homeless pt's?

[scrmblr]

This is my first winter in the ER. The weather just turned really cold and yesterday I had 3 homeless pt's come in with vague complaints...one had just moved from a warmer climate to our bitter cold dry climate and was pretty sick with an asthma exac. 2 of the homeless pt's I had were found a shelter for the night and one was admitted for etoh detox. But trying to find a place for them took me a long time. Not only did it take me a long time, but it seemed that everyone was just too burned out to really help.

My question...How do you deal with your feelings on this. My heart just about broke. A few of the long-timers said things like "these people have made choices in their lives and this is what happens" Or "you can't fix the planet" or "don't feed them, they just come back"

I'm no bleeding heart. I do see that people made choices and took the road that lead them down these paths. I'm just curious to see what your feelings are about homeless pt's in the ER. Do you feel that they are "wasting your beds" are you able to go home and forget about the pathetic pt's? I guess I'm just looking a way to figure out why I feel guilty about having so much when people have so little.

[bethin]

And WHY can they not keep it together? Exactly what you have said in the example of your son: mental illness.

Are people with mental illness to the point they cannot survive on their own meant to survive? That is the question.

The fittest survive, those who are not perish.

Who gets to decide who is the fittest? Please don't tell me natural selection. We are ALL here for a purpose no matter our disabilities or illnesses.

What would you do if you had a child with a mental illness? Would you look at him one day and say "Well, child, I guess you were not meant to survive."

It sounds like you don't put much price on life.

[Jerico, BSN, RN]

I know that you certainly are not saying that my son should die, are you???

I am not saying he should die. Heaven's no!

I am saying those that are not as strong (emotionally, mentally, or physically) will not survive as well or as long.

Being a parent of a mentally ill child is no different than being a parent of a child with Cystic Fibrosis. The child will die/suffer more/sooner due to the ailment/affliction than a child without such.

[Jerico, BSN, RN]

I'd ask you something but I have a feeling I already know the answer. What if your father molested you? Of course, you'd feel pretty crappy about yourself. What if you told your mother and she didn't believe you? Your self esteem would be low. What if your boyfriend raped you and then when you went to the police they didn't believe you. Your mother of course wouldn't believe you. You run away from home because you're running from the abuse. And no, I didn't pull this out of my head. It happened.

I can tell by your previous post that you believe no matter the circumstances, even if the above happened to you, you'd still be skipping down the street. I'd like to see that.

BTW: don't roll your eyes at me. I was making a statement and you should respect my opinion.

Be careful, you do not know what I have or have not been through.

People who are molested get help, people that are raped get help. I am not saying they "get over it" - but they have a capacity to cope and move onward - to survive.

If every person who was raped, molested, teased, not believed over these things were to just let it destroy them - they would not survive.

There is a will to survive, no matter WHAT is done to a person. AND when a person survives and goes on - it makes them stronger - and that strength is passed on. (Survival of the fittest).

When a person does not stay strong - or is not strong they do not survive.

[Jerico, BSN, RN]

Who gets to decide who is the fittest? Please don't tell me natural selection. We are ALL here for a purpose no matter our disabilities or illnesses.

What would you do if you had a child with a mental illness? Would you look at him one day and say "Well, child, I guess you were not meant to survive."

It sounds like you don't put much price on life.

Well, it IS natural selection - a plan. Yes we all are here for a purpose - fit or not fit to survive. Of course.

There is NO price on life. Life is priceless.

[hipab4hands]

A local radio talk show host was talking about human behavior on his show not too long ago. He stated there are 2 personal choices we can make about our behavior. He stated you can be a "victim" or a "survivor". He defined a victim as someone who makes up excuses for thier behavior i.e. "It's everyone elses' fault, so I refuse to change my behavior." He defined a survivor as someone who will try to change their behavior, and continue to try to change their behavior until they succeed, no matter what.

[KatieBell]

Wow, a lot of judgements running around in this thread. I do not feel qualified to make any judgements about the quality of a person, or their strenghth. I really do not see how any of us can even think we are qualified to make these decisions or make blanket statements about "The weak" It depends on how weak is defined and then it continues to get into a downward spiral of confusion.

As far as homeless people- they do come in to the ed. There are some creative ways to give them help, but if they do not meet the criteria for admission, we are just too busy to let them have a bed to sleep in- we have to discharge them. We have our Social Worker give them alternatives, and they can take advantage of them when they want to. If intoxicated, or mentally ill- we have a way to place either one. Most of the ED's I have worked at also have an area for these people that is reserved for them, so it doesn't "take away from the sick people" Our manager always planned for it, since it is not a new phenomena, it shouldn;t be taking any ED by surprise.

Tp be honest, I really do not spend a lot of my time worrying about these people... I do spend time volunteering at the shelter, collecting coats for the "Give a kid a coat" campaign,do ESL teaching, and every week when I do my shopping I buy about 10.00 worth of food and drop it by the local food bank of wherever I am...but I have realized that I am not going to change the world eintrely, so I try not to loose sleep over it. I don't really think I am cold-hearted, but to some this may seem that way.

[bethin]

Be careful, you do not know what I have or have not been through.

People who are molested get help, people that are raped get help. I am not saying they "get over it" - but they have a capacity to cope and move onward - to survive.

