When you talk about emergency medical care, your mind wanders, instantly, to a scene with high adrenaline and chaos. However, in emergency medicine, one of the most important skills needed is communication, but what is communication? To a newborn, communication might be the soft songs, sung by a mother while she gently caresses her child’s head—rocking back and forth in the nursery. To a fourth grader, it might be a note written on a napkin that was packed with love in their lunch box. To a homesick college student, it might be a text from their dad expressing how proud he is of all that they have accomplished. As written by Dr. Phillip Allen Greene, it might be holding on to an elderly woman’s hand as she passes. These are all forms of communication, some written or spoken, others just by physical touch. All are vital, and all can be the culprit when there is a breakdown in communication.
This past winter, I volunteered with the Point in Time. This is an opportunity for the city to count every person experiencing homelessness in a single night in San Antonio. As a part of Street Medicine (now outreach medicine), I was able to volunteer and be part of one of the teams charged with counting but being a medical student and a certified EMT I was also charged with providing medical care to anyone we might encounter during the night. Armed with a backpack of supplies I headed into the night with my roommate and four other teammates. We met with a San Antonio Police Officer and began our search, in our designated area. As the night started, we struck out on our quest to count the homeless. Our assigned police officer took us to homeless camps and areas known for attracting homeless. We slowly began to find people, but not the number of people I had expected. Before that night, I pictured myself tending emergency medical care to numerous people, but I was wrong.
As our time to count slowly dwindled, our team headed back to our cars to head back to the event space where we began. We said our goodbyes to our team and went on our separate ways. The woman who was driving my roommate and I said she wanted to check one more place on our way back. Sure enough, we found two separate people outside of a Walmart. Neither of them required medical attention, as a matter of fact, no one that night required medical attention, which left my roommate and I almost useless standing there with our bags full of medical supplies. As we got back into the car, we thought we saw someone inside the doors of Walmart. We pulled back around and my roommate and I walked into the store, once again armed with our medical equipment. As we walked through the sliding glass doors, I saw a young man sitting on the benches near the second set of sliding doors to enter the store. People were grabbing carts to finish their day with shopping and others were hurrying past us, with arms full of bags, to get home. When we got right up to the bench, the man, who looked like he couldn’t be much older than 18, turned his head as to not be seen. We introduced ourselves and he communicated to us with his defensive body language that he did not want to be bothered. I asked him if I could sit down next to him and talk. He hesitated and we reassured him that we just wanted to talk. He reluctantly let us sit down with him as he guarded a duffle bag and we began to learn about him. He had enlisted in the military right out of high school and deployed. During his deployment he was injured during a training exercise that left his knee and shoulder painful. After the military he was a laborer, but his old injuries proved to be too much to continue his work. It wasn’t long after that he found himself couch surfing and eventually on the streets.
As we gathered all the information we needed for the count we began to grab our things to leave. As we stood up, he thanked us. I immediately wondered, what for, we didn’t get him anything, nor did we provide him medical care. He went on to explain how on the streets everyone avoids eye contact with the homeless. They want to pretend they aren’t there. He said not only is this the first time in a long time that someone has talked to him, but it is also the first time in who knows how long that someone made eye contact with him. We said our goodbyes and headed for the car. I never would have thought that crowded downtown streets could feel so lonely. As my roommate sat in the front seat, I sat alone in the back and felt the tears swell up in my eyes, but none came out.
During the car ride back to the event space, I had flashbacks of times I have walked past the homeless on the street. I immediately thought of a very vivid moment when I was walking downtown headed to dinner. There was a woman sitting on the corner with her hand stretched out, asking for money. As we got closer, I pulled the person I was with closer to me and said, “Don’t look at them, it makes it easier to say no when they ask for money.” A lonesome tear started to come out—silently.
That night I learned that emergency medical care is much more than pumping on a chest to the tune of “Stayin’ Alive.” A softly sung song, a note on a napkin, a random text, the squeeze of a hand. That isn’t where it has to end. A friendly smile, a quick “God Bless”, eye contact.