“What home?” said my
patient, slighty slurring his
words. “I don’t have a home. I
sleep on the street because my
wife won’t let me in the house. I
have no job because I can’t work
because I’m drunk all the time.
It’s four in the morning. Where
am I supposed to go? I’m just a
stupid, drunk Eskimo!”
I had no idea what I would
say next. I didn’t have an answer
for him. It was 40 degrees outside
and four in the morning.
Even the bars were closed. The
nurse had just told my patient,
Oscar, that it was time for him
to be discharged. It was time
for him to go home.
The scene began the other
night when my pager beeped,
and I knew another episode
in my fourth year of medical
school was about to begin.
By the time I arrived at the
Nome ER, the police had
brought in my patient. “We
found him unresponsive on
the street outside a bar downtown,”
they told me. Relying on
the usual physician’s prompt, I
asked my stuporous patient,
“Sir, can you tell me what happened?”
My patient mumbled something
in the Inupiat language.
I looked at the nurse. “Don’t
worry,” she replied to the unspoken
question written across my
face. “He’s a regular. His name’s
Oscar. Here, I already have his
chart for you.”
She handed me a stack of
papers bound in the typical
manila medical folder. Its
thickness rivaled that of the
family Bible or a coffee table
book. I glanced through it.
Oscar had almost earned VIP
status in the Nome ER, having
been already admitted for alcohol
intoxication five times this
month and numerous times
previously.
I tried again, unsuccessfully,
to obtain a history from my
patient. “Oscar, what brought
you to the hospital?” He opened
his eyes for a brief moment,
looked at me, and spat out the
words, “I was drunk,” he said.
He then began to mumble
something in Inupiat. The
patient in the next bed, also
intoxicated and separated
from us by a curtain, replied
to Oscar’s mumblings and they
began shouting to each other in
Inupiat.
While the heated dialogue in
a language I didn’t understand
went on in the background, I
phoned the attending physician
to inform him of the recent
admission and to confirm my
plan of action: to check Oscar’s
blood for his liver function,
start an IV to provide him with
nutrients and check his blood
alcohol level.
The attending concurred
with my plan and said he
would be right over; he lived
across the street. Oscar’s liver
enzymes were well out of the
range of normal, his blood work
showed signs of chronic malnutrition
and his blood alcohol
level was in the range of what
I had learned in medical school
as “should be dead.”
Over the next few hours, we
monitored his vital signs, gave
him fluid intravenously, and
waited for the effects of his
most recent episode of binge
drinking to wear off. A few
hours later, Oscar’s time was
up. Physically, other than a
slightly altered mental status,
he was fine. We had no other
reason to keep him.
I watched as Oscar walked
out the door into the cold air.
I had answered his question by
wishing him well and hoping
for the best. I had a feeling this
wouldn’t be my first encounter
with him in the Nome ER.
Most medical students enter
the profession because they
want to help people. Yet, as I
watched Oscar walk away, I
wondered if I had really helped
him. I had given him some
nutrients his body needed. I
had watched his vital signs to
make sure his lungs and heart
were functioning properly.
And with regard to his physical
health, other than his liver
and possibly his mental status,
he was physically healthy.
But what had I done to help
him cope with the pain of being
separated from his family, from
losing his job or from believing
he was just a “stupid, drunk
Eskimo?”
And what had I done to keep
him from taking the next drink
and perpetuating this cycle of
drunkenness and self-deprecating
image of being a worthless
Native Alaskan? Had I helped
my patient?
If the first two years of medical
school are like being on
“Jeopardy,” then the last two
years are like being on a neverending
episode of “Who’s Line
is it Anyway?” During the first
two years, one diligently memorizes
an extraordinary amount
of facts from which nerves
innervate the neck muscles to
what drug reverses the effects
of narcotics.
The last two years are devoted
to learning how to take the
massive encyclopedia’s worth
of information learned in the
first two years and translate it
into meaningful treatment for
whatever conglomeration of
symptoms and situations may
lie behind the door of the next
exam room.
My role as an aspiring physician
often reminds me of that
of an actor, without a script,
and abruptly shoved on stage to
respond to whatever line may
come next in the ever-unfolding
drama of medicine and health.
With that thought, I realized
that this unscripted, unplanned
episode had ended inconclusively
and with a doubt that I
had played a significant role in
the drama of this patient’s life.

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