In the course of a typical week, we frequently encounter patients who are intoxicated, belligerent, or cantankerous. Sometimes they are all three. The bottom line with these folks is that they really don’t want to be with us. After a brief encounter, the sentiment is usually mutual.

We may ask these patients why they have chosen to visit us if, in the end, they don’t desire our company. This is a conversation best left inside our heads. A wise person said that it is best never to argue with a fool because onlookers may not be able to tell the difference.

Some may bristle at the notion of labeling a patient undesirable. This is an easy thought to have looking down from the ivory tower and less so at ground level. I believe that it is healthy to acknowledge our human nature. If you line up a hundred people (including the person’s mom) and ask them all if they want to spend time with a drunken, malodorous, and hostile oaf, they will all vote NO with both hands. Once we recognize our distaste for these individuals, setting this bias aside becomes easier.

Our ability to do this mighty feat is what separates professionals from pedestrians. We recognize that we must look beyond our immediate desire for physical and emotional distance from those who lack good judgment. Instead of crossing the street and turning our gaze afar, we must run to the social fire and fling open the doors.

I’m not convinced that it is God who looks after drunks and fools. These days it seems that this job has become the purview of the emergency physician. Drunkenness now precludes incarceration, and the police gladly deposit these citizens at our doorstep. No other physician, especially a psychiatrist, is interested in seeing these folks in their impaired state.

Objectionable behavior in a private office leads to a fast train to the ED.

We are the remedy for many apparently unsolvable problems because we are willing and we are adept. We open our arms as well as our minds to many who find only locked doors and disinterest elsewhere.

A few weeks back I encountered a young man who arrived by EMS. He was clearly intoxicated, and there was some question of suicidal intent. He paced the room restlessly and requested medication for pain and anxiety. He made clear to me his desire to leave after I addressed his symptoms. This was the equivalent of a teenager telling his parents to get out of his life in one breath and asking to borrow the car in the next. This lost soul was not making good decisions for himself. That, combined with the question of suicidal intent, made me want to send him to Rescue Crisis after medical clearance.

In Toledo, Rescue is like a psychiatric clearinghouse. We complete a pink slip, which is not pink, and someone comes to get the patient a variable time later. It is sort of like an emotional FedEx distribution center where people are evaluated, sorted, and sent to the proper place for help. FedEx operates much faster, but everything works out in the end.

I evaluated this same patient recently for an unrelated problem. As I entered the room, he smiled and offered his hand to me. I recognized his face but couldn’t quite remember the interaction until he reminded me. Weeks earlier I had stripped him of a few civil rights and forced him to undergo a psychiatric evaluation, yet now he views me favorably. This is because he successfully completed his initial treatment for alcoholism and had been dry for several weeks. He thanked me three times and said that sending him to Rescue was one of the best things anyone had ever done for him. Still, I am struck by this poignant interaction.

I recognize this is a rare event and that many of our patients are hopelessly recalcitrant. This one encounter, however, renewed my faith that occasionally an unexpected person will see the light and find a new path. Time will tell if he stays the course. I as well.

Be happy.

Dr. Baehren lives in Ottawa Hills, Ohio. He practices emergency medicine and is an assistant professor at the University of Toledo (Ohio) Medical Center. Your feedback is welcome at David.Baehren@utoledo.edu.