Hippocrates In San Diego

I refused someone shelter tonight

It’s been raining steadily for the last two days. Today has been especially wet, and (for San Diego) cold. It’s pretty typical to get a prolonged winter rain like this, but this year’s storm is especially rainy.

Yesterday, one of my patients, a homeless woman in the hospital only so she could be placed in a care facility, got tired of waiting and left “Against Medical Advice.”

That’s the medico-legalese term that theoretically provides some cover when a patient makes a decision that counters our advice (such as leaving the hospital without being formally discharged).

Tonight she returned, soaking wet from the rain, and was refused admission by the Emergency physicians, since lack of shelter was her only complaint. Failing that approach, she returned to the nursing unit she had been on only 24 hours earlier, crying and begging the nurses to readmit her.

They called me, hoping I could directly admit her, bypassing the ER. Awful as it makes me feel, I can’t justify using a bed in an at-capacity hospital for someone who doesn’t have an active medical problem. All I could offer her is a taxi voucher to a nearby shelter.

Common decency dictates that when another person asks for something basic — food, water, clothing, shelter — that they can’t provide for themselves, it’s no time for politics or platitudes. You just offer what you can and worry about public policy later. Equally important, though, is preservation of resources for those most in need. When those two ideals conflict, that’s when the hard choices begin.