Origins.

I am the Barber-Surgeon
Shave and a bloodletting,
Two bits.
Fashion and medicine
The not-so distant cousins
It seems.

Cowboys and Indians

While driving alone through vast Montanan landscapes I decided to stop for coffee in Billings, of all places.  A skeleton of former factory glory, Billings lacked character, lacked charm, lacked any reason to survive.  But they had darn good coffee.  After my cup of joe I stood by my car, stretching.  An indigent Native American in ripped and soiled jeans approached me with fearful and bloodshot eyes. He told me his mother was down the road, dying on the 4^th floor of the hospital.  He wept openly.  I consoled him.  I put my arm around him.  He said he was all she had left.  His brother had died in the rodeo years ago, he said.  I told him to go be with her.  He said he couldn’t bear to see her this way.  I urged him to see her.  He said ok.  We embraced—me, a white medical student from Michigan just passing through, and him, a poor Native American stranger from Billings.  His tears were on my shoulder. Then he asked for money, and I said no. Move along.  

Drunk birds.

Intoxicated patients are a dime a dozen in the ED.  They can be found slumbering on cots in the hallways, running naked through the resuscitation bays wearing a blanket like a cape, or simply shouting at the top of their lungs at all hours of the day. Many are “frequent flyers;” familiar faces that consume nothing but beer, medical resources and free sandwiches.  These individuals are received with palpable disdain in the ED.  Eye-rolling and off-color comments abound with their arrival. The goal is always to “get them out the door” as soon as possible. Emergency Department attitudes towards individuals with alcohol dependence and abuse verge on the unethical.  Alcoholics are not recognized as suffering from mental illness, but rather are more or less derided for their “choices.” Addiction is never addressed in the ED.   Undoubtedly, to do so would be time consuming,  resource heavy, and in many cases futile.  However, by ignoring the true illness we simply set these inebriated birds loose on rough winds. We throw these frequent flyers to the ominous skies, encouraging them to fly another day.