A mom.

Mothers will risk their lives to protect their children. Even the most marginal mother does not send her infant to an emergency department alone. There is something about the love a mother has for her children that transcends other human relationships. Unfortunately, as the years pass this important relationship, for varied reasons, is not necessarily reciprocated. While most people are devoted to their parents, many dependent elderly have an acute advocate deficiency.

One might expect that nursing homes would fill this role of advocate, but it seems they just go through the motions. Usually they can’t convey even the most basic information appropriately. I swear that every ECF employee in the country went to the same class on how to run a copy machine. It is uncanny that no matter which facility sends the patient, the first four letters of the names of medications is cut off on the paperwork. It makes you want to reach through the fax machine and do something that would jeopardize your medical license.

I find it interesting that nursing homes rarely send anyone with their patients, but the group homes that send patients to my ED always do this. While the attendants may not know many specifics about the group home resident, they always come with a book that contains just about everything you would want to know. The attendants also seem genuinely concerned about the residents in their charge. Why is it that the nursing homes can’t do this?

So, we are increasingly placed in the position of being doctor to patients with poorly communicated but complex medical problems, as well as being mother to these folks who seem to have no real advocate. This is bad, because the list of uncompensated tasks we are asked to do grows while society at large becomes more dependent on people and agencies outside their immediate family. And the safety net continues to stretch.

The other side is that this is a good thing, because as emergency physicians we are experts in the quick evaluation of complicated patients—and we are fantastic advocates for the underdogs of society. These are the people Dr. Jack McConnell refers to as those whom society renders invisible. We see them just fine.

We go to battle every day to be sure that the “undesirable” patients find a way into the hospital. We cajole consultants and prod social workers to do the right thing, because we know that if we don’t do this, no one else will.