If every person who was raped, molested, teased, not believed over these things were to just let it destroy them - they would not survive.

There is a will to survive, no matter WHAT is done to a person. AND when a person survives and goes on - it makes them stronger - and that strength is passed on. (Survival of the fittest).

When a person does not stay strong - or is not strong they do not survive.

Not all get help and once they do it can take years before they can "move onward". And that comes from personal experience.

On the bright side we do agree on one thing: life is priceless.

I sincerely hope I can stay strong through my current health probs (Crohn's, ulcerative colitis, possible cancer) because I don't want to die. But I don't know how I'll react until I'm in the situation.

[redwinggirlie]

I will always, always care for anyone who comes my way.

[prmenrs, RN]

The posts on this thread are getting a little heated @ this point. There are lot of people on this board--100,000 or more. Inevitably, some situations discussed here can hit very close to home, and that fact should be taken into consideration before opinions are posted.

Your thoughtful attention to this would be appreciated. Thank you.

[rn/writer, RN]

I have debated back and forth on whether to share this, but I have decided that I must. Our much-loved and cherished son is mentally ill. He is now 20 y/o and lives with us. However, he has been homeless in the past. In our area, the governor decided to cut many outpatient services. We were so lucky - our son has insurance and we could get him the care he needed. However, even now, he would have a very difficult time on his own. Maybe in a year or so, he will be doing better. He does work and has been able to complete some college credits. All I can say is don't judge, lest you be humbled like we have. Please know that most homeless folks don't want to be homeless, but can't keep it together enough to do what we take for granted.

Thank you for sharing this. My husband and I have a similar situation. We adopted a foster child who had many social/emotional issues. Like your son, he is now 20. Unlike your son, he does not have insurance and is not willing to change certain things. Our hands are tied, and sometimes it's easier not to watch what we can't do anything about.

The rules that govern physical health care--patient autonomy, ability to refuse care, the right to quit taking meds--do no favors for the mentally ill. How the heck can you have a truly informed consent when a person's mood is unstable and they're hallucinating? In so many states now, you have to wait until damage has been done or the threat is extreme, for there to be any hope of overruling the choices of someone who functioning at a minimal level.

We shouldn't go back to the days where the mentally ill were locked up and warehoused in horrific facilities. But there should be something between that extreme and the other end--the unfettered freedom to destroy yourself because you can't think straight.

It would be nice if the mentally ill could make plans when they are relatively stable that could be carried out by others on their behalf when they flip out. Unfortunately, so-called patient advocates have done their best to see that those who are least equipped to care for themselves have the right to refuse help they would cling to if their symptoms weren't flaring up. In other words, when they need help the most, that's when they're least likely to get it.

Despite all this, I do understand what Jerico is saying. I look at my son and wonder how long he will survive in this world. I don't know if he can't or won't learn from some of his mistakes and, at some point, it doesn't matter. I can't protect him when the law ties my hands and he seems to have a magnetic attraction for people and things that bring out the worst in him. We have had to let go at times and love him from a distance. I don't like this option, but what other choice do we have?

I don't believe it's harsh or malevolent to speak the truth, and the truth is that some people are predisposed to live foreshortened lives on this planet because the way they think and, consequently, the way they act frequently puts them in harm's way. They aren't bad for living rough, but they do perch themselves closer to the dropoff than most of us could bear, and, inevitably, some will go over the edge.

The ones who cause the most sadness for me are those who seem like feral dogs. They can watch the firelight from the shadows, but are far too skittish and set in their antisocial ways to come any closer. The ones who make me angriest are the users who have figured out all kinds of ways to scam the system. But again, the difference between "can't" or "won't" ceases to matter when the outcome is the same.

[VeryPlainJane]

I am not saying he should die. Heaven's no!

I am saying those that are not as strong (emotionally, mentally, or physically) will not survive as well or as long.

Being a parent of a mentally ill child is no different than being a parent of a child with Cystic Fibrosis. The child will die/suffer more/sooner due to the ailment/affliction than a child without such.

Help me understand where you are coming from. As a nurse wouldn't our jobs be to make sure these people (emotionally, mentally, or physically) ill not suffer or die sooner then their disease dictates? If this is just Survivel of the fittist then why treat illness at all and just focuse our attention on the healthy?

A case can be made that Jesus was born homeless. His family was of course forced to leave their home, to become transient and to sleep rough (and give birth) for at least that one night.

But what is perhaps of greater interest is the fact that Jesus chose the way of homelessness during his three years of ministry. In Luke 9 Jesus responds to a man who says he will follow him wherever he goes: 'Foxes have holes and birds of the air have nests, but the Son of Man has nowhere to lay his head.'

http://web.salvationarmy.org.uk/alove/engage_god_homelessjesus.asp

[fusster]

I volunteer at a homeless shelter and I can say from experience that it is important not to judge homeless people or to stereotype. Not every homeless person is the same. They do not all choose to be in the position they are in and many of them cannot help it. Please try not to stereotype homeless people as alcoholics, drug addicts, people who choose to be homeless, uneducated, mentally ill, etc. Take the time to talk to homeless people and you will see that they are not all the same and need to be treated on an individual basis and not stereotyped.