Buddy, Can You Spare a Dime?

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Okay, so this morning I want you to think about something with me. I want you to be honest, as honest as you can, as I will be with you too. Deal? We can’t move forward until you agree.

Right.

What do you feel when you’re driving along, you come to the next busy intersection, stop for the red light, and see that homeless guy? You know the very one I’m talking about. That homeless guy with his grimy, almost blackened clothes, week’s growth of beard, and the cardboard sign that says Will work for food or some such?

Nope, nope, nope, come back here. You said you would be honest with me, and I’m not going to let you weasel out of this one that easily. Your second cup of coffee can wait.

You don’t know this man. You don’t know his story. You don’t know if he’s a scammer (you really think that likely he is), a deadbeat dad (how could he not be, you think, dressed like that and begging?), or just a really, really lazy person (Of course he is-I work for food every day. It’s called a job!). Do you look at him critically, looking for clues to his story in that brief minute that the light is red? Do you look on him with compassion, feeling a sense of urgency to help? Do you look at him with a sense of guilt, knowing that if you don’t help him, right now, that nobody else is likely to for the rest of this day?

Now, take that feeling that you had at the red light, or those feelings, because my hunch is of you’re like me you had a smattering of all of them, and sit with them a minute. How do they hit you? Do they make you feel empowered? Sad? Angry at society? Helpless? Energetic? Depressed. Full of empathy? Disengaged?

Take those feelings and multiply them by a hundred, a thousand, ten thousand. Doesn’t feel so good, does it? Feels downright bad. You want to stop feeling that way. You want to get back to feeling good again, driving away from that intersection and going shopping and spending your money and hugging your children and smelling the fabric softener in your clean clothes.

Indigent patients, truly indigent patients, hit us like that in the emergency department hundreds or thousand of times each month. They are the truly poor, the truly needy. The ones who will be with us always, no matter the party in power or the stock market close. Homeless, down on their luck, no job, no money, no place to stay. Using drugs. Coming in with blood alcohol levels of three, four hundred. Dirty. Smelly. Reeking of alcohol and sweat and vomit and street grime.

I’m sorry, but my part of this bargain is to be honest with you since you stuck around with me.

We all know that being a doctor is glamorous, right? It’s all about Patch Adams and House and ER and Marcus Welby and Grey’s Anatomy. It’s about quickie sex in the supply closet between exciting traumas. It’s about magic tricks and starched white coats and throwing your weight around because you’re a star surgeon who saves lives. It’s about sterile environments and bright lights and making that once in a lifetime diagnosis that gets you noticed and makes you a hospital legend.

Come on. You know better.

ED medicine is about grueling hours and long shifts and inexhaustible waiting rooms full of patients with chest pain and bleeding and suicide attempts and drug overdoses. It’s brutal, folks. A lot of the time it’s just brutal. I hate to burst your bubble, but there it is.

Indigent patients are one of those special groups I was telling you about the other day.

I got to the office yesterday and saw that there had been about a dozen psychiatric consults remaining to be seen when my colleague had gone off shift at midnight the night before. From midnight until eight AM the next morning, another thirteen or so had *dinged* into the work queue. Twenty-five patients with their own stories. A good number of them that guy. The one holding the sign at the intersection, or someone a lot like him.

How can we show compassion to the old, tired, smelly guy with the sign when we are tired before we even get started with the day’s shift? When we see the never-ending line of misery staring back at us on the computer screen and we just want to hit the gas and burn rubber and drive off?

I’ll tell you how.

First, we don’t go into this line of work unless we really want to help people. Sounds all rose colored glasses and kittens and sparkles and unicorns, but it must be true. It has to be. You don’t put up with this shit unless you want to be a doctor.

We train and train hard for a reason. We learn our craft and how to do it backwards, forwards, upside down and sideways, blindfolded and with one hand tied behind our backs. We take long hours of call, we work days on end with little rest and we see patients back to back to back so that we develop toughness. When the fifth indigent patient comes in with the same-old same-old story at midnight on a Saturday when we are so bone-tired that we can’t see straight, we give him the same ear and the same critical workup we’d give the lady with full insurance coverage who drove herself to the ED in the Lexus to have her arthritis checked out. If we’re good doctors we do, that is.

We care for each patient as a person, a person with worth. I don’t care if you’re down on your luck, if you have no money, if you have no job, and if you curse me for everything I’m worth as I tell you I’m going to commit you for your own safety after you drunkenly sliced your wrists opened and guzzled a mixed drink of Tylenol and scotch. I’m going to take care of you the way my excellent mentors taught me to, the same way I would want my own mother or daughters to be taken care of.

Being indigent is not a crime.

Being an arrogant, thoughtless, cold, uncaring doctor should be.

