The following essay was the first-prize winner of the Fordham University Center for Ethics Education’s 2014 Dr. Kuo York and M. Noelle Chynn Undergraduate Prize in Ethics, an essay competition to stimulate self-examination about concepts of ethics and morality encountered personally or as a concerned member of society. The Chynn Prize is funded by the Chynn Family Foundation.
By: Michael Menconi
Patient names have been changed to ensure confidentiality and protect privacy.
Healthcare professionals often refer to their careers in medicine as a life purpose—their “calling” is to treat the sick, mend the injured, comfort the vulnerable, and instill courage in those who have lost all hope. Doctors have a moral, ethical, and professional obligation—or perhaps duty—to do no harm and perform acts of healing, both of which were fundamental virtues established by the Hippocratic Oath over five centuries ago. For a field with such an extensive, prolific history of emphasizing compassion and care for those in need, it is expected (and often assumed) that healthcare providers treat every patient with a fundamental respect for the human condition, unwavering empathy, and superior levels of social and cultural competency.
The United States is widely considered to possess the highest standard of care—and it would be desirable to assume the level of compassion conveyed by the professionals that work in the health system matches this standard. My clinical experiences with stigmatized drug users in both New York, and abroad in Cali, Colombia, have enabled me to grasp a genuine understanding of what it means to be not only a healthcare provider—but more importantly—an empathetic human who treats others as fellow persons possessing equal moral status, regardless of social, economic, ethnic, or religious contexts.
It was 3 a.m. on a cold winter night in December of 2012. I was an exhausted Emergency Medical Technician nearing the end of a 12-hour shift. I found myself in the emergency room at a New York hospital filling out paperwork for a patient I had just transported. A notoriously low-resourced health center that treats thousands of patients per month, many without insurance suffering from crime and drug-related injuries, it is no surprise that the hospital employees appeared emotionally and physically exhausted.
Shortly after my arrival, a patient was brought in handcuffed to his stretcher, escorted by the police. He was visibly intoxicated, and I later found out he was an intravenous drug user who is brought into that hospital’s ER on almost a weekly basis due to complications from his drug use. He is often combative—this particular night I witnessed a nurse shove a mouth gag in him to prevent him from speaking. He was in significant pain from the bacterial infection spreading up his arm, which left blue and red streaks scattering from the injection site.
The hospital staff, however, treated this particular patient in a dehumanizing, discriminatory manner. It seemed as though there was no assistance to be found. He was ushered into a corner of the emergency room, strapped to the bed, and was choking on the gag device. He clearly needed emergency medical attention, but was left in a helpless state of despair, stripped of his dignity, autonomy, and ignored by passing physicians. He could barely breathe—I held myself back from removing the cotton strip knotted around his mouth.
The treatment of this particular patient was not how I imagined myself handling the same situation as future medical professional. This man was homeless, dirty, and high—yet more significantly a member of our human race who requires a fundamental level of compassion and respect. I inquired about this man’s treatment to the attending ER physicians, who proceeded to call him a “frequent flyer.” He was characterized as a patient with self-inflicted injuries from his ongoing drug addiction, repeatedly being hospitalized, and constantly “taking up” valuable beds and resources. His lack of health insurance surely didn’t help the situation. I could sense a level of frustration in the staff’s voices—a sentimentality of, “oh, it’s him again.”
I was seriously disturbed by the way this man was treated in the clinical setting. A hospital is a place where people come to receive treatment, be comforted, and ultimately be made well after being ill. This was the opposite of how I viewed myself practicing clinical medicine as a future healthcare provider. Was this situation representative of how all drug users were treated in United States emergency rooms? My visceral response of frustration and anger arising from my observations left me no choice but to investigate further.
