Notes from an emergency room doctor: The woman
saw the man lying in a culvert behind her home.
She thought he was dead and called the police.
When they arrived, they too thought he was dead.
But when they shook him, he groaned, and flailed
his arms to swat them away. He reeked from the
odor of alcohol, vomit, and months of going unwashed.
Unsure whether he was just drunk or dying, the
police called the paramedics and they brought
him to the emergency room.
"What's your name?" we asked him.
"Mars," he answered. "I'm a *@#*!
He rambled on with foul epithets and spat at
anyone that approached him. Though the day was
hot, he wore layer upon layer of foul smelling
clothes. His entire wardrobe was on his back.
The medics knew him. He was homeless, mentally
ill, and an abuser of drugs and alcohol. They
had often transported him to one hospital or another
over the years, after someone discovered him lying
drunk and unconscious in a gutter, or found him
injured after a fall. He had seizures, diabetes,
and hypertension. Each of his visits had ended
with him being given prescriptions and referrals
for help. He never took the medicines and refused
to go to any havens for the homeless or rehabilitation
facilities. And all we ever knew about him was
that he called himself "Mars" and wanted
to be left alone.
Each of his visits to an emergency room warranted
an extensive and expensive work-up. Our system
and our ethics don't allow us to just assume "Mars
is drunk again," and leave him lying in a
gutter. But when sober enough to walk out, he
It is interesting that our morality requires
us to forcibly hospitalize anyone who commits
the irrational act of attempting suicide. These
people are treated "against their will."
Afterall, you have to be crazy to try to kill
yourself. But if you are really "crazy"
and in the process of killing yourself slowly
by succumbing to the diseases of alcohol, drugs,
or the gutter, you are not high on society's list
There are a lot of homeless on the streets today.
Many are down on their luck and in need of food,
shelter, and the resources necessary to get them
back on their feet again. But there are resources
out there and though seeking them out may be difficult,
time-consuming, and for some demeaning, it is
possible to get help. But there are also tens
of thousands of homeless mentally ill. Their illness
may range from severe depression to severe schizophrenia.
Many are unwilling or unable to accommodate to
the conventions of society's social service systems.
They usually can't keep appointments. And even
if they do get to one, they often can't comply
with treatment recommendations. The skills they
need to survive on the streets - a distrust of
strangers and a defensive hostility - are the
exact opposite characteristics necessary to utilize
shelters and seek out help.
Rather than wasting society's money on the repetitive
emergency room visits of people like Mars, we
should change the "involuntary commitment
laws." The homeless mentally ill should be
treated - even if they refuse care. If we won't
allow someone to kill themselves quickly, why
should we allow them to do it slowly?
But if involuntary commitment laws are liberalized,
we have to be willing to provide increased resources
to care for these people. And that unfortunately
is unlikely to happen. So, for now, Mars will
remain a Martian. And people will continue to
find bodies in their back yards.