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16 thoughts on “Buddy, Can You Spare a Dime?

  1. I agree. Everyone deserves respect, just for existing. I so dislike the idea that respect must be earned. Thanks so much for writing this post and more importantly, for the work that you do.

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  2. Greg,

    As I have said before, I admire you, your commitment to your profession & most of all your obvious compassion for those in need who just happen to cross your path. They cross your path for a reason…you have the capability to ease their pain. I vividly remember a young man holding up a sign around the holidays last year as I was leaving the shopping center … In need of a job … To provide for his family … That’s what the sign said. I believed him absolutely. You would’ve too, if you had seen his eyes. My heart literally hurt for him. I said out loud, “Lord I don’t have a job for him. Please please send someone that does have one.” I don’t know if he got a job. I just know I never saw him or his sign again. Hopefully someone came along that could help him. It is truly heartbreaking to see folks in need & you not be able to ease their pain. You, my friend, are able to do that…one patient at a time. It’s your gift. It’s your curse!

    M

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  3. I grit my teeth everytime I hear nurses say “well, we’re paying for this patient’s care’ in an uncharitable, resentful manner. I don’t see the CARE to be different. Does attitude affect care? Probably – and maybe we’re tired, too, but personally, though in debt, I have resources others don’t have…we can never leave compassion behind because, indeed, the next homeless person through the door could be me.

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  4. Hi there Dr Greg, it’s a wonderful blog you have here!

    I’m a Dentist here in the UK, just wanted to agree totally with what you said. Compassion is critical to any aspect of the healthcare profession. I feel without it or if one is beginning to feel its ‘just a job’ should begin to realise that maybe this isn’t for them. Society in large part has become so materially driven that care and compassion for others is not given the emphasis it should be. Incomes have shot up yet happiness hasn’t let’s all try even a little to cultivate a little more compassion be it a smile or a ‘are you ok’ we ALL will go through major downs at some stage in our lives can be frightening, we are all human. Small acts of kindness go a huge way in creating a better society. Mental wellbeing and happiness are being given a lot of attention worldwide. The reasons being in general people are not ‘happier’ just because we have ‘things’. Compassion for others is one of the things which increases the ‘feelgood’ factor!:)

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  5. Maria,

    Obviously I don’t write about this stuff to talk about what a good job I do, but I thank you for your comments and your compliments.
    I write because I want people to know how hard this work is, like any work worth doing, and how necessary it is to keep us human and compassionate.
    We need to care for each other when that care is the difference between someone having a decent life (as most of us certainly do) and not.

    Greg

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  6. Susan,

    Thanks for reading and for that comment.

    Once again, as I just wrote to Maria, it’s not about me and how compassionate I am. It’s about how we ALL must pay more attention, help more, be better people, and help each other move through through this life the best we can.

    You are doing that in training for your new profession as well.

    I think if we all do our best to help each person that crosses our path today, one at a time, we can go home feeling that we have done our part.

    Greg

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  7. Aman,

    Welcome! I’m so glad you stopped by to read and I hope you will return and share your thoughts often. It’s always wonderful to have readers from other countries who bring fresh perspectives on the issues that we all struggle with.

    As you said, small acts of kindness go a huge way in creating a better society. I think that many of us nowadays see these problems, such as homelessness, as being such huge problems that we can’t effect any change ourselves. Of course, that one act of kindness can have a ripple effect, a pay it forward effect, that can effect positive change for generations to come.

    Thanks again for reading and commenting. I hope to hear from you again and often.

    Greg

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  8. Roberta,

    Well said.

    I have been a patient myself, and I have felt the difference that real caring makes when you are tired, in pain, and wondering if you’re going to be okay.

    While I do believe very strongly in one’s ability to effect change on one’s own life, sometimes it does take a village to help those who are truly less fortunate and need a hand.

    Of course, you’re right. We never know when it’s going to be us needing the care and the compassion.

    Thanks for your comment.

    Greg

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  9. Yes I was recently a patient too I needed iv antibiotics following a fall. I saw both the good and not so good side of care. Both nursing and medical staff should realise that there is a human being at the end of the cannula a person with feelings, emotions etc. I felt a 50/50 split whilst I was under their care some staff very cold and clinical like ‘its just a job’ others who were better. ALL staff should treat a sick or ill human being with the utmost care and respect.
    For those who haven’t heard or read about the physician Dr Richard Teo who passed away at the age of 40 I’d highly recommend this link:
    http://newcitymagazine.com/2012/10/31/dr-richard-teo/

    We ALL will go through a tough patch where health may be compromised its truly frightening, the most humbling experience ever in my opinion. Lets all just be nice, non judgemental and hopefully slowly slowly create a nice society where compassion isn’t just talked about…..a society where compassion is the norm.

