To Feed Or Not To Feed

I walked into Room 22 to find a very interesting patient who presented to our ER with complaints of abdominal pain and associated nausea and vomiting.

The patient sat on her cot with her pant legs rolled up above her knees, refusing, according to her nurse, Gwen, to put on a treatment gown. Her left leg hung in the air, her ankle crossed over the knee of her right leg. Her feet were bare and dirty. Nestled in the crook of her left hip, resting on the cot, was a worn bible, opened to the first page of The Book of Genesis. As Gwen was trying to obtain a better history, the patient was obviously ignoring her, giving all of her attention to the her bible.

Or so I thought. I walked into the room and introduced myself to this patient. She briefly flit her eyes up at me several times. Finally, after gaining her approval, she steadied her gaze on me and extended her hand. We shook. Gwen, meanwhile, seemed to have gotten an even colder-shoulder than before, as the patient turned her back on her to give me her undivided attention.

With her gaze on me, I absorbed this patient's features. She had dirty-blond hair pulled away from her face. Long, thready, frazzled dreadlocks started at the crown of her head and were gathered behind in a bulky ponytail. Her eyes were piercing blue and, quite honestly, unsettling. High cheekbones, clear skin smudged with some dirt, and thin narrow lips accented her prominent nose. Her hemp clothes were worn and faded, tattered almost, and, like her skin and bare feet, smudged with dirt.

She was in her early twenties.

"Hello, Rose," I said with a warm smile, "what brought you to our ER today?"

Her voice was husky yet quiet. "I ate some fish yesterday and I think it was rotten." She went on to explain that she, at the time, wondered if the fish was "not good" because it had "a funny, pink color to it, like salmon. And" she confidently added, "I know my fish--it wasn't salmon."

"Where did you eat this fish?" I asked her. She blatantly ignored my question, which made me wonder if it was from a clean site or a garbage can.

She continued, however, to explain that since eating the fish, she had vomited three times later that evening and once this morning, prior to coming to our ER. "I feel better now, though," she said. She hesitated before continuing. "I'm feeling well enough for a cup of coffee and a sandwich, even."

And there we go--the main reason why Rose was in our ER. She was hungry.

It turned out that she had already asked Gwen for some food and coffee and Gwen had put her on hold. "Rose," Gwen had explained, "we need the doctor to see you and get some of your blood results back before we can give you anything to eat." That explained the snubbing of Gwen. I had to smile, since Gwen was an extremely compassionate, cognizant nurse.

"Rose," I said, looking her in the eyes, "is this the real reason you came to our ER? Are you hungry?"

Rose stared at me as I visualized the cog wheels in her brain churning. Finally, she spoke. "Um," she started, "I came here because I ate some bad fish. But now I feel better. So yeah, I guess so. I was hoping, I guess, that you guys would be able to give me something to eat." As she spoke, she held my gaze. I appreciated her efforts at honesty.

Gwen looked at me with her knowing smile. I looked back to Rose. "Rose," I said, "I need to perform an exam and, since the triage nurse ordered some blood work, I need to review your results and make sure they are all good before we can let you eat. You understand this, right?"

Rose nodded her approval. With Gwen at bedside, I performed a thorough exam of Rose. Everything checked out well. Specifically, she had no abdominal pain on exam. I walked out of Rose's room and reviewed her stable vital signs and her stable blood work on my computer station.

As far as I was concerned, we could now feed Rose.

Which presents the dilemma we sometimes face in the ER. Frequently, we get unfortunate patients that present for reasons other than emergent medical care. It might be a drunk, homeless person, refused for the night by the homeless shelter for his alcohol abuse, who is looking for a place to sleep. It could be a patient who is looking for free prescription vouchers to get his medications renewed. And, in Rose's case, it could be a person simply looking for a meal, a cup of coffee, a warm blanket, or some companionship.

As far as I am concerned, we should extend ourselves, as long as it doesn't take away from providing emergency care to those in dire need. And, as long as our efforts are appreciated. Is a bed free? Go ahead and lie down for a short while. You're hungry? Let's see if we have any pudding or turkey sandwiches for you. Your cold? Here is an extra blanket for you from our trauma blanket warmer. Free vouchers? Well, I see those cigarettes and iPhone poking from your pocket, so we're not going to be able to help you with that tonight. Sorry, but I can only go so far.

With these acts of kindnesses, though, I understand the flip of this coin. You set yourself, your ER, and your staff up for repeat visits by these patients who come to expect these kindnesses every time. And, as a result, they keep coming back and coming back and coming back. Sometimes clogging the system. Eventually, these kind acts are no longer appreciated but, rather, demanded. We've all seen this happen. And it's at this moment when our thought process changes.

With Rose, she had only been to our ER once before so, after Gwen and I agreed, she received a full meal, some warm coffee, some foot slip-ons, and a social service consult prior to being discharged. She was gracious for everything, which helps the cause. And it was our pleasure, really.

However, there are repeat offenders whose visits to our ER number in the fifties and hundreds. Seriously. And, unfortunately, these handfuls of patients are the ones who can ruin it for the others.

The ER presents many moments of internal struggle where, as an individual working there, you have to review and examine your moral fiber and essence. This is one of those struggles for me. I wish we could accommodate every single person's needs, but that is unrealistic. So, I'll just continue to provide on an individual basis. And, hopefully, these kind acts will be appreciated and not abused and demanded.

To feed or not to feed...that is the question.

Happy Monday. I'm eager to hear your thoughts on this post... As always, big thanks for reading. Next post will be Wednesday, May 26th. See you then...

I Like The Fish

A few years back, I took my two older children out on a "Daddy-date" that culminated with a sit-down lunch at McDonalds.

