when people ask me what I do I say I’m a
doctor
and then they asked me what kind and I
say emergency medicine and usually the
next thing people ask for our stories
with blood and guts but the stories that
I really want to share a far more tragic
one of my patients Karen was a young
woman who was abused as a teenager she
suffered from depression and self
medicated with alcohol and opioids at
first she took prescription opioids but
as her tolerance grew so did the cost of
getting high eventually she migrated
from the white pills of percocet
to the white powder of heroin she sold
her body in order to pay for her
addiction and often came to the ER after
being beaten by client I personally took
care of her twice in the ER and I know
others who cared for her as well Karen
was sad and hopeless and had tried to
commit suicide multiple times as I cared
for her I became so frustrated that we
were failing her both as her doctors and
also as a health care system I did the
best I could I showed her empathy I
consulted our social worker I had her
psychiatrist see her but deep down I
knew that just wasn’t enough I knew each
time she was discharged home from the
emergency department she would be back
as a victim of assault as a suicide
attempt or maybe as an accidental
overdose and though I don’t know what
ultimately happened to Karen I’ve seen
enough patients like her to know that
the outcome can’t have been good working
in the emergency room I’ve seen patients
suffering from heart attacks children
who were struck by cars and died
women miscarrying much-desired
pregnancies and patients far younger
than me who were diagnosed with advanced
cancers
I’ve seen a lot of sadness that most
people will never see in their lives
most of these tragedies are complicated
social issues and began long before the
issue that brings the patient’s to the
ER the emergency department is often the
last stop we are the safety net for the
larger healthcare system and I believe
our current healthcare system is killing
us we as a system need to do more we
need to deliver patient-centered care
and we need to build a framework in
order to create a system that actually
heals for so many patients like Karen
their care in the ER points to the most
significant unspoken limitation in our
current healthcare system which is that
it’s not set up to take care of the
patient as a whole
ers are often expected to assume more
responsibility for patient’s overall
health than we are equipped to do while
we can provide intervention and
short-term treatment most of the
patients who come to the ER don’t have
access to timely follow-up care or
robust social support there is a
significant lack of access to care for
patients in our current health care
approximately one in eight visits to us
ers involves mental and substance use
disorders we know that in our society
these disorders are often stigmatized
which can prevent proper care and
treatment there are over two and a half
million visits to ears each year for
violence related injury that’s almost
7,000 patients a day
and there’s over 740 billion dollars
billion that are spent each year on
substance abuse costs related to crime
lost work productivity and health care
there’s no emergency department that can
provide the type of patient-centered
care that a patient like Karen really
needs we are not set up to care for the
underlying issues that coexist with
mental illness substance abuse or
interpersonal violence we see the same
problems over and over as patients get
worse and our system goes broke this
isn’t good for anybody it’s not good for
the patients who want to get better
it’s not good for the emergency
physicians who want to deliver excellent
care it’s not good for whoever’s paying
the bill and we know that even for
so-called uncompensated care someone is
paying to keep the lights on and it’s
not good for our country that loses the
benefits and contributions of citizens
who want to be healthy it’s not good for
anyone and right now there’s no clear
way out of it personally this makes me
really angry I want to tell you about
another one of my patients Stephen was a
19 year old black male who was brought
in from the back of a police car after
being shot multiple times in his chest
and abdomen
despite being dark-skinned he was white
as a ghost he had lost a lot of blood
and wasn’t shocked almost immediately
after his arrival in the ER Stephens
heart stopped beating as doctors we did
what we’re trained to do we gave him
blood we cracked his chest open
we used every tool in our toolbox to
save him the bright red blood poured out
of Steven’s body and despite our best
efforts he died in that moment when we
pronounced him dead the controlled chaos
of the emergency department came to a
halt the loud bustling room turned
eerily quiet that moment the transition
from working so hard to save a life to
the stillness of pronouncing death is
one of the hardest moments for me as a
physician and then Stephens mother
arrived the sound of her screams echoing
through the department still send
shivers down my spine Stephens death was
a tragedy not only because he was a
victim of gun violence but because that
was not Stephens first time being shot
