Revolving Door

Four times yesterday we transported him. That’s four times he asked someone to call an ambulance.

Four times he was taken to an Emergency Department. And all four times, he left before a doctor could see him.

I knew he was lying the fourth time we picked him up, when he told us the ED staff refused to do anything for him. Yet I loaded him in the rig, and took him back there anyway. I had to.

He has renal insufficiency, hypertension, diabetes, and poor circulation in his extremities. He’s already lost several toes on each foot, and the remaining ones on his left foot are so necrotic that I was genuinely concerned that they’d fall off as I gently wrapped his foot.

He’s also a surly, ill-tempered asshole, which doesn’t make it any easier to treat him. Those of us who try, do so with an air of resignation, any inkling of compassion long since burned away by the futility of caring for someone who absolutely, steadfastly refuses to help himself. He’s been given medication. He’s been offered wound care. He’s been hospitalized.

He doesn’t bathe himself, he doesn’t fill his antibiotic prescriptions, and what prescribed painkillers he doesn’t use himself he sells for alcohol and street drugs. Vicodin tabs fetch a nice premium on the street, after all, and crack is cheaper. Gives a better high, too.

Soon enough, one of those 911 calls will be for him in cardiac arrest, and we’ll try our best to resuscitate him. We may even succeed, despite the doubts that each of us secretly harbor but would never give voice to, that maybe society would be better off if he were dead.

And God help me, I hate him because he makes me ask these questions of myself, makes me wonder how much of my soul I’ve subverted over the years taking care of him and people like him. Will I have anything left for the next guy? I hate him because he makes me suspect that compassion comes in a finite supply, and I fear that I’ve used up too much of mine.

Pundits and policy-makers, people whose understanding of health care has been formulated within the reality-insulating walls of a think-tank, would use him as the perfect example of someone who has fallen through the cracks of the system, and the reason we need universal health care.

Those of us who have had those maggot-infested feet within inches of our faces as we loaded him into the rig, have a different view. We know that, no matter what, some people will. just. not. be. helped.

And he’s not unique.