The ethnographic research of Philippe Burgois, a medical anthropologist who studied homeless heroin addicts and their experiences with the healthcare system in San Francisco, reinforced my disturbing observations in the Bronx emergency room. Burgois observed, “from biomedicine’s perspective, homeless injectors appear ignorant, self-destructive, and even pathological.”1 In the eyes of physicians, not only do these patients knowingly self-inflict their injuries, they are “frustrating patients to try to help because they refuse to stay sober after receiving treatment.”1 Further research has revealed that some hospitals in the United States have instituted aggressive, demeaning, “early release plans” for uninsured, indigent patients that drive up the cost of healthcare.
Here demonstrates a clear indicator of market forces (business-focused medical care) driving the treatment of patients1—a perilous, predjudiced, and more significantly—unethical way of practicing medicine. It becomes obvious that the goal of some for-profit hospitals is to release these patients as soon as possible with substandard, inexpensive treatment while simultaneously ignoring the social problems and structural violence that precipitate the patient’s drug addiction. Research has found many drug users abuse street drugs such as heroin to avoid emotional pain precipitated by psychological trauma and toxic stress experienced in childhood.1 The lack of mental health intervention for these individuals yields a viscous cycle of drug addiction and poverty that continues to be ignored in the United States healthcare system, a system that exceeds any other in the world in terms of resources and medical technology. I was discouraged and deeply disappointed in the way certain aspects of the medical field (the field I was planning to invest the rest of my life in) approached vulnerable populations in our society.
About a year later I traveled to Cali, Colombia to study public health and community medicine. Recalling the frustration I experienced after witnessing the maltreatment of indigent populations in the United States healthcare system, I anticipated a lesser standard of care in a developing country. After all, Colombia has significantly less healthcare resources and biotechnology. It is important to note, however, that “standard of care” does not simply mean level of access to healthcare resources and technology, it more importantly refers to the manner in which doctors and nurses treat their patients.
This presumption could not have been further from the truth. During one of my clinical rotations in a local hospital, a public healthcare facility serving the urban lower class in Cali—a patient shuffled through the emergency room doors and collapsed to the floor. Doctors rushed over immediately, picked him up, and exclaimed the words, “it’s Carlos, get a bed.” I asked the doctors how they knew the patient’s name already. They affirmed he was an opioid abuser, who walks to the hospital when he is no longer able to bear the withdrawal symptoms as a result of his inability to acquire (or afford) his drugs. He was shaking, sweating, breathing heavily, and too weak to stand on his own. Tears of distress and shame ran down his cheeks. His torn, ragged clothes dragged behind him as several doctors picked him up and placed him on a hospital bed.
They placed a pillow under his head, and told him “vas a estar bien,” or “it’s all right, you’re going to be okay.” One female physician held his hand, comforting him, while another began an IV line for hydration. A small smile spread across Carlos’ face as a nurse brought him over a blanket and began sponging the beads of sweat off his forehead. His level of distress began to subside as he closed his eyes.
Observing this encounter between a homeless, uninsured drug-addicted individual and the healthcare professionals in one of the poorest public hospitals in Colombia brought to life before my eyes the true essence of medicine. The doctors began treatment immediately—free of judgment, prejudice, or frustration. The fact that Carlos had returned for the second time that week as a result of his self-inflicted condition did not affect the manner in which the doctors or nurses proceeded to care for him. There was no concern about financial reimbursement for their services. As Carlos was ushered into his room where he would continue his medical treatment, I asked the doctors and nurses if they ever looked at these types of patients any differently. They responded that before a healthcare professional acts as a clinician, they must first, “ser humano,” or “be human.”
This resonated with me as the real purpose of healthcare and healing. The fact that I had to travel 3,000 miles away to a developing country to witness the selfless treatment of vulnerable populations has angered me. A healthcare provider’s life serves to improve the life of others. The ethical (and humane) treatment of patients is at times nonexistent in the United States—it is time to suppress profit-seeking clinical practice, bring compassion back across the border and put the “care” back in healthcare.
Michael Menconi (FCRH ’15) is currently completing a B.S. in Cognitive Psychology, with minors in Bioethics and Sociology. An aspiring physician and public health professional, Michael’s research interests include public health and community medicine, with particular emphasis on the social mechanisms behind child abuse and the consequent effects of toxic stress on child development.