he had come to our emergency room a year
earlier after being shot in his lower
leg but it was only a flesh wound
he had no broken bones he didn’t need
surgery and so he wasn’t admitted to the
hospital we just treated him and sent
I’ve cared for so many Stevens young men
who were shot but only had flesh wounds
I’ve sent them home from the ER just as
my colleagues have that night when
Stephen died I thought wait how many
other Stephens have there been how many
young men have I sent home just to
return and die am I just wasting my time
or ER is just revolving doors with no
end in sight could that second shooting
have been prevented and the thing is we
did the best we could the ER didn’t fail
him our society did this is a failure of
our social system I believe it doesn’t
have to happen this way I believe
working as a health care system we can
do more for our society when patients
present to us with mental health illness
addiction or interpersonal violence they
don’t just need medical help they need
patient centered care what would that
health care system look like what would
that society look like it would look
like a place where the larger healthcare
system is more effectively addressing
patient needs where patients have timely
access to care where mental health
illnesses are not stigmatized where we
treat addiction with innovation and
compassion like running supervised
injection sites for heroin users like
Karen we’re gonna ants is recognized as
a public health issue where we fund
violence research and treat its victims
without judgment or bias
and where our communities come together
in order to develop and implement
solutions these things are not
impossible other countries have
accomplished them and we can do it too
it’s about getting everyone to recognize
a few basic truths that everyone is
entitled to care everyone deserves a
chance whatever their socio-economic
status that we treat individuals as part
of a larger whole that we can’t afford
to throw people away or to act like
their problems don’t affect us and that
patient-centered care can work if we’re
willing to prioritize life don’t you
think we could have done better for
Karen and Steven maybe Steven could have
seen a social worker after that first
visit they would have spoken to him
maybe asked him about his life and maybe
his mother wouldn’t have had to scream
like that as an ER doctor I say to all
the Karen’s to all the Stevens and to
all the Stevens mothers we will always
be here for you as a human being and as
a mother myself I say to all of you take
care of yourselves and please take care
of each other thank you you
doctor
and then they asked me what kind and I
say emergency medicine and usually the
next thing people ask for our stories
with blood and guts but the stories that
I really want to share a far more tragic
one of my patients Karen was a young
woman who was abused as a teenager she
suffered from depression and self
medicated with alcohol and opioids at
first she took prescription opioids but
as her tolerance grew so did the cost of
getting high eventually she migrated
from the white pills of percocet
to the white powder of heroin she sold
her body in order to pay for her
addiction and often came to the ER after
being beaten by client I personally took
care of her twice in the ER and I know
others who cared for her as well Karen
was sad and hopeless and had tried to
commit suicide multiple times as I cared
for her I became so frustrated that we
were failing her both as her doctors and
also as a health care system I did the
best I could I showed her empathy I
consulted our social worker I had her
psychiatrist see her but deep down I
knew that just wasn’t enough I knew each
time she was discharged home from the
emergency department she would be back
as a victim of assault as a suicide
attempt or maybe as an accidental
overdose and though I don’t know what
ultimately happened to Karen I’ve seen
enough patients like her to know that
the outcome can’t have been good working
in the emergency room I’ve seen patients
suffering from heart attacks children
who were struck by cars and died
women miscarrying much-desired
pregnancies and patients far younger
than me who were diagnosed with advanced
cancers
I’ve seen a lot of sadness that most
people will never see in their lives
most of these tragedies are complicated
social issues and began long before the
issue that brings the patient’s to the
ER the emergency department is often the
last stop we are the safety net for the
larger healthcare system and I believe
our current healthcare system is killing
us we as a system need to do more we
need to deliver patient-centered care
and we need to build a framework in
order to create a system that actually
heals for so many patients like Karen
their care in the ER points to the most
significant unspoken limitation in our
current healthcare system which is that
it’s not set up to take care of the
patient as a whole
ers are often expected to assume more
responsibility for patient’s overall
health than we are equipped to do while
we can provide intervention and
short-term treatment most of the
patients who come to the ER don’t have
access to timely follow-up care or
robust social support there is a