As we sat eating our meal in the pleather booth, complete with a beautiful busy intersection view, we noticed a homeless person pushing a rusty grocery cart across the road's crosswalk, towards us. Cars were flying by, barely stopping, their horns honking as if that would make this person go faster. Or, as I'm sure some hoped, go away.

"What is that man doing, Daddy?" my son asked, his hand, holding a french fry, paused in the air.

"Why don't we just watch and see where he goes, buddy," I said, hoping the man would reach our side of the road quickly.

The man did make it across the street. He continued to push his cart towards our direction. At this point, my kids were now completely entranced. Nuggets were getting cold, ketchup was drying on french fries, and Happy Meal toys were all but forgotten. And yet, none of us could take our eyes off this lonely figure now struggling with his cart to cross the curb into our parking lot.

Slowly, he advanced up the sidewalk, eventually pushing his cart right up to the building, outside our viewing window. My kids continued to watch closely, absorbing everything about this man that they could. Sadly, I was prepared to avert my eyes, as most of us as adults do, if he would look in at us and see us watching him.

Up close, he was in a sad state. The fall weather was turning cold and this gentleman was obviously struggling to stay atop of the falling temperatures. He was dressed in layers, finished by a top coat that was scrappy at best. Underneath, his exposed shirt was torn and tattered. He wore half-fingered gloves, slender dirty fingers poking out of the frayed edges. Long, scraggly hair poked out from beneath a fragile ski-cap, complimenting his unkempt beard. His pants and boots were in disarray and threadbare.

He parked his shopping cart against the building, returning to it twice to check on it and push it tighter in. Finally, happy with his park-job, we saw a brief smile cross his face as he looked in on us. Taking a note from my children, I did not avert my eyes but, rather, appreciated the raw kindness emanating from his quick glance.

"Daddy, he's coming in!" my daughter squealed. "Can we buy him his lunch?" But of course, I told her.

Slowly, he made his way into the restaurant. My kids spun on their seats, turning to watch the gentleman enter through the doorway. Sadly, as he entered, an exiting couple took a step back, away from his approach. It was, I can only assume, to ensure that they wouldn't get this man's contagious misfortune.

He walked into the restaurant and despite the stares and mumbling, walked up to a booth near ours, head held proudly up. He wiped the table off with his fingerless gloves and then proceeded to spread out a rumpled newspaper he pulled from his pocket.

"Come on, kids. Let's go get a hamburger for this gentleman." The kids eagerly jumped from our booth.

As the man continued to customize his booth table, we walked up to the counter and ordered a Quarter-Pounder Value Meal. "Don't forget to super-size it," my son added. Of course, I assured him, thinking that would be the best additional 35 cents I'll ever spend. We also got him an x-large coffee to go with his Coke.

Excited but nervous, the kids and I approached the gentleman's booth, me holding the coffee and the kids carrying the large drink and bag of food.

"Excuse me, sir," I said, offering over the coffee, "but we thought maybe we could buy you some lunch today."

The man raised his eyes from his table to meet mine. We looked at one another briefly before he turned to closely look over both kids. I felt their free hands tightly grip my pant leg. Finally, he focused on the bag of food.

I took the bag of food from my daughter and the soda from my son and placed them on the table beside the coffee. The cat had definitely gotten my kids' tongues, so I spoke.

"We got you the Quarter-Pounder Meal with a big coke and french fries. We got you coffee, too, in case you wanted to warm up."

"I like the fish."

"Pardon?"

"I like the fish."

Oh, my. The kids looked up at me as he finished talking. I was surprised and a little hurt, to be honest, for this gentleman's lack of appreciation. I mean, come on, free food and drinks! I quickly admonished myself and reasoned through his behavior, though. Being homeless or down-and-out doesn't mean he still can't have likes and dislikes. Suddenly, I appreciated and respected this man's gumption all the more.

Looking down at my kids expectant faces, I knew what we needed to do.

"Sir, I'm sorry we didn't ask you first. Besides the hamburger, is everything else okay? What else do you need?"

He was a man of few words. "Fish," he said, "and hot chocolate. No coffee."

Okay, I thought, we can do that. We hiked back up to the counter, got his order right this time, and carried a fish sandwich meal and hot chocolate back to his table.

He hadn't touched the previous bag of food or either drink while we were gone, but when we returned to the table, he eagerly took the bag holding the fish sandwich from us, looked in, and smiled a big smile when he saw the sandwich.

Slowly, he looked up from the bag. His smile continued, floating there under his ruddy cheeks, and he passed it on to my daughter, then my son, and finally to me. Priceless. We all returned his smile with our own. Such pure delight from something so simple.

"Do you need anything else, sir? Anything at all?"

He nodded his head no to any further offers of help. "Thank you," he spoke softly, quietly, our ears straining to hear his words. I'm sure it was for the food, but a part of me hoped that it might just be for treating him with respect and decency.

We walked back to our seat and gathered our things, cleaned off our table, and threw out our garbage. I couldn't help but wonder what the man would do with the hamburger and extra drinks. Oh well, they were his now.

As we walked out, my shy daughter surprised me. Just before the exit door, she turned around and yelled out to the smiling man eating a fish sandwich alone in his McDonald's booth. "Bye!"

The real surprise, though, was on all of us. Hearing my daughter's voice, this man stopped mid-bite, looked up at us, and waved a goodbye wave.

His attention went quickly back to his fish sandwich, but I could only hope that my kids' attention was focused on seeing beyond this man's misfortunes and seeing him simply as another fellow being, one who deserved a little respect and kindness in our big, infinite world.


Sadly, we haven't seen this man since... as always, thanks for reading. Next post will be Friday, January 22.