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  10. My son was very frustrated with me that I’m looking for a job as a social services specialist with our state department of human services (DHS here). He has been on the wrong side of this broken system — and seen the pain, frustration and dehumanization first hand –by case workers who just don’t care and get frustrated that their taxes are paying for our life (and without our disabilities their job would be???). He wanted me to go work for some place like the MDA or some place that is really showing CARE. I explained to him that the state offers health care benefits that will allow me to go from disability to work without compromising my health or health care coverage. He still was dissatisfied. The system is BROKEN. And he’s right –so broken our DHS was sued –and they lost the suit and reform has been court ordered. (it’s just taking place only time will tell …)

    But I told him “it’s the starfish thing” He surprised me by not knowing what that meant –and I told him the story of the starfish. The man who was walking on the beach after a really high tide and bad storm –the beach was covered in live starfish — thousands as far as the eye can see — and he’s picking them up one at a time and throwing them back into the ocean. Someone comes by and says “why bother? you can’t save them all? you can’t even begin to make a difference” The man responded by picking up one and throwing it back in the ocean and said “I just made the difference for that one”
    So I told my son, I know the system is broken –but if I can make a difference in the lives of the ones that I can — then I’ve made a difference for that one” He thought about it and said “when you get a job there – you need a starfish on your desk so you don’t become part of the broken system and remember that you’re there to make a difference for “that one”
    (I love his sense of social justice, wisdom and caring — I wonder if he realizes just how much he inspires me — I’ve told him but I’m not sure he KNOWS)

    I see a lot of “made a difference for that one” in your posts ..and I greatly appreciate it.

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  11. Hey Greg,
    I know you were not tooting your own horn. But I have seen so many health professionals who are cynical and jaded and just don’t care much anymore. They are doing the job for the paycheck and I honestly wish they would find other work because of the damage they do.

    Early in my career I accompanied clients to clinic appointments and was treated as badly as they were treated just because I was with them. I have never forgotten the way it made me feel, especially when my client turned to me on the way out of the clinic and said, “Now do you see why I don’t keep all my appointments?” Every human being deserves dignity and respect, no matter who they are. And 99% of those I have dealt with have been trying their best to get what they think they need to survive, even if their methods aren’t the best way to achieve that. I try to ask myself what I would do in their circumstances with their limitations.

    So again, thank you for maintaining your compassion and professionalism. It is good to know folks like you are still in the business.

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  12. Aman,

    A very good goal for all of us. I’ve felt the same thing while sick myself, but I can (thankfully) say that most of the people providing my care treated me well.

    Greg

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  13. PK,

    Wow, just wow. So much in that one little comment. The story of someone (YOU!) who has tried hard to pull themselves up, fight illness, go to school, better herself, work hard, sacrifice, teach her kid what is really important-the list goes on and on. YOU inspire ME.

    It’s only by telling the stories, over and over and over again, and by doing what we talk about that the system(s) will change little by little, case by case, person by person. I MUST believe that, or I would quit tomorrow, wouldn’t you?

    You are doing what you need to do to make good, solid decisions for yourself, to take good care of yourself. BUT, you are not losing sight of what it means to make a difference for others too.

    This comment has me so pumped.

    You keep teaching that son of yours what is important and how you’re going to make a difference. Let him see you do it. (I think he knows.) Be proud of what you are doing.

    You rock.

    Greg

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  14. Susan,

    It breaks my heart to know that patients were treated like that, but it’s even more terrible that you were an actual, face to face witness to it!

    What are people thinking when they treat others like that in a clinical setting? I just don’t get it sometimes. Get out and sell real estate or paint houses or something-anything-so that you don’t damaged the damaged and depress the depressed.

    I am glad that you are also extending your life of service in a new, exciting direction that will touch lives in a different way. You have a good heart, too, and you use it every day, I know.

    Thank you for your kind words, but there is no need for you or me or anyone else to toot my horn. I get my satisfaction, even on the busiest and most trying of days, knowing that I may just help one person make it in the world when they might not have made it without me. That is a paycheck that nobody can match.

    Peace, my friend.

    Greg

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  15. Greg,

    Yes…just about any career worth pursuing is difficult…challenging…has its ups & downs, and crazy wild days. But a medical career, especially in your field just takes a bit more. More education first off. More motivation & gumption to even complete that education/internship/residency, etc. More patience b/c you are consistently dealing with PEOPLE. And some pretty sick ones at that. Definitely more compassion, empathy, kindness, nonjudgmental attitude. More of an ability to maybe try to put yourself in that sick person’s place. I’m just thankful to God above for doctors like you…those who share their love for people with the ones who need it most.

    M

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