No one moved.
I knew we were being watched, and I felt bad. We were being critiqued for our unresponsiveness—or, perhaps, our apathy. The patient’s silent frustration gave way to periodic outbursts. A glance at the large monitor above the triage desk gave me a two-word synopsis: alcohol detox.
Trailing behind the ER attending, I passed by Room 14.
The attending didn’t stop, so neither did I.
“That’s great… Nice job following the Hippocratic Oath…”
The sarcastic words wafted from the room and stung me like lidocaine. A medical student at the time, I inwardly knew that to succeed in this career, I must become numb to such venom. And yet what a poetic circumstance: walking in the steps of both the Greek idea of ethical medicine and its apparent manifestation in that of a bearded, Russian physician.
Anxiously, I awaited the requisite re-crossing of Room 14. To my momentary relief, no verbal stones were pitched. But I did feel a continued, awful sense of helplessness—a frustration that I could do nothing for this drunk. I approached the other attending.
“You know what you could do,” he said, “is give him the cordless phone and have him arrange a ride to Alliance.”
“What’s Alliance?” I asked, ignorant.
“He’ll know what it means.”
I hesitated, feeling like a Christian about to be fed to the lions.
“Don’t worry. I wouldn’t send you into a lion’s den,” the attending added, quite effectively reading my mind. “Alliance is a rehab center. It’s a better option for him than prison.”
In stolen glances to the patient (and, earlier, to the monitor), I had seen he was only a year my junior. I felt oddly presumptuous in entering his room.
“We’re not ignoring you,” I began, simultaneously dodging the expected bullet and passing the buck. It was a weak attempt at an apology. I didn’t want to offer more, lest he think his previous remarks were an acceptable way to get attention. They had of course affected me, but I wasn’t about to let him know that. I wanted to give off a focused, professional demeanor.
I wasn’t the only one putting up a bit of a front. To my absolute surprise, the patient turned out to be a nice guy. Physically, he looked a lot like the boyfriend of one of my classmates. In fact, other than the white hospital bracelet around his wrist, there was nothing that warranted his separation into the role of “patient.” The faint smell of beer lingered in the room, but he was no longer drunk. He didn’t even look sick. He looked to be an average guy.
My first few minutes in the room blurred into a period of unexpected bonding. He acknowledged he probably hadn’t conducted himself in the best way—this was his half-way apology. I agreed, and we moved on. I realized I had pitied him. I held a contemptuous sadness for him, the situation he had ostensibly created for himself and how that, in turn, made me feel. I was frustrated by the choices he had made and that I had become emotionally involved in them.
“So what happened?” I asked, searching for the story behind this parallel image of myself. I had known nothing when I entered the room. Now that I found myself sitting bedside, acting more like a brother than a student doctor, I was curious.
“Well, I like heroin way too much,” he said openly, almost amused by the statement. Fragments of his life’s story came pouring out, like the pieces of a jigsaw puzzle that had been dumped on the floor. I tried to fit my perception of this young man into the frame he had just created. “Homeless.” I rotated the piece between my thumb and index finger; I turned the word over in my head. He was clean-shaven and seemed well-nourished. “I’ve never met a homeless person before,” I thought, before casting it away with other naive statements like, “Oh! I’ve never talked to an alcoholic before.” Sure I have, I just didn’t always know it.
A few more pieces followed: The rehab clinic won’t take in a simple heroin addict. The potential admission must be an alcoholic, at least. Whereas alcohol withdrawal warrants medical intervention, addiction to other drugs does not. I thought back to the frustrated words of a worker from the Hartford methadone clinic: “We tell addicts to save a little money for cheap alcohol so when they decide to quit the harder drugs, they can be admitted to a rehab program.” And, after being rejected once before for being sober, this is what my patient attempted to do. His mistake, however, was driving there. He was charged with DUI by the police and somehow ended up at the hospital. The prospect of prison—and the people therein—weighed on him. He was anxious and wanted a cigarette. He began to pace the room.
I looked at him, searching for some meaningful piece of advice that would carry him through rehab, something he could recount in what I hoped to be his future years of sobriety. “I’m sorry,” I concluded. “All I can do for you is pray. I don’t really know what you’ve gone through.” I looked at him helplessly, unable to offer the solution I so badly wanted to give.
He fished a gray hoodie out of a plastic bag. “One thing you have to understand,” he said, slipping the sweatshirt over his head. “This world isn’t as far off as you might think.” He paused. “You and me, we get along. Me and the average car thief, not so much.” It sounded like he spoke from the kind of experience only earned in bruises. He pulled a wool hat over his head, turned the brim to an angle and sat down on the bed. “I guess this is just bored Connecticut white kid s---.”
I blew a breath out through my nose, as I do when someone makes an interesting point. The patient and I had similar roots and yet our paths were so divergent. In bits and pieces over the course of two hours, we had gotten glimpses into the other’s life—a temporary respite from worrying about our own future.
Having alternated between the roles of supportive parent and learning child, I found it difficult to let my peer leave. I walked with him outside. As the cold night winds lashed at our faces, I realized I would probably never know if he succeeded or failed in regaining control of his life. The closing of the taxicab door seemed final—a Hollywood ending to my medical vignette. But, on my side at least, I knew the exchange would somehow last beyond that night. Perhaps it was a lesson in understanding another human’s experience without experiencing it, in digging beneath the surface, in investing in a person and showing kindness. Even upon later reflection, it is hard to express what the ultimate significance was. Knowing, while it was happening that this interaction was important had sent my brain into overdrive. There is not always an answer. Medicine attempts to ground itself in fact and evidence, but mankind is less predictable. I had stepped into the unknown and learned some facts, but was left with other things I would never know.
Benjamin Silverberg is a second-year graduate student and practicing physician. This is his final column of the semester. Send Ben a message on Twitter @hobogeneous.