of narcotics. The patient who has been to every Emergency Department in the local vicinity in the last week, accumulating narcotic prescriptions, who yells aggressively when confronted. My patient who inflicts harm on herself on a regular basis and wants us to do nothing but fix her wounds.
It is easy to make quick judgments. It is easy to feel as if they are less than. It is easy to push all the fault on their shoulders. But who are we to judge? We come from a place without heart failure where we can excitedly enjoy an unrestricted holiday meal when reuinited with our families without worrying about our breathing. We come from a place without three day a week dialysis, a place where we are sober, a place where we are not crippled with anxiety, a place where chronic pain doesn’t have a vice grip on our lives, a place where we haven’t fallen to the addictive properties of narcotics, a place where we have never experienced or worked through mental illness that urges us to harm ourselves.
Who am I to judge? I am no different. I am a person with my own issues; I am just exceedingly lucky my issues do not lead me to the Emergency Department on a regular basis. So, I’ll work harder to challenge myself. I am not here for judgment. I am never here for judgment. I won’t fault myself for being human, but I will check myself and know the bottom line is that my patients are in need.
They are in need.
Whatever that need may be, in the Emergency Department, we are better equipped to help them navigate it at this moment than they can do by themselves.
That day I took a deep breath. I checked my judgment. I repaired all of her injuries. The Emergency Department outside her room was bursting at the seams, but she deserved my full care like everyone else. It took me about an hour. I looked her in the eyes, mother to mother. Wife to wife. Human being to human being. I asked her openly if there was anything else I could do for her today. “No”, she said. “That is all.”