significant lack of access to care for
patients in our current health care
approximately one in eight visits to us
ers involves mental and substance use
disorders we know that in our society
these disorders are often stigmatized
which can prevent proper care and
treatment there are over two and a half
million visits to ears each year for
violence related injury that’s almost
7,000 patients a day
and there’s over 740 billion dollars
billion that are spent each year on
substance abuse costs related to crime
lost work productivity and health care
there’s no emergency department that can
provide the type of patient-centered
care that a patient like Karen really
needs we are not set up to care for the
underlying issues that coexist with
mental illness substance abuse or
interpersonal violence we see the same
problems over and over as patients get
worse and our system goes broke this
isn’t good for anybody it’s not good for
the patients who want to get better
it’s not good for the emergency
physicians who want to deliver excellent
care it’s not good for whoever’s paying
the bill and we know that even for
so-called uncompensated care someone is
paying to keep the lights on and it’s
not good for our country that loses the
benefits and contributions of citizens
who want to be healthy it’s not good for
anyone and right now there’s no clear
way out of it personally this makes me
really angry I want to tell you about
another one of my patients Stephen was a
19 year old black male who was brought
in from the back of a police car after
being shot multiple times in his chest
and abdomen
despite being dark-skinned he was white
as a ghost he had lost a lot of blood
and wasn’t shocked almost immediately
after his arrival in the ER Stephens
heart stopped beating as doctors we did
what we’re trained to do we gave him
blood we cracked his chest open
we used every tool in our toolbox to
save him the bright red blood poured out
of Steven’s body and despite our best
efforts he died in that moment when we
pronounced him dead the controlled chaos
of the emergency department came to a
halt the loud bustling room turned
eerily quiet that moment the transition
from working so hard to save a life to
the stillness of pronouncing death is
one of the hardest moments for me as a
physician and then Stephens mother
arrived the sound of her screams echoing
through the department still send
shivers down my spine Stephens death was
a tragedy not only because he was a
victim of gun violence but because that
was not Stephens first time being shot
he had come to our emergency room a year
earlier after being shot in his lower
leg but it was only a flesh wound
he had no broken bones he didn’t need
surgery and so he wasn’t admitted to the
hospital we just treated him and sent
I’ve cared for so many Stevens young men
who were shot but only had flesh wounds
I’ve sent them home from the ER just as
my colleagues have that night when
Stephen died I thought wait how many
other Stephens have there been how many
young men have I sent home just to
return and die am I just wasting my time
or ER is just revolving doors with no
end in sight could that second shooting
have been prevented and the thing is we
did the best we could the ER didn’t fail
him our society did this is a failure of
our social system I believe it doesn’t
have to happen this way I believe
working as a health care system we can
do more for our society when patients
present to us with mental health illness
addiction or interpersonal violence they
don’t just need medical help they need
patient centered care what would that
health care system look like what would
that society look like it would look
like a place where the larger healthcare
system is more effectively addressing
patient needs where patients have timely
access to care where mental health
illnesses are not stigmatized where we
treat addiction with innovation and
compassion like running supervised
injection sites for heroin users like
Karen we’re gonna ants is recognized as
a public health issue where we fund
violence research and treat its victims
without judgment or bias
and where our communities come together
in order to develop and implement
solutions these things are not
impossible other countries have
accomplished them and we can do it too
it’s about getting everyone to recognize
a few basic truths that everyone is
entitled to care everyone deserves a
chance whatever their socio-economic
status that we treat individuals as part
of a larger whole that we can’t afford
to throw people away or to act like
their problems don’t affect us and that
patient-centered care can work if we’re
willing to prioritize life don’t you
think we could have done better for
Karen and Steven maybe Steven could have
seen a social worker after that first
visit they would have spoken to him
maybe asked him about his life and maybe
his mother wouldn’t have had to scream
like that as an ER doctor I say to all
the Karen’s to all the Stevens and to
all the Stevens mothers we will always
be here for you as a human being and as
a mother myself I say to all of you take
care of yourselves and please take care
of each other thank you you
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