I find it personally fascinating to see how the very simplest of human tendencies comes out in the crucible that is the emergency department (and perhaps more broadly in the crucible that is the hospital). As humans we sort ourselves into “us” and the “them” in many ways, but perhaps the most insidious manifestation of this is in situations in the emergency department. Troubling is our capacity– yes, our collective capacities– to reinforce that we, the members of care teams at the hospital, are different from those who present to the hospital in fragile, vulnerable, troubling, decrepit, annoying, boring, and/or disgusting states. Patients can easily become the “them” to our “us.” Why do we do this? Maybe in some basic instinctual attempt to assert control and organization over what can be a chaotic and unpredictable environment. Or maybe in some attempt to make the working conditions in the ED (i.e., the pressure, stress, or fatigue) feel more bearable by focusing on something other than the reality of hard work. Or maybe to make one’s self feel better about their own perceived deficits or displeasure. Or maybe because we see something in a patient we don’t like about ourselves or someone we know. Or maybe out of sheer boredom. Either way, those that belong to group Them can easily become a point of fascination, revulsion, or apathy for those in group Us. Not only are “they” bare in body, mind, and (one could argue) spirit in front of “us” in the ED– without much ability to hide, without much privacy in tact– but “they” also become something of a spectacle for “us” to laugh about or analyze or judge or doubt. “They” are different than “us,” and in so far as they are not us, they become less than us. In a quick slip of the mind, they become less than fully human.
We can shelter ourselves inside a bubble of self-importance, of clinical distance from “them,” but ultimately, “they” are as much us as we are. They are us. We are as much addicts as they are, scared as they are, mortal as they are, naive as they are, foreign as they are, weak of mind or body as they are, helpless as they are. If we were suddenly forced to live indefinitely on the streets like our community’s homeless do, how quickly we might realize how similar we are to them in shape and smell. If our drugs of choice were suddenly criminalized (choose one: sugar or alcohol or coffee), how quickly we might realize with a broken heart our unity with those caught in addictions to criminalized substances, and how quickly we might realize the “liars” that we all are.
The emergency medicine clerkship has been nothing but learning. Some of the biggest lessons for me have been in skills such as suturing or interpreting radiographs or crafting a thoughtful differential diagnosis, yet some of the lessons that made the biggest impact were ones regarding the practice of patient education and communication. Working in emergency medicine felt like being at the pulse of healthcare. I saw people receiving life-changing diagnoses or reassurance that there was nothing amiss with them. I saw life-saving interventions and simple interventions. I saw patients who had never in their lives been to a doctor for a check-up and those who maybe didn’t fully understand how the healthcare system in the United States works; some came in for complaints that were probably better suited to a primary care clinic and then other people came in with true medical emergencies. Through each encounter I had with a patient– regardless of their health literacy or level of acuity– was an opportunity to glimpse the privileges and pitfalls of medical practice in the emergency department. Ultimately, I think I’ve grown as a person because of this clerkship. In some way, I feel more aware of my own humanity, including the dark shadowy parts full of cobwebs– the ones that my patients showed me.
karuṇā 